患有妊娠高血压疾病(HDP)的妇女在分娩后几年内有明确的慢性高血压风险,但是这些妇女对产后高血压的管理仍然不一致。
■通过HDP状态和产前使用抗高血压药物评估分娩后最初2年内开始使用抗高血压药物的发生率。
■这项基于丹麦注册的队列研究使用了从1995年1月1日至2018年12月31日分娩的至少1次妊娠持续20个或更多孕周(仅考虑该期间的第一次妊娠)的妇女的数据。统计分析于2022年10月至2023年9月进行。
■妊娠期高血压疾病。
■根据HDP状态和产前药物使用情况,产后2年内(5个产后时间间隔)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人(4.7%[95%CI,4.7%-4.8%])患有HDP(HDP:分娩时的中位年龄,29.1年[IQR,26.1-32.7岁];无HDP:分娩年龄中位数,29.0年[IQR,25.9-32.3年])。开始产后降压治疗的2年累积发生率从没有HDP的妇女的1.8%(95%CI,1.8%-1.8%)到重度先兆子痫妇女的44.1%(95%CI,40.0%-48.2%)。大多数在分娩后3个月内开始使用HDP后需要产后抗高血压药物的妇女(重度先兆子痫,86.6%[95%CI,84.6%-89.4%];先兆子痫,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%)的先兆子痫妇女,24.9%(95%CI,22.5%-27.5%)的妊娠期高血压妇女,76.7%(95%CI,76.3%-77.1%)的无HDP患者在分娩后3个月以上首次服用降压药。妊娠期高血压妇女产后1年以上开始用药的比例最高,11.6%(95%CI,10.0%-13.2%)在这段时间后开始治疗。在产后前3个月开处方的妇女中,高达55.9%(95%CI,46.2%-66.1%)需要产后3个月以上的进一步处方,取决于HDP状态和产前药物使用情况。
■在这项针对产后妇女的队列研究中,出生后开始使用抗高血压药物的发生率因HDP状态而异,HDP严重性,和产前降压药物的使用。高达24.9%的女性在HDP后3个月以上开始使用抗高血压药物,1年后开始治疗高达11.6%。常规的产后血压监测可以防止开始使用抗高血压药物的诊断延迟,并改善妇女的心血管疾病预防。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Hypertensive disorders of pregnancy.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.