Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Fetal Medicine Unit, St George's Hospital, University of London, London, United Kingdom.
JAMA Netw Open. 2024 Aug 1;7(8):e2426394. doi: 10.1001/jamanetworkopen.2024.26394.
Women who had a hypertensive disorder of pregnancy (HDP) have a well-documented risk of chronic hypertension within a few years of delivery, but management of postpartum hypertension among these women remains inconsistent.
To assess the incidence of initiation of antihypertensive medication use in the first 2 years after delivery by HDP status and antenatal antihypertensive medication use.
DESIGN, SETTING, AND PARTICIPANTS: This Danish register-based cohort study used data from women with at least 1 pregnancy lasting 20 or more gestational weeks (only the first pregnancy in the period was considered) who delivered from January 1, 1995, to December 31, 2018. Statistical analysis was conducted from October 2022 to September 2023.
Hypertensive disorders of pregnancy.
Cumulative incidences and hazard ratios of initiating antihypertensive medication use within 2 years post partum (5 postpartum time intervals) by HDP status and antenatal medication use.
The cohort included 784 782 women, of whom 36 900 (4.7% [95% CI, 4.7%-4.8%]) had an HDP (HDP: median age at delivery, 29.1 years [IQR, 26.1-32.7 years]; no HDP: median age at delivery, 29.0 years [IQR, 25.9-32.3 years]). The 2-year cumulative incidence of initiating postpartum antihypertensive treatment ranged from 1.8% (95% CI, 1.8%-1.8%) among women who had not had HDPs to 44.1% (95% CI, 40.0%-48.2%) among women with severe preeclampsia who required antihypertensive medication during pregnancy. Most women who required postpartum antihypertensive medication after an HDP initiated use within 3 months of delivery (severe preeclampsia, 86.6% [95% CI, 84.6%-89.4%]; preeclampsia, 75.3% [95% CI, 73.8%-76.2%]; and gestational hypertension, 75.1% [95% CI, 72.9%-77.1%]). However, 13.4% (95% CI, 11.9%-14.1%) of women with severe preeclampsia, 24.7.% (95% CI, 24.0%-26.0%) of women with preeclampsia, 24.9% (95% CI, 22.5%-27.5%) of women with gestational hypertension, and 76.7% (95% CI, 76.3%-77.1%) of those without an HDP first filled a prescription for antihypertensive medication more than 3 months after delivery. Women with gestational hypertension had the highest rate of initiating medication after more than 1 year post partum, with 11.6% (95% CI, 10.0%-13.2%) starting treatment after this period. Among women who filled a prescription in the first 3 months post partum, up to 55.9% (95% CI, 46.2%-66.1%) required further prescriptions more than 3 months post partum, depending on HDP status and antenatal medication use.
In this cohort study of postpartum women, the incidence of initiation of postnatal antihypertensive medication use varied by HDP status, HDP severity, and antenatal antihypertensive medication use. Up to 24.9% of women initiated antihypertensive medication use more than 3 months after an HDP, with up to 11.6% initiating treatment after 1 year. Routine postpartum blood pressure monitoring might prevent diagnostic delays in initiation of antihypertensive medication use and improve cardiovascular disease prevention among women.
患有妊娠高血压疾病（HDP）的女性在分娩后几年内患有慢性高血压的风险有明确的记录，但这些女性的产后高血压管理仍然不一致。
评估 HDP 状态和产前抗高血压药物使用与产后 2 年内开始使用抗高血压药物的发生率。
设计、设置和参与者：这项丹麦基于登记的队列研究使用了至少有一次持续 20 周或以上妊娠（该期间仅考虑第一次妊娠）的女性的数据，这些女性于 1995 年 1 月 1 日至 2018 年 12 月 31 日分娩。统计分析于 2022 年 10 月至 2023 年 9 月进行。
妊娠高血压疾病。
根据 HDP 状态和产前药物使用情况，产后 5 个时间间隔内开始使用抗高血压药物的累积发生率和危险比。
该队列包括 784782 名女性，其中 36900 名（4.7%[95%CI，4.7%-4.8%]）患有 HDP（HDP：分娩时的中位年龄为 29.1 岁[IQR，26.1-32.7 岁]；无 HDP：分娩时的中位年龄为 29.0 岁[IQR，25.9-32.3 岁]）。产后开始使用抗高血压治疗的 2 年累积发生率范围从未患 HDP 的女性的 1.8%（95%CI，1.8%-1.8%）到需要产前抗高血压药物治疗的重度子痫前期女性的 44.1%（95%CI，40.0%-48.2%）。大多数需要产后抗高血压药物治疗的 HDP 女性在分娩后 3 个月内开始使用药物（重度子痫前期，86.6%[95%CI，84.6%-89.4%]；子痫前期，75.3%[95%CI，73.8%-76.2%]；和妊娠期高血压，75.1%[95%CI，72.9%-77.1%]）。然而，13.4%（95%CI，11.9%-14.1%）的重度子痫前期女性、24.7%（95%CI，24.0%-26.0%）的子痫前期女性、24.9%（95%CI，22.5%-27.5%）的妊娠期高血压女性和 76.7%（95%CI，76.3%-77.1%）的无 HDP 女性在产后 3 个月后首次开抗高血压药物处方。患有妊娠期高血压的女性在产后 1 年以上开始药物治疗的比例最高，其中 11.6%（95%CI，10.0%-13.2%）的女性在这段时间后开始治疗。在产后 3 个月内开处方的女性中，多达 55.9%（95%CI，46.2%-66.1%）的女性在产后 3 个月后需要进一步的处方，具体取决于 HDP 状态和产前药物使用情况。
在这项针对产后女性的队列研究中，产后开始使用抗高血压药物的发生率因 HDP 状态、HDP 严重程度和产前抗高血压药物使用而有所不同。多达 24.9%的 HDP 女性在产后 3 个月后开始使用抗高血压药物，多达 11.6%的女性在 1 年后开始治疗。常规产后血压监测可能会防止抗高血压药物治疗的诊断延迟，并改善女性的心血管疾病预防。
