Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan (S.-K.H., M.-S.L., H.-Y.L., L.-C.C., C.-H.C., B.-H.Y., H.-J.Y., F.-C.H., W.-Y.C.).
School of Medicine, Tzu Chi University, Hualien, Taiwan (S.-K.H., M.-S.L., H.-Y.L., C.-J.C., W.-Y.C.).
Stroke. 2022 Feb;53(2):338-344. doi: 10.1161/STROKEAHA.121.034109. Epub 2022 Jan 5.
Hypertensive disorders of pregnancy (HDP) comprise 4 subtypes. Previous studies have not investigated the relationship between stroke risk, different HDP subtypes, and follow-up time, which was the purpose of this study.
Data of 17 588 women aged 18 to 45 years who had a history of HDP in Taiwan from 2000 to 2017 was retrospectively reviewed. After matching with confounders, 13 617 HDP women and 54 468 non-HDP women were recruited.
HDP women had an adjusted hazard ratio (aHR) of 1.71 (95% CI, 1.46-2.00) for stroke, and 1.60 (1.35-1.89) and 2.98 (2.13-4.18) for ischemic and hemorrhagic stroke, respectively (<0.001 for all). The overall stroke risk in the HDP group was still 2.04 times 10 to 15 years after childbirth (1.47-2.83, <0.001). Although the risks of both ischemic and hemorrhagic stroke persisted, their risk time trends were different. The risk of ischemic stroke reached peak during 1 to 3 years after childbirth with an aHR of 2.14 (1.36-3.38), while hemorrhagic stroke risk gradually increased and had an aHR of 4.64 (2.47-8.73) after 10 to 15 years of childbirth (both <0.001). Among the 4 HDP subtypes, chronic hypertension with superimposed preeclampsia had the highest stroke risk (aHR=3.86, 1.91-7.82, <0.001), followed by preeclampsia-eclampsia (aHR=2.00, 1.63-2.45, <0.001), and gestational hypertension (aHR=1.68, 1.13-2.52, <0.05); chronic preexisting hypertension had the lowest stroke risk (aHR=1.27, 0.97-1.68, >0.05). Furthermore, multiple HDP combined with preeclampsia had aHR of 5.48 (1.14-26.42, <0.05).
The effect of HDP on the risk of future stroke persisted for up to 17 years, both for ischemic and hemorrhagic strokes. The presence of multiple HDP and preeclampsia further increase the stroke risk.
妊娠高血压疾病（HDP）包括 4 个亚型。既往研究并未探讨不同 HDP 亚型与卒中风险及随访时间之间的关系，本研究旨在探究上述内容。
回顾性分析了 2000 年至 2017 年期间在台湾有 HDP 病史的 17588 名 18 至 45 岁的女性患者的数据。经过混杂因素匹配后，纳入了 13617 名 HDP 女性和 54468 名非 HDP 女性。
HDP 女性发生卒中的校正风险比（aHR）为 1.71（95%CI，1.46-2.00），发生缺血性卒中和出血性卒中的 aHR 分别为 1.60（1.35-1.89）和 2.98（2.13-4.18）（均<0.001）。HDP 组患者产后 10-15 年整体卒中风险仍升高 2.04 倍（1.47-2.83，<0.001）。尽管缺血性卒中和出血性卒中的风险仍然存在，但风险的时间趋势不同。缺血性卒中的风险在产后 1-3 年内达到峰值，aHR 为 2.14（1.36-3.38），而出血性卒中的风险逐渐增加，产后 10-15 年 aHR 为 4.64（2.47-8.73）（均<0.001）。在 4 种 HDP 亚型中，慢性高血压伴子痫前期的卒中风险最高（aHR=3.86，1.91-7.82，<0.001），其次是子痫前期-子痫（aHR=2.00，1.63-2.45，<0.001）和妊娠期高血压（aHR=1.68，1.13-2.52，<0.05）；慢性原发性高血压的卒中风险最低（aHR=1.27，0.97-1.68，>0.05）。此外，多种 HDP 合并子痫前期的 aHR 为 5.48（1.14-26.42，<0.05）。
HDP 对未来卒中风险的影响可持续长达 17 年，无论是缺血性卒中和出血性卒中。存在多种 HDP 和子痫前期会进一步增加卒中风险。
