美国孕妇的降压药物处方配给：一项队列研究。
Antihypertensive medication prescription dispensation among pregnant women in the United States: A cohort study.
机构信息
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY.
出版信息
Am Heart J. 2024 Dec;278:5-13. doi: 10.1016/j.ahj.2024.08.010. Epub 2024 Aug 22.
IMPORTANCE
Hypertension is increasingly common in pregnancy capable individuals, yet there is limited data on antihypertensive medication dispensation in peripartum individuals.
OBJECTIVE
To describe antihypertensive medication dispensation from preconception through the first year postpartum.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used the Truven Health Market Scan administrative data from 2008 to 2014 to identify women in the United States with commercial or government health insurance, aged 15-54, free from heart disease, who experienced a pregnancy and filled at least 1 prescription for an antihypertensive medication between 3 months prior to conception and 12 months after the end of the pregnancy.
MAIN OUTCOMES AND MEASURES
We describe antihypertensive dispensation patterns (continuation, initiation, and discontinuation) by medication class during 5 time periods: preconception, first, second, and third trimesters, and the first year postpartum.
RESULTS
Of 1,058,521 pregnancies, 108,614 (10.3%) were exposed to at least 1 antihypertensive medication dispensation. The most commonly dispensed medications across all periods combined were adrenergic blockers, calcium channel blockers (CCBs), and diuretics. Renin-angiotensin-aldosterone system (RAAS) inhibitors were the third most dispensed medication class in the preconception period (26.4%), and fills decreased to 5.7% and 1.7% in the second and third trimesters, respectively. Of the women with chronic hypertension who filled at least 1 prescription prior to conception, 8.4% were not dispensed an antihypertensive medication during the first year after delivery.
CONCLUSIONS AND RELEVANCE
Antihypertensive prescription dispensation of both preferred and potentially harmful agents is common in pregnancy capable individuals. Patterns of dispensation suggest room for improvement in the treatment of chronic hypertension after a pregnancy.
重要性
高血压在有生育能力的人群中越来越常见，但有关围产期抗高血压药物使用的数据有限。
目的
描述从受孕前到产后第一年的抗高血压药物使用情况。
设计、地点和参与者：这项回顾性队列研究使用了 Truven Health Market Scan 从 2008 年到 2014 年的行政数据，在美国确定了有商业或政府健康保险、年龄在 15-54 岁之间、无心脏病史的女性，她们在受孕前 3 个月至怀孕结束后 12 个月期间至少有一次抗高血压药物处方。
主要结果和措施
我们描述了在 5 个时间段内按药物类别划分的抗高血压药物使用模式（继续、开始和停止）：受孕前、第一个、第二个和第三个三个月，以及产后第一年。
结果
在 1058521 例妊娠中，有 108614 例（10.3%）至少使用了一种抗高血压药物。所有时期联合使用最广泛的药物是肾上腺素能阻滞剂、钙通道阻滞剂（CCBs）和利尿剂。肾素-血管紧张素-醛固酮系统（RAAS）抑制剂是受孕前时期第三大处方药物类别（26.4%），在第二个和第三个三个月分别降至 5.7%和 1.7%。在受孕前至少开了 1 种降压药的慢性高血压妇女中，有 8.4%的人在分娩后第一年没有开降压药。
结论和相关性
有生育能力的人群中，抗高血压药物的处方既包括首选药物，也包括潜在有害药物，这很常见。处方模式表明，在治疗妊娠后的慢性高血压方面还有改进的空间。
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