英国牛津大学Paul Leeson团队研究了高血压妊娠者接受医生优化自我管理后对长期血压控制的影响。该研究于2023年11月11日发表在《美国医学会杂志》上。

妊娠高血压会导致不良的心脏重构，并在以后的生活中增加高血压和心血管疾病的发病率。

该研究旨在评估产后更好地控制血压的干预措施是否与产后前9个月低于常规门诊护理的血压有关，研究组在英国一家医院进行了一项随机、开放标签、盲法、终点试验。符合条件的参与者年龄在18岁及以上，妊娠后并发先兆子痫或妊娠期高血压，出院后需要服用抗高血压药物。

第一次登记发生在2020年2月21日，最后一次随访发生在2021年11月2日。随访时间约为9个月。参与者被1:1随机分配到自我监测以及医生优化的降压滴定或常规产后护理。主要结局是产后9个月的24小时平均舒张压，并根据产后基线血压进行校正。

220名参与者被随机分配到干预组（n = 112）或对照组（n = 108）。参与者的平均（SD）年龄为32.6（5.0）岁，40%患有妊娠期高血压，60%患有先兆子痫。200名参与者（91%）被纳入初步分析。

干预组在产后249（16）天测得的24小时平均舒张压（SD）（71.2[5.6]毫米汞柱）比对照组（76.6[5.7]mm汞柱）低5.8毫米汞柱。组间差异为−5.80 mm Hg（P < .001）。同样，干预组的24小时平均收缩压（SD）（114.0[7.7]mm Hg）比对照组的（120.3[9.1]mm汞柱）低6.5 mm Hg。组间差异为−6.51 mm Hg（P < .001）。

研究结果表明，在这项单中心试验中，自我监测和医生指导的降压药物滴定与产后前9个月的血压低于英国常规产后门诊护理的血压相关。

附：英文原文

Title: Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management: The POP-HT Randomized Clinical Trial

Author: Jamie Kitt, Rachael Fox, Annabelle Frost, Milensu Shanyinde, Katherine Tucker, Paul A. Bateman, Katie Suriano, Yvonne Kenworthy, Annabelle McCourt, William Woodward, Winok Lapidaire, Miriam Lacharie, Mauro Santos, Cristian Roman, Lucy Mackillop, Christian Delles, Basky Thilaganathan, Lucy C. Chappell, Adam J. Lewandowski, Richard J. McManus, Paul Leeson

Issue&Volume: 2023-11-11

Abstract:

Importance  Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life.

Objective  To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum.

Design, Setting, and Participants  Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months.

Interventions  Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care.

Main Outcomes and Measures  The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure.

Results  Two hundred twenty participants were randomly assigned to either the intervention group (n=112) or the control group (n=108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was 5.80 mm Hg (95% CI, 7.40 to 4.20; P<.001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was 6.51 mm Hg (95% CI, 8.80 to 4.22; P<.001).

Conclusions and Relevance  In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK.

DOI: 10.1001/jama.2023.21523

Source: https://jamanetwork.com/journals/jama/fullarticle/2811976