妊娠期高血压疾病的血压管理
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摘要
妊娠期高血压疾病(HDP)是一种严重威胁母胎安全的疾病,是孕产妇和胎儿死亡的重要原因。随着我国二孩政策的实施、孕产妇的高龄化及心血管疾病发生的低龄化,临床上对这部分患者的治疗和管理面临巨大挑战。国内外妇产科及心血管病专家通过对HDP的不断研究和探索,推出一系列管理指南及专家共识。了解HDP的诊断标准、治疗策略及常用降压药物,有助于患者的血压管理,降低并发症发生率,改善孕妇及胎儿的预后,保障母儿安全。
Hypertensive disorders of pregnancy( HDP) is a serious threat to maternal and fetal safety,and it is an important cause of maternal and fetal death. With the implementation of two-child policy in China,the aging of pregnant women and the younger age of cardiovascular diseases,treatment and management of these patients is facing great challenges. Both domestic and foreign experts in obstetrics,gynecology and cardiovascular diseases have introduced a series of guidelines and expert consensus through continuous research and exploration of HDP. Understanding the diagnostic criteria,treatment strategies and common antihypertensive drugs for HDP,is helpful for the management of blood pressure of the patients,reducing the incidence of complications,improving the prognosis of pregnant women and fetus,and ensuring the safety of mothers and babies.
Hypertensive disorders of pregnancy( HDP) is a serious threat to maternal and fetal safety,and it is an important cause of maternal and fetal death. With the implementation of two-child policy in China,the aging of pregnant women and the younger age of cardiovascular diseases,treatment and management of these patients is facing great challenges. Both domestic and foreign experts in obstetrics,gynecology and cardiovascular diseases have introduced a series of guidelines and expert consensus through continuous research and exploration of HDP. Understanding the diagnostic criteria,treatment strategies and common antihypertensive drugs for HDP,is helpful for the management of blood pressure of the patients,reducing the incidence of complications,improving the prognosis of pregnant women and fetus,and ensuring the safety of mothers and babies.
引文
[1] Leeman L,Dresang LT,Fontaine P. Hypertensive disorders of pregnancy[J]. Am Fam Physician,2016,93(2):121-127.
[2] Umesawa M,Kobashi G. Epidemiology of hypertensive disorders in pregnancy:Prevalence,risk factors,predictors and prognosis[J]. Hypertens Res,2017,40(3):213-220.
[3] Berhe AK,Kassa GM,Fekadu GA,et al. Prevalence of hypertensive disorders of pregnancy in Ethiopia:A systemic review and meta-analysis[J]. BMC Pregnancy Childbirth,2018,18(1):34.
[4] Ye C,Ruan Y,Zou L,et al. The 2011 survey on hypertensive disorders of pregnancy(HDP)in China:Prevalence,risk factors,complications,pregnancy and perinatal outcomes[J]. PLoS One,2014,9(6):e100180.
[5] Duley L. The global impact of pre-eclampsia and eclampsia[J].Semin Perinatol,2009,33(3):130-137.
[6] WHO Guidelines Approved by the Guidelines Review Committee.WHO recommendations for prevention and treatment of preeclampsia and eclampsia[Z]. Geneva:World Health Organization,2011:12.
[7] Berhan Y,Berhan A. Causes of maternal mortality in Ethiopia:A significant decline in abortion related death[J]. Ethiop J Health Sci,2014,24 Suppl:15-28.
[8] Subki AH,Algethami MR,Baabdullah WM,et al. Prevalence,risk factors,and fetal and maternal outcomes of hypertensive disorders of pregnancy:A retrospective study in western saudi arabia[J].Oman Med J,2018,33(5):409-415.
[9] Bramham K,Parnell B,Nelson-Piercy C,et al. Chronic hypertension and pregnancy outcomes:Systematic review and metaanalysis[J]. BMJ,2014,348:g2301.
[10] Powe CE,Levine RJ,Karumanchi SA. Preeclampsia,a disease of the maternal endothelium:The role of antiangiogenic factors and implications for later cardiovascular disease[J]. Circulation,2011,123(24):2856-2869.
