Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control.

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY Obstetrics and gynecology Pub Date : 2024-09-12 DOI:10.1097/AOG.0000000000005715

Samantha L Martin, Hui-Chien Kuo, Kim Boggess, Lorraine Dugoff, Baha Sibai, Kirsten Lawrence, Brenna L Hughes, Joseph Bell, Kjersti Aagaard, Kelly S Gibson, David M Haas, Lauren Plante, Torri D Metz, Brian M Casey, Sean Esplin, Sherri Longo, Matthew Hoffman, George R Saade, Janelle Foroutan, Methodius G Tuuli, Michelle Y Owens, Hyagriv N Simhan, Heather A Frey, Todd Rosen, Anna Palatnik, Susan Baker, Phyllis August, Uma M Reddy, Wendy Kinzler, Emily J Su, Iris Krishna, Nicki Nguyen, Mary E Norton, Daniel Skupski, Yasser Y El-Sayed, Dotun Ogunyemi, Zorina S Galis, Namasivayam Ambalavanan, Suzanne Oparil, Ronald Librizzi, Leonardo Pereira, Everett F Magann, Mounira Habli, Shauna Williams, Giancarlo Mari, Gabriella Pridjian, David S McKenna, Marc Parrish, Eugene Chang, Sarah Osmundson, JoAnne Quinones, Erika Werner, Jeff M Szychowski, Alan T N Tita

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Abstract

Objective: To compare differences in postpartum blood pressure (BP) control (BP below 140/90 mm Hg) for participants with hypertension randomized to receive antihypertensive treatment compared with no treatment during pregnancy.

Methods: This study was a planned secondary analysis of a multicenter, open-label, randomized controlled trial (The CHAP [Chronic Hypertension and Pregnancy] trial). Pregnant participants with mild chronic hypertension (BP below 160/105 mm Hg) were randomized into two groups: active (antihypertensive treatment) or control (no treatment unless severe hypertension, BP 160/105 mm Hg or higher). Study outcomes were BP control below 140/90 mm Hg (primary) and medication nonadherence based on a composite score threshold (secondary) at the 6-week postpartum follow-up visit. Participants without follow-up BP measurements were excluded from analysis of the BP control outcome. Participants without health care professional-prescribed antihypertensives at delivery were excluded from the analysis of the adherence outcome. Multivariable logistic regression was used to adjust for potential confounders.

Results: Of 2,408 participants, 1,684 (864 active, 820 control) were included in the analysis. A greater percentage of participants in the active group achieved BP control (56.7% vs 51.5%; adjusted odds ratio [aOR] 1.22, 95% CI, 1.00-1.48) than in the control group. Postpartum antihypertensive prescription was higher in the active group (81.7% vs 58.4%, P<.001), and nonadherence did not differ significantly between groups (aOR 0.81, 95% CI, 0.64-1.03).

Conclusion: Antihypertensive treatment of mild chronic hypertension during pregnancy was associated with better BP control below 140/90 mm Hg in the immediate postpartum period.

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孕期降压治疗对产后血压控制的影响

目的比较随机接受降压治疗的高血压患者与孕期未接受治疗的患者在产后血压控制（血压低于 140/90 mm Hg）方面的差异：本研究是对一项多中心、开放标签、随机对照试验（CHAP[慢性高血压与妊娠]试验）的二次分析。患有轻度慢性高血压（血压低于 160/105 mm Hg）的孕妇被随机分为两组：积极组（抗高血压治疗）或对照组（除非严重高血压，血压为 160/105 mm Hg 或更高）。研究结果为血压控制在 140/90 mm Hg 以下（主要结果）和产后 6 周随访时根据综合评分阈值得出的药物治疗不依从性（次要结果）。在分析血压控制结果时，未进行随访血压测量的参与者被排除在外。在分析依从性结果时，不包括分娩时没有医护人员开具降压药处方的参与者。多变量逻辑回归用于调整潜在的混杂因素：在 2,408 名参与者中，1,684 人（864 名积极参与者，820 名对照组参与者）被纳入分析。与对照组相比，积极治疗组达到血压控制的比例更高（56.7% vs 51.5%；调整后的几率比 [aOR] 1.22，95% CI，1.00-1.48）。积极治疗组的产后抗高血压处方率更高（81.7% 对 58.4%）：妊娠期轻度慢性高血压的降压治疗与产后血压更好地控制在 140/90 mm Hg 以下有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obstetrics and gynecology 医学-妇产科学

CiteScore

11.10

自引率

4.20%

发文量

867

审稿时长

1 months

期刊介绍： "Obstetrics & Gynecology," affectionately known as "The Green Journal," is the official publication of the American College of Obstetricians and Gynecologists (ACOG). Since its inception in 1953, the journal has been dedicated to advancing the clinical practice of obstetrics and gynecology, as well as related fields. The journal's mission is to promote excellence in these areas by publishing a diverse range of articles that cover translational and clinical topics. "Obstetrics & Gynecology" provides a platform for the dissemination of evidence-based research, clinical guidelines, and expert opinions that are essential for the continuous improvement of women's health care. The journal's content is designed to inform and educate obstetricians, gynecologists, and other healthcare professionals, ensuring that they stay abreast of the latest developments and best practices in their field.