Webster Louise M, Conti-Ramsden Frances, Seed Paul T, Webb Andrew J, Nelson-Piercy Catherine, Chappell Lucy C
Women's Health Academic Centre, King's College London, St Thomas' Hospital, London, United Kingdom
Women's Health Academic Centre, King's College London, St Thomas' Hospital, London, United Kingdom.
J Am Heart Assoc. 2017 May 17;6(5):e005526. doi: 10.1161/JAHA.117.005526.
Chronic hypertension complicates around 3% of all pregnancies. There is evidence that treating severe hypertension reduces maternal morbidity. This study aimed to systematically review randomized controlled trials of antihypertensive agents treating chronic hypertension in pregnancy to determine the effect of this intervention.
Medline (via OVID), Embase (via OVID) and the Cochrane Trials Register were searched from their earliest entries until November 30, 2016. All randomized controlled trials evaluating antihypertensive treatments for chronic hypertension in pregnancy were included. Data were extracted and analyzed in Stata (version 14.1). Fifteen randomized controlled trials (1166 women) were identified for meta-analysis. A clinically important reduction in the incidence of severe hypertension was seen with antihypertensive treatment versus no antihypertensive treatment/placebo (5 studies, 446 women; risk ratio 0.33, 95%CI 0.19-0.56; I 0.0%). There was no difference in the incidence of superimposed pre-eclampsia (7 studies, 727 women; risk ratio 0.74, 95%CI 0.49-1.11; I 28.1%), stillbirth/neonatal death (4 studies, 667 women; risk ratio 0.37, 95%CI 0.11-1.26; I 0.0%), birth weight (7 studies, 802 women; weighted mean difference -60 g, 95%CI -200 to 80 g; I 0.0%), or small for gestational age (4 studies, 369 women; risk ratio 1.01, 95%CI 0.53-1.94; I 0.0%) with antihypertensive treatment versus no treatment/placebo.
Antihypertensive treatment reduces the risk of severe hypertension in pregnant women with chronic hypertension. A considerable paucity of data exists to guide choice of antihypertensive agent. Adequately powered head-to-head randomized controlled trials of commonly used antihypertensive agents are required to inform prescribing.
慢性高血压使约3%的妊娠复杂化。有证据表明，治疗重度高血压可降低孕产妇发病率。本研究旨在系统评价治疗妊娠期慢性高血压的抗高血压药物的随机对照试验，以确定这种干预措施的效果。
检索Medline（通过OVID）、Embase（通过OVID）和Cochrane试验注册库，检索时间从最早记录至2016年11月30日。纳入所有评估妊娠期慢性高血压抗高血压治疗的随机对照试验。数据在Stata（版本14.1）中提取和分析。确定了15项随机对照试验（1166名女性）进行荟萃分析。与未进行抗高血压治疗/使用安慰剂相比，抗高血压治疗使重度高血压的发生率出现了具有临床意义的降低（5项研究，446名女性；风险比0.33，95%CI 0.19 - 0.56；I² 0.0%）。在并发子痫前期的发生率（7项研究，727名女性；风险比0.74，95%CI 0.49 - 1.11；I² 28.1%）、死产/新生儿死亡（4项研究，667名女性；风险比0.37，95%CI 0.11 - 1.26；I² 0.0%）、出生体重（7项研究，802名女性；加权平均差 -60 g，95%CI -200至80 g；I² 0.0%）或小于胎龄儿（4项研究，369名女性；风险比1.01，95%CI 0.53 - 1.94；I² 0.0%）方面，抗高血压治疗与未治疗/使用安慰剂之间没有差异。
抗高血压治疗可降低患有慢性高血压的孕妇发生重度高血压的风险。指导抗高血压药物选择的数据严重匮乏。需要进行足够样本量的常用抗高血压药物的直接对比随机对照试验，以为处方提供依据。
