妊娠期高血压和未来心血管风险的血压阈值。

IF 6.7 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Mayo Clinic proceedings Pub Date : 2025-10-01 DOI:10.1016/j.mayocp.2025.04.028

Andrea G. Kattah MD , Thais D. Coutinho MD , Jane Vermunt MD , Lisa E. Vaughan MS , Sonja Suvakov MD, PhD , Yvonne S. Butler Tobah MD , Alanna M. Chamberlain PhD , Sue J. Bielinski PhD , Vesna Garovic MD, PhD

{"title":"妊娠期高血压和未来心血管风险的血压阈值。","authors":"Andrea G. Kattah MD , Thais D. Coutinho MD , Jane Vermunt MD , Lisa E. Vaughan MS , Sonja Suvakov MD, PhD , Yvonne S. Butler Tobah MD , Alanna M. Chamberlain PhD , Sue J. Bielinski PhD , Vesna Garovic MD, PhD","doi":"10.1016/j.mayocp.2025.04.028","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact of blood pressure threshold (≥140/90 vs ≥130/80 mm Hg) and cardiovascular disease (CVD) risk factors on the association of hypertensive disorders of pregnancy (HDP) and CVD.</div></div><div><h3>Patients and Methods</h3><div>A cohort of parous women 45 years of age were followed up for an average of 18.6 years. Hypertension in pregnancy was defined using 2 thresholds: ≥140/90 and ≥130/80 mm Hg (with more than 50% of readings greater than or equal to threshold after first elevation). Cox proportional hazards models were used to evaluate the association between HDP and CVD after adjusting for CVD risk factors (at age 45 or as time-dependent covariates after 45), age at first pregnancy, and parity.</div></div><div><h3>Results</h3><div>Among 1755 women, 263 (15.0%) had HDP during one or more of their pregnancies using the 140/90 mm Hg or greater threshold, while 780 (44.4%) had HDP based on the 130/80 mm Hg or greater threshold. Adjusting for age at pregnancy, parity, body mass index, and CVD risk factors after age 45, both term and preterm preeclampsia were associated with an increased risk of CVD using the 140/90 mm Hg or greater threshold (hazard ratio (HR), 1.45; 95% CI, 1.00 to 2.09; <em>P</em>=.048; and HR, 2.25; 95% CI, 1.25 to 4.06; <em>P</em>=.007, respectively) and the 130/80 mm Hg or greater threshold (HR, 1.42; 95% CI, 1.01 to 1.99; <em>P</em>=.042; and HR, 1.98; 95% CI, 1.09 to 3.60; <em>P</em>=.024, respectively). Women who had HDP only at 130/80 mm Hg or greater (not ≥140/90 mm Hg) had a lower prevalence of hypertension at 45 years compared with the higher threshold (11.0% [57 of 517] vs 24.7% [63 of 263]; <em>P</em><.001).</div></div><div><h3>Conclusion</h3><div>Lowering the blood pressure threshold increased the incidence of HDP but did not impact the association of HDP and future CVD.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 10","pages":"Pages 1745-1757"},"PeriodicalIF":6.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Blood Pressure Thresholds for Hypertension in Pregnancy and Future Cardiovascular Risk\",\"authors\":\"Andrea G. Kattah MD , Thais D. Coutinho MD , Jane Vermunt MD , Lisa E. Vaughan MS , Sonja Suvakov MD, PhD , Yvonne S. Butler Tobah MD , Alanna M. Chamberlain PhD , Sue J. Bielinski PhD , Vesna Garovic MD, PhD\",\"doi\":\"10.1016/j.mayocp.2025.04.028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To evaluate the impact of blood pressure threshold (≥140/90 vs ≥130/80 mm Hg) and cardiovascular disease (CVD) risk factors on the association of hypertensive disorders of pregnancy (HDP) and CVD.</div></div><div><h3>Patients and Methods</h3><div>A cohort of parous women 45 years of age were followed up for an average of 18.6 years. Hypertension in pregnancy was defined using 2 thresholds: ≥140/90 and ≥130/80 mm Hg (with more than 50% of readings greater than or equal to threshold after first elevation). Cox proportional hazards models were used to evaluate the association between HDP and CVD after adjusting for CVD risk factors (at age 45 or as time-dependent covariates after 45), age at first pregnancy, and parity.</div></div><div><h3>Results</h3><div>Among 1755 women, 263 (15.0%) had HDP during one or more of their pregnancies using the 140/90 mm Hg or greater threshold, while 780 (44.4%) had HDP based on the 130/80 mm Hg or greater threshold. Adjusting for age at pregnancy, parity, body mass index, and CVD risk factors after age 45, both term and preterm preeclampsia were associated with an increased risk of CVD using the 140/90 mm Hg or greater threshold (hazard ratio (HR), 1.45; 95% CI, 1.00 to 2.09; <em>P</em>=.048; and HR, 2.25; 95% CI, 1.25 to 4.06; <em>P</em>=.007, respectively) and the 130/80 mm Hg or greater threshold (HR, 1.42; 95% CI, 1.01 to 1.99; <em>P</em>=.042; and HR, 1.98; 95% CI, 1.09 to 3.60; <em>P</em>=.024, respectively). Women who had HDP only at 130/80 mm Hg or greater (not ≥140/90 mm Hg) had a lower prevalence of hypertension at 45 years compared with the higher threshold (11.0% [57 of 517] vs 24.7% [63 of 263]; <em>P</em><.001).</div></div><div><h3>Conclusion</h3><div>Lowering the blood pressure threshold increased the incidence of HDP but did not impact the association of HDP and future CVD.</div></div>\",\"PeriodicalId\":18334,\"journal\":{\"name\":\"Mayo Clinic proceedings\",\"volume\":\"100 10\",\"pages\":\"Pages 1745-1757\"},\"PeriodicalIF\":6.7000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Mayo Clinic proceedings\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0025619625002411\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Mayo Clinic proceedings","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0025619625002411","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

