妊娠高血压疾病患者血压管理策略的研究进展

Progress in blood pressure management strategies for patients with pregnancy-induced hypertension syndrome

妊娠高血压综合征(pregnancy-induced hypertension syndrome,PIH)是妊娠与高血压(hypertension)并存的一组疾病,亦是孕产妇、胎儿及新生儿死亡的主要原因之一。当前多数指南依据血压水平将其划分为轻度及重度高血压。对于重度高血压(妊娠期间血压≥160/110 mmHg)孕妇的治疗已达成共识,但对于轻度高血压孕妇的治疗仍存争议。先前认为,治疗轻度高血压可降低重度高血压的发生风险,但无法减少先兆子痫(preeclampsia)、早产及生长受限等不良结局的发生。然而,近期有研究表明降低妊娠期目标血压不仅安全,且可使患者获益;指南亦就PIH启动降压治疗时机、降压目标以及降压治疗的安全下限作出推荐。该文简要概述PIH对母亲及子代的影响,就PIH患者血压管理研究进展作一综述,着重强调轻度高血压孕妇的管理策略,为PIH的管理提供依据。

Pregnancy-induced hypertension syndrome(PIH)is a group of diseases that coexist with pregnancy and hypertension,which is one of the main causes of mortality in pregnant women,fetuses,and newborns.According to most current guidelines,PIH is classified as mild and severe hypertension based on blood pressure levels.Consensus has been reached on the treatment of pregnant women with severe hypertension(blood pressure during pregnancy≥160/110 mmHg).However,the treatment of pregnant women with mild hypertension remains controversial.Previous views had suggested that treatment of mild hypertension reduced the risk of severe hypertension,but not the incidence of adverse outcomes such as preeclampsia,premature delivery and growth restriction.However,recent studies have shown that reducing the target blood pressure during pregnancy is not only safe,but also beneficial for patients.The guidelines also recommend the timing,goals,and lower safety limits for initiating antihypertensive therapy for PIH.This article overviewed the effects of PIH on mothers and offspring,reviewed the progress of blood pressure management in patients with PIH,emphasized the management strategies of pregnant women with mild hypertension,so as to provide a basis for the management of PIH.