Stott D, Bolten M, Salman M, Paraschiv D, Douiri A, Kametas N A
Antenatal Hypertension Clinic, King's College Hospital, London, UK.
Department of Primary Care and Public Health Sciences and NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust Addison House, King's College London, Guy's Campus, London, UK.
J Hum Hypertens. 2017 Feb;31(2):126-131. doi: 10.1038/jhh.2016.50. Epub 2016 Jul 28.
This prospective observational study aimed to identify at presentation the maternal hemodynamic and demographic variables associated with a therapeutic response to oral labetalol and to use these variables to develop a prediction model to anticipate the response to labetalol monotherapy in women with hypertension. It was set at a maternity unit in a UK teaching hospital. Maternal demographic data from 50 pregnant women, presenting with hypertension between January and August 2013, was collected and blood pressure measured with a device validated for pregnancy and pre-eclampsia. Maternal haemodynamics were assessed with a bioreactance monitor. Participants were commenced on oral labetalol, and reviewed until delivery and discharge home. Logistic regression analysis was performed to assess the prediction of response to labetalol according to the maternal demographic and hemodynamic variables. Main outcome measures were the response to labetalol monotherapy up to delivery and discharge home, defined as sustained blood pressure control <140/90, and the rates of severe hypertension. Thirty-seven women (74%) had their blood pressure well controlled with labetalol monotherapy, 13 (26%) failed to achieve control with labetalol alone, of whom 9 developed severe hypertension. Multivariate logistic regression showed that heart rate, ethnicity and stroke volume index were independent predictors of the response to labetalol. The predictive accuracy of the model was 96% (95% confidence interval (CI) 86-99%). Maternal demographics and haemodynamics are potent predictors for the response to labetalol, and these parameters may guide therapy to enable effective blood pressure control and a lowering of severe hypertension rates.
这项前瞻性观察性研究旨在确定就诊时与口服拉贝洛尔治疗反应相关的母体血流动力学和人口统计学变量，并利用这些变量建立一个预测模型，以预测高血压女性对拉贝洛尔单药治疗的反应。该研究在英国一家教学医院的产科病房进行。收集了2013年1月至8月期间50名患有高血压的孕妇的母体人口统计学数据，并用经过妊娠和先兆子痫验证的设备测量血压。用生物反应监测仪评估母体血流动力学。参与者开始口服拉贝洛尔，并在分娩和出院前进行复查。进行逻辑回归分析，以评估根据母体人口统计学和血流动力学变量对拉贝洛尔反应的预测。主要结局指标是直至分娩和出院时对拉贝洛尔单药治疗的反应，定义为血压持续控制在<140/90，以及重度高血压的发生率。37名女性（74%）通过拉贝洛尔单药治疗血压得到良好控制，13名（26%）仅用拉贝洛尔未能实现控制，其中9名发展为重度高血压。多变量逻辑回归显示，心率、种族和每搏量指数是对拉贝洛尔反应的独立预测因素。该模型的预测准确率为96%（95%置信区间（CI）86 - 99%）。母体人口统计学和血流动力学是对拉贝洛尔反应的有力预测因素，这些参数可指导治疗，以实现有效的血压控制并降低重度高血压发生率。
