妊娠高血压综合征的治疗及用药安全性的研究进展

Research progress on the treatment and medication safety of hypertensive disorders during pregnancy

妊娠高血压综合征(HDP)是产妇和围生儿死亡的主要原因之一,同时产妇在之后的生活中有患心血管疾病和其他慢性疾病的风险。HDP的治疗取决于血压(BP)的水平、胎龄,以及相关孕母和胎儿危险因素的存在,同时需要考虑到对孕母和胎儿的影响。本文对常用抗高血压药物以及药物对母亲、胎儿和哺乳期的影响进行阐述。妊娠期轻中度高血压以及无终末器官损害高血压的治疗仍存在争议,对何时开始降压治疗、最佳降压靶点以及推荐的治疗药物尚未达成一致。妊娠期重度高血压的降压目标是在几分钟到几小时内将BP降低至160/105 mmHg,随后将BP稳步降至并维持在140~150/90~100 mmHg,大多数指南建议使用拉贝洛尔、甲基多巴或硝苯地平进行降压治疗。而硝苯地平、拉贝洛尔以及某些血管紧张素转换酶抑制剂类药物如卡托普利、依那普利可以在母乳喂养期间安全使用。本文通过对HDP治疗药物的详细梳理,为HDP患者进行安全的、有效的降压治疗提供临床参考。

Hypertensive disorders during pregnancy(HDP)represent a major cause of maternal,fetal and neonatal mortality and identifies women at risk for cardiovascular and other chronic diseases later in life.Treatment of HDP concerns both the mother and the fetus and depends on blood pressure(BP)level,gestational age,and presence of associated maternal and fetal risk factors.This article reviews the effect of antihypertensive drugs on mother and fetus when administered during pregnancy and/or post-partum.Treatment of mild hypertension and no end-organ damage during pregnancy remains controversial and there is no agreement about when to initiate antihypertensive therapy,optimal BP targets or recommended drugs.In severe hypertension the goal is to reduce BP to<160/105 mmHg over minutes to hours and then to achieve a sustained BP of 140-150/90-100 mmHg,and most guidelines recommend antihypertensive therapy with labetalol,methyldopa,or nifedipine.Nifedipine,labetalol and some angiotensin-converting enzyme inhibitors(captopril and enalapril)can be used safely during breastfeeding.This review could provide clinical references for treating HDP patients safety and effectively by describing antihypertensive drugs in details.