[11]林彤,陈丽红,胡继芬,等.妊娠期高血压的危险因素[J].中华高血压杂志,2015,23(1):83-85.
[12] Kahsay HB,Gashe FE,Ayele WM. Risk factors for hypertensive disorders of pregnancy among mothers in Tigray region,Ethiopia:Matched case-control study[J]. BMC Pregnancy Childbirth,2018,18(1):482.
[13] van Gelder MM,Van Bennekom CM,Louik C,et al. Maternal hypertensive disorders,ntihypertensive medication use,and the risk of birth defects:A case control study[J]. BJOG,2015,122(7):1002-1009.
[14] Jaimchariyatam N,Na-Rungsri K,Tungsanga S,et al. Obstructive sleep apnea as a risk factor for preeclampsia-eclampsia[J]. Sleep Breath,2019,23(2):687-693.
[15]中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华妇产科杂志,2015,50(10):721-728.
[16] Butalia S,Audibert F,C?té AM,et al. Hypertension Canada's2018 guidelines for the management of hypertension in pregnancy[J]. Can J Cardiol,2018,34(5):526-531.
[17] Williams B,Mancia G,Spiering W,et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension[J]. Eur Heart J,2018,39(33):3021-3104.
[18] Brown MA,Magee LA,Kenny LC,et al. Hypertensive disorders of pregnancy:ISSHP classification,diagnosis,and management recommendations for international practice[J]. Hypertension,2018,72(1):24-43.
[19]中国高血压防治指南修订委员会,高血压联盟(中国)中华医学会心血管病学分会,中国医师协会高血压专业委员会,等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志,2018,24(1):24-56.
[20] Guerrero M. Committee opinion No. 692 summary:Emergent therapy for acute-onset,severe hypertension during pregnancy and the postpartum period[J]. Obstet Gynecol,2017,129(4):769-770.
[21] Queensland Clinical Guidelines. Hypertensive disorders of pregnancy[EB/OL](2016-08-01)[2019-4-30]. www. health.qld. gov. au/qcg.
[22] Magee LA,Singer J,von Dadelszen P,et al. Less-tight versus tight control of hypertension in pregnancy[J]. N Eng J Med,2015,372(24):2367-2368.
[23] Briggs GG,Freeman RK,Towers CV,et al. Drugs in pregnancy and lactation[M]. 11th ed. Philadelphia:Lippincott Williams&Wilkins,2017:262-1034.
[24]顾宁,胡娅莉.拉贝洛尔治疗妊娠期轻中度高血压对母儿结局影响的meta分析[J].中华围产医学杂志,2014,17(10):682-688.
[25] Thewissen L,Pistorius L,Baerts W,et al. Neonatal haemodynamic effects following foetal exposure to labetalol in hypertensive disorders of pregnancy[J]. J Matern Fetal Neonatal Med,2017,30(13):1533-1538.
[26]代培培.拉贝洛尔联合硫酸镁治疗重症妊娠高血压的疗效和分娩结局研究[J].山西医药杂志,2018,47(5):557-559.
[27]戴婉波,蔡瑞贤,杨芬红,等.硝苯地平与拉贝洛尔治疗重度子痫前期对血压及孕产妇和围产儿结局的影响[J].山西医药杂志,2019,48(4):462-464.
[28] Webster LM,Myers JE,Nelson-Piercy C,et al. Labetalol versus nifedipine as antihypertensive treatment for chronic hypertension in pregnancy:A randomized controlled trial[J]. Hypertension,2017,70:915-922.
[29] Shekhar S,Gupta N,Kirubakaran R,et al. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy:A systematic review and meta-analysis[J]. BJOG,2016,123(1):40-47.
[30] Shawkat E,Mistry H,Chmiel C,et al. The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy[J]. Pregnancy Hypertens,2018,11:92-98.
[31] Rothberger S,Carr D,Brateng D,et al. Pharmacodynamics of clonidine therapy in pregnancy:A heterogeneous maternal response impacts fetal growth[J]. Am J Hypertens,2010,23(11):1234-1240.
