Watson D L, Bhatia R K, Norman G S, Brindley B A, Sokol R J
Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, Detroit, Michigan.
Obstet Gynecol. 1989 Oct;74(4):573-6.
The etiology of postpartum eclampsia and hypertension remains controversial. Recent reports have suggested a possible idiosyncratic hypertensive reaction associated with the use of bromocriptine mesylate. The purpose of this study was to determine whether bromocriptine, used for lactation suppression, is a risk factor for postpartum hypertension. In 1813 consecutively delivered staff patients, blood pressures at three separate home visits were obtained between 3-21 days postpartum. Postpartum hypertension, defined for the purposes of this study as systolic pressure of 140 mmHg or greater and/or diastolic pressure of 90 mmHg or greater on any of the three home visits, was the dependent variable; bromocriptine exposure was the independent variable. Covariates included age, race, chronic hypertension, pregnancy-induced hypertension, and antihypertensive medication. Discriminant analysis, including the first-order interactions, revealed that race, history of chronic hypertension, pregnancy-induced hypertension, and antihypertensive medication contributed significantly to postpartum hypertension (F (7, 1803) = 107.9; P less than .001, explained variance 30%). Of all the interaction terms, only the bromocriptine by pregnancy-induced hypertension interaction was significant. These findings support the contention that patients with antepartum pregnancy-induced hypertension who receive bromocriptine for lactation suppression are at increased risk for postpartum hypertension. Avoiding the elective use of this drug in patients with pregnancy-induced hypertension might constitute a reasonable clinical response to these findings.
产后子痫和高血压的病因仍存在争议。最近的报告表明，使用甲磺酸溴隐亭可能会引发一种特殊的高血压反应。本研究的目的是确定用于抑制泌乳的溴隐亭是否为产后高血压的一个危险因素。在1813例连续分娩的医护人员患者中，在产后3至21天期间进行了三次单独的家访并测量血压。本研究将产后高血压定义为在任何一次家访中收缩压达到或高于140 mmHg和/或舒张压达到或高于90 mmHg，它是因变量；溴隐亭暴露情况是自变量。协变量包括年龄、种族、慢性高血压、妊娠高血压以及抗高血压药物。判别分析（包括一阶交互作用）显示，种族、慢性高血压病史、妊娠高血压以及抗高血压药物对产后高血压有显著影响（F(7, 1803) = 107.9；P < 0.001，解释方差30%）。在所有交互项中，只有溴隐亭与妊娠高血压的交互作用具有显著性。这些发现支持了这样一种观点，即产前患有妊娠高血压且接受溴隐亭抑制泌乳的患者产后高血压风险增加。对于这些发现，避免对患有妊娠高血压的患者选择性使用这种药物可能是一种合理的临床应对措施。
