妊娠期高血压对分娩后妇女远期血压水平的影响
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摘要
目的探讨妊娠期高血压(HIP)对分娩后妇女远期血压水平的影响。方法采用回顾性队列研究,选择1976年10月至2014年12月在开滦医疗集团住院分娩并且参加了2006-2014年健康体检年龄30～60岁女职工4331人为观察队列,排除妊娠前有高血压病史者、健康体检之后分娩者以及健康体检时收缩压或舒张压缺失者,最终纳入统计分析者4072例。根据是否有HIP史将观察对象分为HIP组(n=602)与非妊娠期高血压(NHIP)组(n=3470),观察比较两组人群在2006-2014年健康体检时高血压的发生情况,并采用线性回归和多因素Logistic回归方法分析HIP对整体及不同年龄段观察对象分娩后血压水平的影响。结果经过平均17.17年的随访,发现在4072例观察对象中共检出高血压患者789例(发病密度1.13/100人年),其中NHIP组589例(1.02/100人年),HIP组200例(1.64/100人年)。在整体观察对象中,校正其他混杂因素后,线性回归分析发现HIP对体检妇女收缩压、舒张压的影响分别为+4.37、+2.63 mm Hg;多因素Logistic回归分析发现与NHIP组比较,HIP组高血压的患病风险增加34%。对年龄进行分层分析结果显示,HIP对年龄30～<40岁、40～<50岁体检妇女收缩压的影响分别为+4.17、+3.81 mm Hg,舒张压分别为+3.08、+2.49 mm Hg;多因素Logistic回归分析发现与NHIP组比较,30～<40岁、40～<50岁、50～60岁体检妇女HIP组高血压的患病风险均增加,其RR值(95%CI)分别为2.06(1.35～3.16)、1.45(1.16～1.81)和1.23(1.01～1.50)。结论与NHIP妇女相比,HIP妇女分娩后高血压发病率增加。HIP是妇女分娩后发生高血压的危险因素。在30～60岁的观察对象中,HIP妇女高血压的患病风险随着年龄的增加逐渐降低,而在年龄30～<50岁的观察对象中HIP妇女收缩压、舒张压升高幅度随着年龄的增加逐渐降低。
Objective To investigate the effect of hypertension in pregnancy(HIP) on long-term blood pressure of postpartum women. Methods A total of 4331 females aged 30 to 60 years who gave birth in Kailuan Group Hospital during the period between October 1976 to December 2014 and participated in physical examination from 2006 to 2014 served as study cohorts, excluded of pre-pregnancy history of hypertension, delivery after physical examination and absence of systolic blood pressure or diastolic blood pressure at physical examination, eventually 4072 cases were included in the retrospective cohort study. Participants were divided into HIP(n=602) and NHIP(n=3470) group by the history of HIP, comparing the incidence of hypertension during the physical examination from 2006 to 2014. Linear regression and multivariate Logistic regression were used to analyze the effect of HIP on blood pressure in postpartum women. Results After an average follow-up of 17.17 years, a total of 789 cases(1.13/100 person-years) of hypertension were detected in 4072 subjects, including 589 cases(1.02/100 person-years) in NHIP group and 200 cases(1.64/100 person-years) in HIP group. In the overall subjects of observation, linear regression analysis showed that HIP was associated with an estimated increase in systolic blood pressure of 4.37 mm Hg and diastolic blood pressure of 2.63 mm Hg. And multivariate Logistic regression analysis showed that the risk of hypertension in HIP group was 34% higher than that in NHIP group after adjusting for other risk factors. However, the analysis of different age groups found that HIP was associated with an estimated increase in systolic blood pressure of 4.17, 3.81 mm Hg and diastolic blood pressure of 3.08, 2.49 mm Hg in 30-<40 and 40-<50 years old women, respectively. Multivariate Logistic regression analysis showed that the risk of hypertension in HIP group was higher than that in NHIP group, and RR(95% CI) were 2.06(1.35-3.16), 1.45(1.16-1.81), 1.23(1.01-1.50) in 30-<40, 40-<50, and 50-60 years old women, respectively. Conclusion Compared with NHIP women, the incidence of hypertension increases in women with HIP after delivery. HIP is a risk factor for hypertension in women after delivery. For the women aged 30-60, the risk of hypertension gradually decreased with the increase of age in HIP women. However, it is only statistically significant when the subjects aged from 30-<50 years old that systolic blood pressure and diastolic blood pressure gradually decreased with the increase of age in HIP women.