[32] Duley L,Meher S,Jones L. Drugs for treatment of very high blood pressure during pregnancy[J/CD]. Cochrane Database Syst Rev,2013(7):CD001449.
[33]田婷,李小丹.硝苯地平控释片联合酚妥拉明对妊娠期高血压孕妇的影响[J].实用临床医药杂志,2017,21(23):101-107.
[34] Vertkin AL,TopolianskiǐAV,Abdullaeva AU,et al. Hypertensive crisis:Pathogenesis,clinic,treatment[J]. Kardiologiia,2013,53(6):66-70.
[35] Harewood WJ,Phippard AF,Duggin GG,et al. Fetotoxicity of angiotensin-converting enzyme inhibition in primate pregnancy:Aprospective,placebo-controlled study in baboons(Papio hamadryas)[J]. Am J Obstet Gynecol,1994,171(3):633-642.
[36] Alwan S,Polifka JE,Friedman JM. AngiotensinⅡreceptor antagonist treatment during pregnancy[J]. Birth Defects Res A Clin Mol Teratol,2005,73(2):123-130.
[2] Umesawa M,Kobashi G. Epidemiology of hypertensive disorders in pregnancy:Prevalence,risk factors,predictors and prognosis[J]. Hypertens Res,2017,40(3):213-220.
[3] Berhe AK,Kassa GM,Fekadu GA,et al. Prevalence of hypertensive disorders of pregnancy in Ethiopia:A systemic review and meta-analysis[J]. BMC Pregnancy Childbirth,2018,18(1):34.
[4] Ye C,Ruan Y,Zou L,et al. The 2011 survey on hypertensive disorders of pregnancy(HDP)in China:Prevalence,risk factors,complications,pregnancy and perinatal outcomes[J]. PLoS One,2014,9(6):e100180.
[5] Duley L. The global impact of pre-eclampsia and eclampsia[J].Semin Perinatol,2009,33(3):130-137.
[6] WHO Guidelines Approved by the Guidelines Review Committee.WHO recommendations for prevention and treatment of preeclampsia and eclampsia[Z]. Geneva:World Health Organization,2011:12.
[7] Berhan Y,Berhan A. Causes of maternal mortality in Ethiopia:A significant decline in abortion related death[J]. Ethiop J Health Sci,2014,24 Suppl:15-28.
[8] Subki AH,Algethami MR,Baabdullah WM,et al. Prevalence,risk factors,and fetal and maternal outcomes of hypertensive disorders of pregnancy:A retrospective study in western saudi arabia[J].Oman Med J,2018,33(5):409-415.
[9] Bramham K,Parnell B,Nelson-Piercy C,et al. Chronic hypertension and pregnancy outcomes:Systematic review and metaanalysis[J]. BMJ,2014,348:g2301.
[10] Powe CE,Levine RJ,Karumanchi SA. Preeclampsia,a disease of the maternal endothelium:The role of antiangiogenic factors and implications for later cardiovascular disease[J]. Circulation,2011,123(24):2856-2869.
[11]林彤,陈丽红,胡继芬,等.妊娠期高血压的危险因素[J].中华高血压杂志,2015,23(1):83-85.
[12] Kahsay HB,Gashe FE,Ayele WM. Risk factors for hypertensive disorders of pregnancy among mothers in Tigray region,Ethiopia:Matched case-control study[J]. BMC Pregnancy Childbirth,2018,18(1):482.
[13] van Gelder MM,Van Bennekom CM,Louik C,et al. Maternal hypertensive disorders,ntihypertensive medication use,and the risk of birth defects:A case control study[J]. BJOG,2015,122(7):1002-1009.
[14] Jaimchariyatam N,Na-Rungsri K,Tungsanga S,et al. Obstructive sleep apnea as a risk factor for preeclampsia-eclampsia[J]. Sleep Breath,2019,23(2):687-693.
[15]中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2015)[J].中华妇产科杂志,2015,50(10):721-728.
[16] Butalia S,Audibert F,C?té AM,et al. Hypertension Canada's2018 guidelines for the management of hypertension in pregnancy[J]. Can J Cardiol,2018,34(5):526-531.
