Billings Clinic, Billings, MT, USA.
University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA.
Am J Health Syst Pharm. 2021 Jul 9;78(14):1317-1322. doi: 10.1093/ajhp/zxab162.
The use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to treat hypertension (HTN) during pregnancy presents well-established risks to a developing fetus. A cross-sectional study was conducted to evaluate the current state of antihypertensive prescribing and contraceptive use in females of childbearing age within a large safety-net health system.
The retrospective cross-sectional study focused on females aged 18-49 years with a documented diagnosis of HTN. The proportion of patients prescribed an ACE inhibitor or ARB and using a documented form of contraception was calculated. Documented forms of contraception included oral contraceptives, intrauterine devices, injections, implants, and surgical intervention.
A total of 4,187 patients were identified from the HTN registry; after application of exclusion criteria 3,045 patients were included in the study population. The mean age was 39 years (range, 18-49 years). The most frequently prescribed classes of antihypertensive medications were ACE inhibitors and ARBs (one or the other was used by 1,146 patients [37.6%]), followed by thiazide diuretics (n = 710, 23.3%) and calcium channel blockers (n = 599, 19.7%). Of the 1,146 patients prescribed an ACE inhibitor or ARB, 553 (48%) were using a documented form of contraception.
Rates of ACE inhibitor or ARB prescribing to females of childbearing age were high despite the teratogenic risks, and fewer than half of patients had documented protection from pregnancy. Provider and patient education and potential creation of best practice alerts in the electronic medical record regarding the risks of using ACE inhibitors and ARBs in females of childbearing age are warranted.
在怀孕期间使用血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂（ARB）治疗高血压（HTN）对胎儿发育有明确的风险。本研究通过回顾性横断面研究评估了大型医疗保障体系中育龄女性高血压的降压药物开具情况和避孕方法使用情况。
本研究的回顾性横断面研究聚焦于有高血压诊断记录的 18-49 岁女性。计算了开具 ACE 抑制剂或 ARB 且有记录避孕方法的患者比例。记录的避孕方法包括口服避孕药、宫内节育器、注射剂、植入物和手术干预。
共从高血压登记处确定了 4187 名患者；应用排除标准后，有 3045 名患者纳入研究人群。患者平均年龄为 39 岁（范围：18-49 岁）。最常开具的降压药物类别为 ACE 抑制剂和 ARB（有 1146 名患者[37.6%]使用一种或另一种），其次是噻嗪类利尿剂（n=710，23.3%）和钙通道阻滞剂（n=599，19.7%）。在开具 ACE 抑制剂或 ARB 的 1146 名患者中，有 553 名（48%）使用了记录避孕方法。
尽管有潜在致畸风险，但仍有大量育龄女性开具 ACE 抑制剂或 ARB，而且不到一半的患者有记录的妊娠保护。需要对提供者和患者进行教育，并可能在电子病历中创建关于在育龄女性中使用 ACE 抑制剂和 ARB 的风险的最佳实践提醒。