Objective To investigate the effect of hypertension in pregnancy(HIP) on long-term blood pressure of postpartum women. Methods A total of 4331 females aged 30 to 60 years who gave birth in Kailuan Group Hospital during the period between October 1976 to December 2014 and participated in physical examination from 2006 to 2014 served as study cohorts, excluded of pre-pregnancy history of hypertension, delivery after physical examination and absence of systolic blood pressure or diastolic blood pressure at physical examination, eventually 4072 cases were included in the retrospective cohort study. Participants were divided into HIP(n=602) and NHIP(n=3470) group by the history of HIP, comparing the incidence of hypertension during the physical examination from 2006 to 2014. Linear regression and multivariate Logistic regression were used to analyze the effect of HIP on blood pressure in postpartum women. Results After an average follow-up of 17.17 years, a total of 789 cases(1.13/100 person-years) of hypertension were detected in 4072 subjects, including 589 cases(1.02/100 person-years) in NHIP group and 200 cases(1.64/100 person-years) in HIP group. In the overall subjects of observation, linear regression analysis showed that HIP was associated with an estimated increase in systolic blood pressure of 4.37 mm Hg and diastolic blood pressure of 2.63 mm Hg. And multivariate Logistic regression analysis showed that the risk of hypertension in HIP group was 34% higher than that in NHIP group after adjusting for other risk factors. However, the analysis of different age groups found that HIP was associated with an estimated increase in systolic blood pressure of 4.17, 3.81 mm Hg and diastolic blood pressure of 3.08, 2.49 mm Hg in 30-<40 and 40-<50 years old women, respectively. Multivariate Logistic regression analysis showed that the risk of hypertension in HIP group was higher than that in NHIP group, and RR(95% CI) were 2.06(1.35-3.16), 1.45(1.16-1.81), 1.23(1.01-1.50) in 30-<40, 40-<50, and 50-60 years old women, respectively. Conclusion Compared with NHIP women, the incidence of hypertension increases in women with HIP after delivery. HIP is a risk factor for hypertension in women after delivery. For the women aged 30-60, the risk of hypertension gradually decreased with the increase of age in HIP women. However, it is only statistically significant when the subjects aged from 30-<50 years old that systolic blood pressure and diastolic blood pressure gradually decreased with the increase of age in HIP women.
引文
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[17] Parikh NI, Norberg M, Ingelsson E, et al. Association of pregnancy complications and characteristics with future risk of elevated blood pressure: the V?sterbotten intervention program[J].Hypertension,2017,39(1):e1-10.
[18] 王艳秀,吴寿岭,朱婕,等. 高敏C反应蛋白对新发缺血性脑卒中风险的预测价值[J].中华高血压杂志,2010,18(3):244-248.
[19] 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南2015[J].中华产科急救电子杂志,2015,4(4):206-213.
[20] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[21] American Diabetes Association. Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2010,33(Suppl):S62-69.
[22] Reference values for arterial stiffness collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors:establishing normal and reference values[J].Eur Heart J,2010,31(19):2338-2350.
[23] 黄宇玲,王志军,刘雪梅,等.静息心率与中老年人群颈动脉斑块检出率的关系[J].中华高血压杂志,2014,22(9):841-846.
[24] Tobin MD, Sheehan NA, Scurrah KJ, et al. Adjusting for treatment effects in studies of quantitative traits:antihypertensive therapy and systolic blood pressure[J].Stat Med,2005,24(19):2911-2935.
[25] Fox ER, Musani SK, Singh P, et al. Association of plasma B-type natriuretic peptide concentrations with longitudinal blood pressure tracking in African Americans:findings from the Jackson heart study[J].Hypertension,2013,61(1):48-54.
[26] Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women:2011 update:a guideline from American Heart Association[J].Circulation,2011,123(11):1243-1262.
[27] 中国女性心血管疾病预防专家共识组.中国女性心血管疾病预防专家共识[J].中国心血管病研究,2012,10(5):321-328.
[28] Narkiewicz K, Kjeldsen SE, Hedner T. Hypertension and cardiovascular disease in women: progress towards better understanding of gender-specific differences?[J].Blood Press,2006,15(2):68-70.
[29] Duygu H, Turkoglu C, Kirilmaz B, et al. Effect of mean platelet volume on postintervention coronary blood flow in patients with chronic stable anginapectoris[J].J Invasive Cardiol,2008,20(3):120-124.
[30] Chung I, Choudhury A, Patel J, et al. Soluble CD40L, platelet surface CD40L and total platelet CD40L in congestive heart failure: relationship to platelet volume, mass and granularity[J].J Intern Med,2008,263(3):313-321.
[2] 陈妍华,马淑平,郑玉巧,等.围产期干预对妊高征血压转归远期随访观察[J].高血压杂志,2002,10(3):216-218.
[3] Mounier-Vehier C, Amar J, Boivin JM, et al. Hypertension and pregnancy. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology[J].Presse Med,2016,45(7/8):682-699.
[4] Ahmad AS, Samuelsen SO. Hypertensive disorders in pregnancy and fetal death at different gestational lengths:a population study of 2121371 pregnancies[J].BJOG,2012,119(12):1521-1528.
