美国女性的不良童年经历与血压：系统评价。
Adverse Childhood Experiences and Blood Pressure in Women in the United States: A Systematic Review.
机构信息
Duke University School of Nursing, Durham, North Carolina.
Division of Health of Women, Children, and Families, Duke University School of Nursing, Durham, North Carolina.
出版信息
J Midwifery Womens Health. 2021 Jan;66(1):78-87. doi: 10.1111/jmwh.13213. Epub 2021 Feb 11.
INTRODUCTION
Elevated blood pressure is a leading contributor to adverse cardiovascular outcomes. Some studies suggest there is an association between adverse childhood experiences (ACEs) and subsequent elevated blood pressure in adulthood. The literature specific to ACEs and blood pressure in women has not been synthesized; thus the purpose of this systematic review was to examine what is known about the association between ACEs and blood pressure in women living in the United States.
METHODS
In collaboration with a medical librarian, a systematic search of the literature published between January 1998 and December 2019 was conducted. Original, peer-reviewed publications were identified from PubMed, CINAHL, and PsycINFO databases. Studies were excluded if they (1) were conducted outside the United States, (2) measured acute stress or adult stressors, or (3) measured childhood- or pregnancy-related outcomes.
RESULTS
Of 1740 articles, 12 publications met criteria for inclusion in this study, 8 of which were from cohort studies. Racial and ethnic diversity was limited, with half of the articles in this review consisting of samples that were majority white. Of the studies that used a self-reported history of hypertension, 60% obtained significant associations with ACEs, compared with only 30% of the studies that had objective blood pressure data. ACEs were associated with lower blood pressure in 3 studies.
DISCUSSION
More research is needed to elucidate the relationship between ACEs and elevated blood pressure. Inconsistencies in the findings may be related to the measurement of blood pressure, assessment of ACEs, and population characteristics. Future studies should incorporate diverse population-representative samples with consideration for sex- or race-specific stressors such as pregnancy or racism and their potential influence on blood pressure. Health care providers may consider the history of ACEs as part of screening for cardiovascular risk factors among female patients, especially younger women presenting with elevated blood pressure.
简介
高血压是导致不良心血管结局的主要因素之一。一些研究表明，不良童年经历（ACEs）与成年后血压升高之间存在关联。关于 ACEs 和女性血压的文献尚未得到综合分析；因此，本系统评价的目的是研究在美国生活的女性中 ACEs 与血压之间的关系。
方法
与医学图书馆员合作，对 1998 年 1 月至 2019 年 12 月期间发表的文献进行了系统搜索。从 PubMed、CINAHL 和 PsycINFO 数据库中确定了原始的同行评审出版物。如果研究（1）在美国境外进行，（2）测量急性应激或成人应激源，或（3）测量儿童期或妊娠相关结局，则将其排除在外。
结果
在 1740 篇文章中，有 12 篇符合纳入本研究的标准，其中 8 篇来自队列研究。种族和民族多样性有限，本综述中有一半的文章样本主要为白人。在使用高血压病史的自我报告的研究中，有 60%的研究与 ACEs 相关，而只有 30%的研究有客观的血压数据。有 3 项研究表明 ACEs 与血压降低有关。
讨论
需要更多的研究来阐明 ACEs 和高血压之间的关系。研究结果的不一致可能与血压的测量、ACEs 的评估以及人口特征有关。未来的研究应纳入具有代表性的多样化人群样本，考虑到性别或种族特异性的应激源，如妊娠或种族主义，以及它们对血压的潜在影响。医疗保健提供者可以考虑 ACEs 病史作为女性患者心血管危险因素筛查的一部分，尤其是年轻女性血压升高时。
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