School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Can J Cardiol. 2020 May;36(5):775-779. doi: 10.1016/j.cjca.2020.02.090. Epub 2020 Mar 4.
The Hypertension Canada 2018 clinical guidance for pregnancy hypertension recommends antihypertensive therapy for raised blood pressure in pregnancy to a target diastolic blood pressure (BP) of 85 mm Hg (ie, "tight" control). Although evidence shows this approach reduces the incidence of severe maternal hypertension without increasing risk to the baby, we do not know how pregnant women feel about this approach, particularly as they are generally medication averse. An online survey assessed pregnant women's preferences for management of pregnancy hypertension and explored decisional needs. The survey included information provision and knowledge assessment, a preference elicitation task, and a decisional needs assessment. Survey responses were analysed descriptively, by latent class analysis to identify treatment priority subgroups, and by logistic regression to assess predictors of treatment preference. For the 183 pregnant respondents, 3 treatment priority subgroups were identified, with most respondents expressing equal prioritization of treatment outcomes and components (eg, taking medication). Participants who preferred tight control (49%) were more often white (odds ratio [OR]: 2.38; 95% confidence interval [CI]: 1.18-4.55), with a university education/professional qualification (OR 1.95; 95% CI: 1.02-3.7), and had greater knowledge about pregnancy hypertension and pregnancy complications (OR 1.37; 95% CI: 1.15-1.65). Participants reported diverse decisional needs, but most preferred to make final treatment decisions themselves (70%), with (48%) or without (22%) physician input. The diversity of priorities, preferences, and decisional needs for management of pregnancy hypertension identified in this study emphasises the importance of an individualized approach to treatment recommendations.
加拿大高血压学会 2018 年妊娠高血压临床指南建议对妊娠高血压进行降压治疗，目标舒张压（BP）为 85mmHg（即“严格”控制）。尽管有证据表明，这种方法可降低严重孕妇高血压的发生率，而不会增加婴儿的风险，但我们不知道孕妇对此类方法的看法，尤其是因为她们通常对药物治疗持抵触态度。一项在线调查评估了孕妇对妊娠高血压管理的偏好，并探讨了决策需求。该调查包括信息提供和知识评估、偏好 elicitation 任务以及决策需求评估。使用潜在类别分析来识别治疗优先级亚组，并使用逻辑回归来评估治疗偏好的预测因素，对调查回复进行描述性分析。对于 183 名怀孕受访者，确定了 3 个治疗优先级亚组，大多数受访者对治疗结果和组成部分（例如，服用药物）的优先级表达相等。偏好严格控制（49%）的参与者更常为白人（优势比[OR]：2.38；95%置信区间[CI]：1.18-4.55），具有大学教育/专业资格（OR 1.95；95% CI：1.02-3.7），并且对妊娠高血压和妊娠并发症的知识有更多了解（OR 1.37；95% CI：1.15-1.65）。参与者报告了不同的决策需求，但大多数人更愿意自己做出最终治疗决策（70%），有（48%）或没有（22%）医生的意见。本研究确定了妊娠高血压管理方面的优先事项、偏好和决策需求的多样性，这强调了针对治疗建议采用个体化方法的重要性。
