Roberts James M, Pearson Gail, Cutler Jeff, Lindheimer Marshall
Department of Obstetrics, Gynecology and Reproductive Sciences, Graduate School of Public Health, University of Pittsburgh, and Magee-Womens Research Institute, Pittsburgh, Pa, USA.
Hypertension. 2003 Mar;41(3):437-45. doi: 10.1161/01.HYP.0000054981.03589.E9. Epub 2003 Feb 10.
A Working Group on Research in Hypertension in Pregnancy was recently convened by the National Heart, Lung, and Blood Institute to determine the state of knowledge in this area and suggest appropriate directions for research. Hypertensive disorders in pregnancy, especially preeclampsia, are a leading cause of maternal death worldwide and even in developed countries increase perinatal mortality rates 5-fold. Much has been learned about preeclampsia, but gaps in the knowledge necessary to direct therapeutic strategies remain. Oxidative stress is a biologically plausible contributor to the disorder that may be amenable to intervention. Hypertension that antedates pregnancy (chronic hypertension) bears many similarities to hypertension in nonpregnant women, but the special setting of pregnancy demands information to guide evidence-based therapy. The recommendations of the Working Group are to attempt a clinical trial of antioxidant therapy to prevent preeclampsia that is be complemented by mechanistic research to increase understanding of the genetics and pathogenesis of the disorder. For chronic hypertension, clinical trials are recommended to direct choice of drugs, evaluate degree of control, and assess implications to the mother and fetus. Recommendations to increase participation in this research are also presented.
美国国立心肺血液研究所最近召集了一个妊娠期高血压研究工作组，以确定该领域的知识现状，并为研究提出适当的方向。妊娠期高血压疾病，尤其是先兆子痫，是全球孕产妇死亡的主要原因，即使在发达国家，也会使围产期死亡率增加5倍。关于先兆子痫已经了解了很多，但指导治疗策略所需的知识仍存在空白。氧化应激在生物学上可能是导致该疾病的一个因素，或许可以通过干预来解决。妊娠前就存在的高血压（慢性高血压）与非妊娠女性的高血压有许多相似之处，但妊娠这一特殊情况需要相关信息来指导循证治疗。工作组的建议是尝试进行抗氧化治疗预防先兆子痫的临床试验，并辅以机制研究，以加深对该疾病遗传学和发病机制的理解。对于慢性高血压，建议进行临床试验以指导药物选择、评估控制程度，并评估对母亲和胎儿的影响。还提出了增加参与这项研究的建议。
