Xu Jiahao, Li Ting, Wang Yixiao, Xue Lu, Miao Zhijing, Long Wei, Xie Kaipeng, Hu Chen, Ding Hongjuan
Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China.
Department of Public Health, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China.
Front Cardiovasc Med. 2022 Jul 7;9:897771. doi: 10.3389/fcvm.2022.897771. eCollection 2022.
This meta-analysis comprehensively evaluated the association between hypertensive disorders in pregnancy (HDP) and the risk of developing chronic hypertension and the associations between specific types of HDP, including preeclampsia (PE) and gestational hypertension (GH), and the risk of developing chronic hypertension.
Systematic review and meta-analysis.
The PubMed, Embase and Cochrane Library databases were searched from inception to August 20, 2021.
Depending on heterogeneity, the combined odds ratio (OR) of the 95% confidence interval (CI) was obtained with a random-effects or fixed-effects model. We used meta-regression analysis to explore the sources of heterogeneity. We analyzed the OR value after adjusting for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors. Additionally, we evaluated the results of the subgroup analysis by the year of publication (< 2016, ≥ 2016), study design, sample size (< 500, ≥ 500), region (North and South America, Europe, and other regions) and NOS score (< 7, ≥ 7).
Our systematic review and meta-analysis comprehensively explored the relationships between HDP, GH, and PE and chronic hypertension. Twenty-one articles that included 634,293 patients were included. The results of this systematic review and meta-analysis suggested that women with a history of HDP are almost 3.6 times more likely to develop chronic hypertension than those without a history of HDP, women with a history of GH are almost 6.2 times more likely to develop chronic hypertension than those without a history of GH, and women with a history of PE are almost 3.2 times more likely to develop chronic hypertension than those without a history of PE. In addition, we further calculated the probability of developing chronic hypertension among patients with HDP or PE after adjusting for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors. The results suggested that women with a history of HDP are almost 2.47 times more likely to develop chronic hypertension than those without a history of HDP and that women with a history of PE are almost 3.78 times more likely to develop chronic hypertension than those without a history of PE. People in Asian countries are more likely to develop chronic hypertension after HDP or PE, while American people are not at high relative risk.
These findings suggest that HDP, GH, and PE increase the likelihood of developing chronic hypertension. After adjustment for age and BMI at recruitment, prepregnancy BMI, age at first delivery, and other factors, patients with HDP or PE were still more likely to develop chronic hypertension. HDP may be a risk factor for chronic hypertension, independent of other risk factors. GH and PE, as types of HDP, may also be risk factors for chronic hypertension.
[www.ClinicalTrials.gov], identifier [CRD42021238599].
本荟萃分析全面评估了妊娠高血压疾病（HDP）与慢性高血压发生风险之间的关联，以及特定类型的HDP（包括子痫前期（PE）和妊娠高血压（GH））与慢性高血压发生风险之间的关联。
系统评价和荟萃分析。
检索了PubMed、Embase和Cochrane图书馆数据库，检索时间从建库至2021年8月20日。
根据异质性，采用随机效应或固定效应模型获得95%置信区间（CI）的合并比值比（OR）。我们使用荟萃回归分析来探索异质性来源。我们在对招募时的年龄和BMI、孕前BMI、首次分娩年龄及其他因素进行调整后分析OR值。此外，我们按发表年份（<2016年，≥2016年）、研究设计、样本量（<500，≥500）、地区（北美和南美、欧洲及其他地区）和NOS评分（<7，≥7）对亚组分析结果进行了评估。
我们的系统评价和荟萃分析全面探讨了HDP、GH和PE与慢性高血压之间的关系。纳入了21篇文章，共634293例患者。该系统评价和荟萃分析结果表明，有HDP病史的女性发生慢性高血压的可能性几乎是无HDP病史女性的3.6倍，有GH病史的女性发生慢性高血压的可能性几乎是无GH病史女性的6.2倍，有PE病史的女性发生慢性高血压的可能性几乎是无PE病史女性的3.2倍。此外，我们在对招募时的年龄和BMI、孕前BMI、首次分娩年龄及其他因素进行调整后，进一步计算了HDP或PE患者发生慢性高血压的概率。结果表明，有HDP病史的女性发生慢性高血压的可能性几乎是无HDP病史女性的2.47倍，有PE病史的女性发生慢性高血压的可能性几乎是无PE病史女性的3.78倍。亚洲国家的人在发生HDP或PE后更易发生慢性高血压，而美国人的相对风险不高。
这些发现表明，HDP、GH和PE会增加发生慢性高血压的可能性。在对招募时的年龄和BMI、孕前BMI、首次分娩年龄及其他因素进行调整后，有HDP或PE的患者仍更易发生慢性高血压。HDP可能是慢性高血压的一个危险因素，独立于其他危险因素。GH和PE作为HDP的类型，也可能是慢性高血压的危险因素。
