Nabhan Ashraf F, Elsedawy Maged M
Department of Obstetrics and Gynecology, Ain Shams University, 16 Ali Fahmi Kamel Street, Heliopolis, Cairo, Egypt, 11351.
Cochrane Database Syst Rev. 2011 Jul 6(7):CD006907. doi: 10.1002/14651858.CD006907.pub2.
The question of the target blood pressure in pregnant women with mild-moderate hypertension continues to be an area of debate.
To compare tight versus very tight control of mild-moderate pre-existing or non-proteinuric gestational hypertension for improving outcomes
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), CENTRAL (The Cochrane Library 2011, Issue 3), MEDLINE (January 1966 to March 2011), and the metaRegister of Controlled Trials (31 March 2011). We handsearched citation lists of relevant publications, review articles, and included studies.
Randomized controlled trials of tight versus very tight control in pregnant women with mild or moderate pre-existing or non-proteinuric gestational hypertension.
Two authors independently assessed trial quality and extracted data. We expressed results as risk ratio (RR) or mean differences, together with their 95% confidence intervals (CI).
We included two studies (256 participants) with mild-moderate pre-existing or non-proteinuric gestational hypertension. There was no evidence of a difference between tight and very tight control groups regarding severe pre-eclampsia (risk ratio (RR) 1.28, 95% CI 0.97 to 1.70; two trials, 256 participants). More women in the tight group were hospitalized during their pregnancy (RR 2.53, 95% CI 1.14 to 5.63; one trial, 125 participants). There was no evidence of a difference in other outcome measures including fetal distress, IUGR, neonatal admission to a NICU, perinatal deaths, induction of labor and cesarean delivery between the tight and the very tight control groups. Gestational age at delivery had a non-significant mean difference (MD) of -0.15 weeks between the tight and very tight control groups (MD -0.15, 95% CI -1.52 to 1.21, random-effects, T² = 0.75, I² = 77%; two trials, 256 participants). The MD in birthweight between the tight and the very tight control group was not significant (MD -100.00 grams, 95% CI -363.69 to 163.69; one trial, 125 participants).
AUTHORS' CONCLUSIONS: For pregnant women with non-severe pre-existing or non-proteinuric gestational hypertension, there is insufficient evidence to determine how tight control of hypertension should be achieved to improve maternal and fetal-neonatal outcomes.
轻度至中度高血压孕妇的目标血压问题仍是一个存在争议的领域。
比较对轻度至中度孕前或非蛋白尿性妊娠高血压进行严格控制与极严格控制对改善结局的效果。
我们检索了Cochrane妊娠与分娩组试验注册库（2011年3月31日）、Cochrane系统评价数据库（《Cochrane图书馆》2011年第3期）、MEDLINE（1966年1月至2011年3月）以及对照试验元注册库（2011年3月31日）。我们手工检索了相关出版物、综述文章及纳入研究的参考文献列表。
对轻度或中度孕前或非蛋白尿性妊娠高血压孕妇进行严格控制与极严格控制的随机对照试验。
两位作者独立评估试验质量并提取数据。我们将结果表示为风险比（RR）或均值差，并给出其95%置信区间（CI）。
我们纳入了两项研究（256名参与者），这些研究对象为轻度至中度孕前或非蛋白尿性妊娠高血压患者。在重度子痫前期方面，没有证据表明严格控制组与极严格控制组之间存在差异（风险比（RR）1.28，95%CI 0.97至1.70；两项试验，256名参与者）。严格控制组中有更多女性在孕期住院（RR 2.53，95%CI 1.14至5.63；一项试验，125名参与者）。在其他结局指标方面，包括胎儿窘迫、胎儿生长受限、新生儿入住新生儿重症监护病房、围产期死亡、引产和剖宫产，没有证据表明严格控制组与极严格控制组之间存在差异。严格控制组与极严格控制组之间分娩时的孕周平均差无统计学意义（MD -0.15周，95%CI -1.52至1.21，随机效应模型，T² = 0.75，I² = 77%；两项试验，256名参与者）。严格控制组与极严格控制组之间出生体重的均值差无统计学意义（MD -100.00克，95%CI -363.69至163.69；一项试验，125名参与者）。
对于非重度孕前或非蛋白尿性妊娠高血压孕妇，没有足够证据确定应如何严格控制高血压以改善母婴及胎儿 - 新生儿结局。
