严格控制血压对轻中度妊娠期高血压女性妊娠结局影响的荟萃分析

A meta-analysis of the effect of tight blood pressure control on perinatal outcomes in women with mild-moderate gestational hypertension

目的采用荟萃分析方法,评估严格的血压控制对轻中度妊娠期高血压女性妊娠结局的影响。方法从PubMed、EMBASE、Cochrane library、中国知网(CNKI)、万方、维普以及中国生物医学文献数据库(CBM)中,检索关于轻中度妊娠期高血压控制的随机对照试验及队列研究。要求研究对血压控制水平进行分组,严格血压控制组血压控制在<130/80 mm Hg,非严格控制组的降压目标为血压<140/90 mm Hg,或者按照原文献分组定义。完成检索后由两名研究人员根据纳入和排除标准独立筛选文献、提取资料和评价文献质量,纳入合适文献资料后应用RevMan 5.3和Stata 15软件进行荟萃分析。结果最终纳入4项研究,共计1576例患者,其中3项为随机对照试验,1项为回顾性队列研究。分析结果显示,在主要结局方面,严格控制血压可以降低严重高血压(RR=0.55,95%CI 0.37~0.84,P=0.005)和子痫前期(RR=0.88,95%CI 0.79~0.98,P=0.017)的发病风险,而对于新生儿的死亡风险,严格的血压控制并不能带来收益(RR=0.77,95%CI 0.38~1.58,P=0.483)。对于胎儿生长方面的分析显示,在小于胎龄儿、出生体质量、分娩孕周数等指标上,严格和非严格的血压控制组间差异无统计学意义(均P>0.05)。结论对轻中度妊娠期高血压女性采取严格的血压控制策略,可以降低严重高血压的发生,但对其他妊娠结局无影响,在合理范围内适当采取严格的血压控制可能给孕期女性带来获益。

Objective A meta-analysis was performed to investigate the effect of tight blood pressure control on perinatal outcomes in women with mild-moderate gestational hypertension.Methods Randomized controlled trials and cohort studies on the blood pressure control for mild-moderate gestational hypertension were selected via retrieving the PubMed,EMBASE,Cochrane library,China National Knowledge Infrastructure(CNKI),WanFang database,VIP database and China Biology Medicine(CBM)database.Systolic/diastolic blood pressure in the tight control group was controlled below 130/80 mm Hg(or as defined by study author).The target for the less-tight control group was 140/90 mm Hg(or as defined by study author).Two researchers independently selected the studies according to predefined eligibility criteria,extracted data and evaluated study quality.Data were analyzed by using RevMan version 5.3 and STATA version 15.Results The results of 4 studies(3 randomized controlled trials and 1 retrospective cohort study)involving 1576 patients were synthesized.In terms of major outcomes,tight blood pressure control significantly reduced the risk of severe hypertension[relative risk(RR)=0.55,95%confidence interval(CI):0.37-0.84,P=0.005]and preeclampsia(RR=0.88,95%CI:0.79-0.98,P=0.017).For neonatal mortality risk,tight blood pressure control presented no beneficial effect(RR=0.77,95%CI:0.38-1.58,P=0.483).Assessment of fetal growth showed no statistical difference between tight and less-tight blood pressure control groups in terms of small for gestational age infant,birth weight,and gestational age in delivery.Conclusions Implementation of tight blood pressure control strategy for women with mild-moderate gestational hypertension can reduce the risk of severe hypertension,yet its effect on other pregnancy outcomes was not obvious.Appropriate tight blood pressure control may bring benefits to pregnant women.