家庭血压监测可检测出有子痫前期病史女性未被发现的高血压：BP-PRESELF研究结果
Home blood pressure monitoring detects unrevealed hypertension in women with a history of preeclampsia: Results of the BP-PRESELF study.
作者信息
Muijsers Hella E C, Wu Pensee, van der Heijden Olivier W H, Wijnberger Lia D E, van Bijsterveldt Chantal, Buijs Ciska, Pagels Jens, Tönnies Peter, Heiden Susanne, Roeleveld Nel, Maas Angela H E M
机构信息
Radboud University Medical Center, Department of Cardiology, Geert-Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
Keele Cardiovascular Research Group, School of Medicine, Keele University, Staffordshire ST5 5BG, UK.
出版信息
Am J Prev Cardiol. 2022 Nov 11;12:100429. doi: 10.1016/j.ajpc.2022.100429. eCollection 2022 Dec.
OBJECTIVES
The risk of cardiovascular disease more than doubles after hypertensive disorders of pregnancy. As early onset chronic hypertension contributes to cardiovascular risk, implementation of screening strategies, using home blood pressure monitoring (HBPM), may help to improve long-term cardiovascular health.We evaluated whether HBPM among women with a history of preeclampsia/HELLP syndrome is feasible for early detection and management of hypertension.
METHODS
The BP-PRESELF study is a multicenter randomized controlled trial. Participants were randomized to intervention group with HBPM for the duration of 1 year or the control group with 'usual care'. The primary outcome was feasibility of HBPM during 1 year of follow-up, defined as protocol adherence, protocol persistence and patient acceptance. Secondary outcomes were blood pressure levels and prevalence of hypertension.
RESULTS
We recruited 198 women with a mean age of 45 years. Protocol adherence decreased during the first 6 months, after which it stabilized. Protocol persistence remained high throughout follow-up. During the study period, 33 women (34%) in the intervention group were diagnosed with hypertension versus only 10 women (11%) in the control group, <0.001. At 1-year follow-up, mean systolic blood pressure (SD) was 120.4 (11.6) mmHg in the intervention group versus 126.1 (14.3) mmHg in the control group, =0.003. Mean diastolic blood pressure (SD) values were 77.1 (8.0) mmHg versus 81.7 (9.4) mmHg, <0.001, respectively. Adjusted systolic and diastolic differences (95% confidence interval) were -6.81 (-10.17, -3.45) and -4.93 (-7.26, -2.61) mm Hg, with 80% less hypertension at 1-year follow-up in the intervention group.
CONCLUSIONS
HBPM appears to be feasible for follow-up of blood pressure in women after preeclampsia/HELLP syndrome, while it detected hypertension and blood pressure levels reduced in one-third of women in this group.
目的
妊娠高血压疾病后心血管疾病风险增加一倍多。由于早发性慢性高血压会增加心血管疾病风险，采用家庭血压监测（HBPM）实施筛查策略可能有助于改善长期心血管健康。我们评估了子痫前期/HELLP综合征病史女性进行HBPM对高血压的早期检测和管理是否可行。
方法
BP-PRESELF研究是一项多中心随机对照试验。参与者被随机分为接受为期1年HBPM的干预组或接受“常规护理”的对照组。主要结局是随访1年期间HBPM的可行性，定义为方案依从性、方案持续性和患者接受度。次要结局是血压水平和高血压患病率。
结果
我们招募了198名平均年龄为45岁的女性。方案依从性在前6个月下降，之后趋于稳定。整个随访期间方案持续性保持较高水平。在研究期间，干预组有33名女性（34%）被诊断为高血压，而对照组仅有10名女性（11%），P<0.001。在1年随访时，干预组平均收缩压（标准差）为120.4（11.6）mmHg，对照组为126.1（14.3）mmHg，P=0.003。平均舒张压（标准差）值分别为77.1（8.0）mmHg和81.7（9.4）mmHg，P<0.001。校正后的收缩压和舒张压差异（95%置信区间）分别为-6.81（-10.17，-3.45）和-4.93（-7.26，-2.61）mmHg，干预组在1年随访时高血压发生率降低了80%。
结论
HBPM对于子痫前期/HELLP综合征后女性的血压随访似乎可行，同时它检测到该组三分之一女性的高血压且血压水平降低。
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