[5] Craici I, Wagner S, Garovic VD. Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test[J].Ther Adv Cardiovasc Dis,2008,2(4):249-259.
[6] Sun SY, Goldstein DP, Bernstein MR, et al. Maternal near miss according to World Health Organization classification among women with a hydatidiform mole:experience at the New England Trophoblastic Disease Center,1994-2013[J].J Reprod Med,2016,61(5/6):210-214.
[7] Ray JG, Vermeulen MJ, Schul MJ, et al. Cardiovascular health after maternal placental syndromes(CHAMPS): population-based retrospective cohort study[J].Lancet,2005,366(9499):1797-1803.
[8] Newstead J, vonDadelszen P, Magee LA.Preeclampsia and future cardiovascular risk[J].Expert Rev Cardiovasc Ther,2007,5(2):283-294.
[9] Wang IK, Chang SN, Liao CC, et al. Hypertensive disorders in pregnancy and preterm delivery and subsequent stroke in Asian women: a retrospective cohort study[J].Stroke,2011,42(3):716-721.
[10] Lykke JA, Langhoff-Roos J, Sibai BM, et al. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother[J].Hypertension,2009,53(6):944-951.
[11] Bellamy L, Casas JP, Hingorani AD, et al. Pre-eclampsia and risk of cardiovascular disease and cancer in later life:systematic review and meta-analysis[J].BMJ,2007,335(7627):974.
[12] Sabour S, Franx A, Rutten A, et al. High blood pressure in pregnancy and coronary calcification[J].Hypertension,2007,49(4):813-817.
[13] 谢志红,苏海,张倩,等.妊娠高血压综合征患者远期高血压患病率的调查[J].中华高血压杂志,2008,16(3):261-263.
[14] Callaway LK, David McIntyre H, Williams GM, et al. Diagnosis and treatment of hypertension 21 years after a hypertensive disorder of pregnancy[J].Aust NZJ Obstet Gynaecol,2011,51(5):437-440.
[15] Wilson BJ, Watson MS, Prescott GJ, et al. Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life:results from cohort study[J].BMJ,2003,326(7394):845.
[16] Nisell H, Lintu H, Lunell NO, et al. Blood pressure and renal function seven years after pregnancy complicated by hypertension[J].Br J Obstet Gynaecol,1995,102(11):876.
[17] Parikh NI, Norberg M, Ingelsson E, et al. Association of pregnancy complications and characteristics with future risk of elevated blood pressure: the V?sterbotten intervention program[J].Hypertension,2017,39(1):e1-10.
[18] 王艳秀,吴寿岭,朱婕,等. 高敏C反应蛋白对新发缺血性脑卒中风险的预测价值[J].中华高血压杂志,2010,18(3):244-248.
[19] 中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南2015[J].中华产科急救电子杂志,2015,4(4):206-213.
[20] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[21] American Diabetes Association. Diagnosis and classification of diabetes mellitus[J].Diabetes Care,2010,33(Suppl):S62-69.
[22] Reference values for arterial stiffness collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors:establishing normal and reference values[J].Eur Heart J,2010,31(19):2338-2350.
[23] 黄宇玲,王志军,刘雪梅,等.静息心率与中老年人群颈动脉斑块检出率的关系[J].中华高血压杂志,2014,22(9):841-846.
[24] Tobin MD, Sheehan NA, Scurrah KJ, et al. Adjusting for treatment effects in studies of quantitative traits:antihypertensive therapy and systolic blood pressure[J].Stat Med,2005,24(19):2911-2935.
[25] Fox ER, Musani SK, Singh P, et al. Association of plasma B-type natriuretic peptide concentrations with longitudinal blood pressure tracking in African Americans:findings from the Jackson heart study[J].Hypertension,2013,61(1):48-54.
[26] Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women:2011 update:a guideline from American Heart Association[J].Circulation,2011,123(11):1243-1262.
[27] 中国女性心血管疾病预防专家共识组.中国女性心血管疾病预防专家共识[J].中国心血管病研究,2012,10(5):321-328.
[28] Narkiewicz K, Kjeldsen SE, Hedner T. Hypertension and cardiovascular disease in women: progress towards better understanding of gender-specific differences?[J].Blood Press,2006,15(2):68-70.
[29] Duygu H, Turkoglu C, Kirilmaz B, et al. Effect of mean platelet volume on postintervention coronary blood flow in patients with chronic stable anginapectoris[J].J Invasive Cardiol,2008,20(3):120-124.
[30] Chung I, Choudhury A, Patel J, et al. Soluble CD40L, platelet surface CD40L and total platelet CD40L in congestive heart failure: relationship to platelet volume, mass and granularity[J].J Intern Med,2008,263(3):313-321.
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