乌干达西南部一家三级医院中患有妊娠高血压疾病的女性产后3个月持续性高血压情况。
Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda.
作者信息
Lugobe Henry Mark, Kayondo Musa, Mceniery Carmel M, Catov Janet M, Wilkinson Ian B, Wylie Blair J, Vaught Arthur J, Muhindo Rose, Boatin Adeline A
机构信息
Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda (Drs Lugobe and Kayondo).
Department of Medicine, Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom (Drs Lugobe, Mceniery, and Wilkinson).
出版信息
AJOG Glob Rep. 2023 Jan 25;3(1):100163. doi: 10.1016/j.xagr.2023.100163. eCollection 2023 Feb.
BACKGROUND
Hypertension is a key contributor to the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor. Hypertensive disorders of pregnancy, of which preeclampsia and eclampsia are the most common forms, have been shown to be a female-specific risk factor for chronic hypertension.
OBJECTIVE
This study aimed to determine the proportion and risk factors for persistent hypertension at 3 months after delivery among women with hypertensive disorders of pregnancy in Southwestern Uganda.
STUDY DESIGN
This was a prospective cohort study of pregnant women with hypertensive disorders of pregnancy admitted for delivery at Mbarara Regional Referral Hospital in Southwestern Uganda from January 2019 to December 2019; however, women with chronic hypertension were excluded from the study. The participants were followed up for 3 months after delivery. Participants with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg or receiving antihypertension therapy at 3 months after delivery were considered to have persistent hypertension. Multivariable logistic regression was used to determine independent risk factors associated with persistent hypertension.
RESULTS
A total of 111 participants with hypertensive disorders of pregnancy diagnosed at hospital admission were enrolled with a follow-up rate of 49% (54/111) at 3 months after delivery. Of these women, 21 of 54 (39%) had persistent hypertension 3 months after delivery. In the adjusted analyses, an elevated serum creatinine level (>106.08 µmol/L [≤1.2 mg/dL]) at admission for delivery was the only independent risk factor for persistent hypertension at 3 months after delivery (adjusted relative risk, 1.93; 95% confidence interval, 1.08-3.46; =.03), controlling for age, gravidity, and eclampsia.
CONCLUSION
Approximately 4 of 10 women presenting with hypertensive disorders of pregnancy at our institution remained hypertensive 3 months after delivery. Innovative strategies are needed to identify these women and provide long-term care to optimize blood pressure control and reduce future cardiovascular disease after hypertensive disorders of pregnancy.
背景
高血压是全球心血管疾病流行的关键因素，在全球范围内，其导致的死亡人数超过任何其他心血管危险因素。妊娠高血压疾病（其中子痫前期和子痫是最常见的形式）已被证明是慢性高血压的女性特异性危险因素。
目的
本研究旨在确定乌干达西南部患有妊娠高血压疾病的妇女产后3个月持续性高血压的比例和危险因素。
研究设计
这是一项对2019年1月至2019年12月在乌干达西南部姆巴拉拉地区转诊医院住院分娩的患有妊娠高血压疾病的孕妇进行的前瞻性队列研究；然而，患有慢性高血压的妇女被排除在研究之外。对参与者在产后进行了3个月的随访。产后3个月收缩压≥140 mmHg或舒张压≥90 mmHg或接受抗高血压治疗的参与者被认为患有持续性高血压。采用多变量逻辑回归来确定与持续性高血压相关的独立危险因素。
结果
共有111名入院时诊断为妊娠高血压疾病的参与者被纳入研究，产后3个月的随访率为49%（54/111）。在这些妇女中，54人中有21人（39%）在产后3个月患有持续性高血压。在调整分析中，分娩入院时血清肌酐水平升高（>106.08 µmol/L[≤1.2 mg/dL]）是产后3个月持续性高血压的唯一独立危险因素（调整相对风险，1.93；95%置信区间，1.08 - 3.46；P =.03），同时控制了年龄、孕次和子痫。
结论
在我们机构中，约十分之四的患有妊娠高血压疾病的妇女在产后3个月仍患有高血压。需要创新策略来识别这些妇女并提供长期护理，以优化血压控制并降低妊娠高血压疾病后未来心血管疾病的发生风险。
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