摘要

目的：评价血压阈值（≥140/90 vs≥130/80 mm Hg）和心血管疾病（CVD）危险因素对妊娠期高血压疾病（HDP）与CVD相关性的影响。患者和方法：对一组年龄45岁的产妇进行平均18.6年的随访。妊娠期高血压的定义采用2个阈值：≥140/90和≥130/80 mm Hg（超过50%的读数大于或等于首次升高后的阈值）。在调整心血管疾病危险因素（45岁时或45岁后随时间变化的协变量）、首次妊娠年龄和胎次后，使用Cox比例风险模型来评估HDP与CVD之间的关系。结果：在1755名妇女中，263名（15.0%）在一次或多次怀孕期间使用140/90 mm Hg或更高的阈值患有HDP，而780名（44.4%）基于130/80 mm Hg或更高的阈值患有HDP。调整妊娠年龄、胎次、体重指数和45岁以后CVD危险因素后，使用140/90 mm Hg或更高的阈值，足月和早产先兆子痫与CVD风险增加相关(风险比（HR）， 1.45；95% CI, 1.00 ~ 2.09；P = .048;HR为2.25；95% CI, 1.25 ~ 4.06；P =。007)和130/80 mm Hg或更高的阈值(HR, 1.42；95% CI, 1.01 ~ 1.99；P = .042;HR为1.98；95% CI, 1.09 ~ 3.60；P =。024年,分别)。与较高阈值相比，HDP仅为130/80 mm Hg或更高（不≥140/90 mm Hg）的女性在45岁时的高血压患病率较低(11.0%[517例中的57例]vs 24.7%[263例中的63例]；结论：降低血压阈值可增加HDP的发生率，但不影响HDP与未来CVD的相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Blood Pressure Thresholds for Hypertension in Pregnancy and Future Cardiovascular Risk

Objective

To evaluate the impact of blood pressure threshold (≥140/90 vs ≥130/80 mm Hg) and cardiovascular disease (CVD) risk factors on the association of hypertensive disorders of pregnancy (HDP) and CVD.

Patients and Methods

A cohort of parous women 45 years of age were followed up for an average of 18.6 years. Hypertension in pregnancy was defined using 2 thresholds: ≥140/90 and ≥130/80 mm Hg (with more than 50% of readings greater than or equal to threshold after first elevation). Cox proportional hazards models were used to evaluate the association between HDP and CVD after adjusting for CVD risk factors (at age 45 or as time-dependent covariates after 45), age at first pregnancy, and parity.

Results

Among 1755 women, 263 (15.0%) had HDP during one or more of their pregnancies using the 140/90 mm Hg or greater threshold, while 780 (44.4%) had HDP based on the 130/80 mm Hg or greater threshold. Adjusting for age at pregnancy, parity, body mass index, and CVD risk factors after age 45, both term and preterm preeclampsia were associated with an increased risk of CVD using the 140/90 mm Hg or greater threshold (hazard ratio (HR), 1.45; 95% CI, 1.00 to 2.09; P=.048; and HR, 2.25; 95% CI, 1.25 to 4.06; P=.007, respectively) and the 130/80 mm Hg or greater threshold (HR, 1.42; 95% CI, 1.01 to 1.99; P=.042; and HR, 1.98; 95% CI, 1.09 to 3.60; P=.024, respectively). Women who had HDP only at 130/80 mm Hg or greater (not ≥140/90 mm Hg) had a lower prevalence of hypertension at 45 years compared with the higher threshold (11.0% [57 of 517] vs 24.7% [63 of 263]; P<.001).

Conclusion

Lowering the blood pressure threshold increased the incidence of HDP but did not impact the association of HDP and future CVD.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Mayo Clinic proceedings 医学-医学：内科

CiteScore

16.80

自引率

1.10%

发文量

383

审稿时长

37 days

期刊介绍： Mayo Clinic Proceedings is a premier peer-reviewed clinical journal in general medicine. Sponsored by Mayo Clinic, it is one of the most widely read and highly cited scientific publications for physicians. Since 1926, Mayo Clinic Proceedings has continuously published articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal welcomes submissions from authors worldwide and includes Nobel-prize-winning research in its content. With an Impact Factor of 8.9, Mayo Clinic Proceedings is ranked #20 out of 167 journals in the Medicine, General and Internal category, placing it in the top 12% of these journals. It invites manuscripts on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics.