每次访问血压变异性和不良围产期结局之间是否存在关系？

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health Pub Date : 2025-02-13 DOI:10.1016/j.preghy.2025.101200

Laura Ormesher , Jill Stewart , Beth Renwick , Emma Shawkat , Jenny E Myers

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引用次数: 0

摘要

目的探讨血压变异性与围生儿结局的关系。研究设计：这是一项对996名有高血压/妊娠期高血压危险因素的孕妇的回顾性研究。BP变异性通过访间标准差（SD）和平均差（MD）计算。逻辑回归探讨血压变异性与围产期结局之间的关系，调整混杂因素。主要结局指标：血压变异性与i)胎儿生长受限（FGR）和ii)早产（PTB）的相关性。结果fgr和PTB并发症分别为128/996例（13%）和233/996例（23%）。在访问1时，61名（6%）妇女服用拉贝他洛尔，125名（13%）服用钙通道阻滞剂，780名（78%）未服用抗高血压药物。血压变异性增加与FGR和PTB相关。在调整抗高血压药物的数量、孕前血压、BMI、种族和既往FGR的收缩压变异性（FGR调整OR: 1.16 [95% C.I. 1.03-1.30]）后，这些关系仍然存在；Ptb: 1.16[1.05-1.29])。然而，调整最大血压后，没有统计学意义。与拉贝他洛尔相比，硝苯地平与血压变异性增加相关，尽管校正了种族和既往高血压（校正差异：1.93 mmHg [0.13-3.73], p = 0.04）。结论收缩压而非舒张压变异性的增加与不良的围产期结局有关。然而，目前尚不清楚血压不稳定是否直接影响围产期结局，或者仅仅反映血压峰值。降压药之间血压变异性的差异可能反映了不同的降压药效果或影响降压药选择的因素。需要前瞻性研究来调查抗高血压药物、血压变异性和围产期结局之间的潜在联系。

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Is there a relationship between visit-to-visit blood pressure variability and adverse perinatal outcomes?

Objective

To explore the relationship between blood pressure (BP) variability and perinatal outcomes.

Study design

This was a retrospective study of 996 pregnant women with hypertension/risk factors for hypertension in pregnancy. BP variability was calculated by visit-to-visit standard deviation (SD) and mean difference (MD). Logistic regression explored the relationship between BP variability and perinatal outcome, adjusting for confounders.

Main Outcome Measures

Correlation between BP variability and i) fetal growth restriction (FGR) and ii) preterm birth (PTB).

Results

FGR and PTB complicated 128/996 (13 %) and 233/996 (23 %) pregnancies. At visit 1, 61 (6 %) women were taking labetalol, 125 (13 %) were taking calcium channel blockers and 780 (78 %) were not taking antihypertensives. Increased BP variability was associated with FGR and PTB. These relationships persisted after adjustment for number of antihypertensives, pre-pregnancy BP, BMI, ethnicity and previous FGR for systolic but not diastolic BP variability (adjusted OR for FGR: 1.16 [95 % C.I. 1.03–1.30]; PTB: 1.16 [1.05–1.29]). However, statistical significance was lost after adjustment for maximum BP. Nifedipine was associated with increased BP variability, compared with labetalol, despite adjustment for ethnicity and pre-existing hypertension (adjusted difference: 1.93 mmHg [0.13–3.73], p = 0.04).

Conclusions

Increased visit-to-visit systolic but not diastolic BP variability is associated with adverse perinatal outcomes. Nevertheless, it is unclear whether BP lability directly influences perinatal outcome, or merely reflects peak BP. The difference in BP variability between antihypertensives may reflect varying effectiveness or factors influencing antihypertensive choice. Prospective research is needed to investigate any potential link between antihypertensive medications, BP variability and perinatal outcome.

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来源期刊

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health OBSTETRICS & GYNECOLOGYPERIPHERAL VASCULAR-PERIPHERAL VASCULAR DISEASE

CiteScore

4.90

自引率

0.00%

发文量

127

期刊介绍： Pregnancy Hypertension: An International Journal of Women''s Cardiovascular Health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research, and advance education in the field. We publish articles pertaining to human and animal blood pressure during gestation, hypertension during gestation including physiology of circulatory control, pathophysiology, methodology, therapy or any other material relevant to the relationship between elevated blood pressure and pregnancy. The subtitle reflects the wider aspects of studying hypertension in pregnancy thus we also publish articles on in utero programming, nutrition, long term effects of hypertension in pregnancy on cardiovascular health and other research that helps our understanding of the etiology or consequences of hypertension in pregnancy. Case reports are not published unless of exceptional/outstanding importance to the field.