[17] Williams B,Mancia G,Spiering W,et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension[J]. Eur Heart J,2018,39(33):3021-3104.
[18] Brown MA,Magee LA,Kenny LC,et al. Hypertensive disorders of pregnancy:ISSHP classification,diagnosis,and management recommendations for international practice[J]. Hypertension,2018,72(1):24-43.
[19]中国高血压防治指南修订委员会,高血压联盟(中国)中华医学会心血管病学分会,中国医师协会高血压专业委员会,等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志,2018,24(1):24-56.
[20] Guerrero M. Committee opinion No. 692 summary:Emergent therapy for acute-onset,severe hypertension during pregnancy and the postpartum period[J]. Obstet Gynecol,2017,129(4):769-770.
[21] Queensland Clinical Guidelines. Hypertensive disorders of pregnancy[EB/OL](2016-08-01)[2019-4-30]. www. health.qld. gov. au/qcg.
[22] Magee LA,Singer J,von Dadelszen P,et al. Less-tight versus tight control of hypertension in pregnancy[J]. N Eng J Med,2015,372(24):2367-2368.
[23] Briggs GG,Freeman RK,Towers CV,et al. Drugs in pregnancy and lactation[M]. 11th ed. Philadelphia:Lippincott Williams&Wilkins,2017:262-1034.
[24]顾宁,胡娅莉.拉贝洛尔治疗妊娠期轻中度高血压对母儿结局影响的meta分析[J].中华围产医学杂志,2014,17(10):682-688.
[25] Thewissen L,Pistorius L,Baerts W,et al. Neonatal haemodynamic effects following foetal exposure to labetalol in hypertensive disorders of pregnancy[J]. J Matern Fetal Neonatal Med,2017,30(13):1533-1538.
[26]代培培.拉贝洛尔联合硫酸镁治疗重症妊娠高血压的疗效和分娩结局研究[J].山西医药杂志,2018,47(5):557-559.
[27]戴婉波,蔡瑞贤,杨芬红,等.硝苯地平与拉贝洛尔治疗重度子痫前期对血压及孕产妇和围产儿结局的影响[J].山西医药杂志,2019,48(4):462-464.
[28] Webster LM,Myers JE,Nelson-Piercy C,et al. Labetalol versus nifedipine as antihypertensive treatment for chronic hypertension in pregnancy:A randomized controlled trial[J]. Hypertension,2017,70:915-922.
[29] Shekhar S,Gupta N,Kirubakaran R,et al. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy:A systematic review and meta-analysis[J]. BJOG,2016,123(1):40-47.
[30] Shawkat E,Mistry H,Chmiel C,et al. The effect of labetalol and nifedipine MR on blood pressure in women with chronic hypertension in pregnancy[J]. Pregnancy Hypertens,2018,11:92-98.
[31] Rothberger S,Carr D,Brateng D,et al. Pharmacodynamics of clonidine therapy in pregnancy:A heterogeneous maternal response impacts fetal growth[J]. Am J Hypertens,2010,23(11):1234-1240.
[32] Duley L,Meher S,Jones L. Drugs for treatment of very high blood pressure during pregnancy[J/CD]. Cochrane Database Syst Rev,2013(7):CD001449.
[33]田婷,李小丹.硝苯地平控释片联合酚妥拉明对妊娠期高血压孕妇的影响[J].实用临床医药杂志,2017,21(23):101-107.
[34] Vertkin AL,TopolianskiǐAV,Abdullaeva AU,et al. Hypertensive crisis:Pathogenesis,clinic,treatment[J]. Kardiologiia,2013,53(6):66-70.
[35] Harewood WJ,Phippard AF,Duggin GG,et al. Fetotoxicity of angiotensin-converting enzyme inhibition in primate pregnancy:Aprospective,placebo-controlled study in baboons(Papio hamadryas)[J]. Am J Obstet Gynecol,1994,171(3):633-642.
[36] Alwan S,Polifka JE,Friedman JM. AngiotensinⅡreceptor antagonist treatment during pregnancy[J]. Birth Defects Res A Clin Mol Teratol,2005,73(2):123-130.