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Intervention Review

Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

  1. Edgardo Abalos1,*,
  2. Lelia Duley2,
  3. D Wilhelm Steyn3,
  4. David J Henderson-Smart4

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 24 JAN 2007

Assessed as up-to-date: 14 NOV 2006

DOI: 10.1002/14651858.CD002252.pub2


How to Cite

Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD002252. DOI: 10.1002/14651858.CD002252.pub2.

Author Information

  1. 1

    Centro Rosarino de Estudios Perinatales (CREP), Rosario, Santa Fe, Argentina

  2. 2

    University of Nottingham, Nottingham Clinical Trials Unit, Nottingham, UK

  3. 3

    University of Stellenbosch, Obstetrics & Gynaecology, Tygerberg, Stellenbosch, South Africa

  4. 4

    Faculty of Medicine, University of Sydney, c/o Central Clinical School, Sydney, NSW, Australia

*Edgardo Abalos, Centro Rosarino de Estudios Perinatales (CREP), Moreno 878, 6th floor, Rosario, Santa Fe, S2000DKR, Argentina. edgardoabalos@crep.org.ar. crep@crep.org.ar.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JAN 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

Background

Mild to moderate hypertension during pregnancy is common. Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease, and thereby improve outcome.

Objectives

To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 3), MEDLINE (1966 to November 2005), LILACS (1984 to November 2005) and EMBASE (1974 to November 2005).

We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 6 August 2012 and added the results to the awaiting classification section of the review.

Selection criteria

All randomised trials evaluating any antihypertensive drug treatment for mild to moderate hypertension during pregnancy defined, whenever possible, as systolic blood pressure 140 to 169 mmHg and diastolic blood pressure 90 to 109 mmHg. Comparisons were of one or more antihypertensive drug(s) with placebo, with no antihypertensive drug, or with another antihypertensive drug, and where treatment was planned to continue for at least seven days.

Data collection and analysis

Two review authors independently extracted data.

Main results

Forty-six trials (4282 women) were included. Twenty-eight trials compared an antihypertensive drug with placebo/no antihypertensive drug (3200 women). There is a halving in the risk of developing severe hypertension associated with the use of antihypertensive drug(s) (19 trials, 2409 women; relative risk (RR) 0.50; 95% confidence interval (CI) 0.41 to 0.61; risk difference (RD) -0.10 (-0.12 to -0.07); number needed to treat (NNT) 10 (8 to 13)) but little evidence of a difference in the risk of pre-eclampsia (22 trials, 2702 women; RR 0.97; 95% CI 0.83 to 1.13). Similarly, there is no clear effect on the risk of the baby dying (26 trials, 3081 women; RR 0.73; 95% CI 0.50 to 1.08), preterm birth (14 trials, 1992 women; RR 1.02; 95 % CI 0.89 to 1.16), or small-for-gestational-age babies (19 trials, 2437 women; RR 1.04; 95 % CI 0.84 to 1.27). There were no clear differences in any other outcomes.

Nineteen trials (1282 women) compared one antihypertensive drug with another. Beta blockers seem better than methyldopa for reducing the risk of severe hypertension (10 trials, 539 women, RR 0.75 (95 % CI 0.59 to 0.94); RD -0.08 (-0.14 to 0.02); NNT 12 (6 to 275)). There is no clear difference between any of the alternative drugs in the risk of developing proteinuria/pre-eclampsia. Other outcomes were only reported by a small proportion of studies, and there were no clear differences.

Authors' conclusions

It remains unclear whether antihypertensive drug therapy for mild to moderate hypertension during pregnancy is worthwhile.

[Note: The 23 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

Not enough evidence to show whether antihypertensive drug treatment for mild to moderate hypertension during pregnancy is worthwhile.

During the early weeks of normal pregnancy, blood pressure falls and climbs slowly in later pregnancy to reach pre-pregnancy levels at term. Mild to moderate hypertension (high blood pressure) is common during pregnancy. In some women, it can become more serious, resulting in hospital admission, pre-eclampsia (a complication of pregnancy that includes high blood pressure) and possible premature delivery. Antihypertensive drugs are often used to lower blood pressure in the belief that they will prevent this progression. The review of 46 trials, involving 4282 women, found there was not enough evidence to show the benefit of antihypertensive drugs for mild to moderate hypertension during pregnancy. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

孕期輕到中度高血壓的抗高血壓藥物療法

背景

孕期中常見輕微到中度高血壓。通常使用抗高血壓藥物,相信降低血壓將可避免進展成為更嚴重的疾病,並因此改善成果。

目標

想要評估抗高血壓藥物治療在孕期出現輕微到中度高血壓婦女上的治療效果。

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Group's Trials Register(2006年3月)、the Cochrane Central Register of Controlled Trials(The Cochrane Library 2005, Issue 3)、MEDLINE (1966年到2005年11月)、LILACS (1984年到2005年11月)與EMBASE (1974年到2005年11月).

我們於2012年8月6日更新the Cochrane Pregnancy and Childbirth Group's Trials Register的搜尋並增加結果到審閱的等候分級小節。

選擇標準

限定所有評估任何抗高血壓藥物治療孕期輕微到中度高血壓的隨機試驗,於可能之時,當收縮壓為140 to 169 mmHg 且舒張壓為90到109 mmHg時。比較為一或多種抗高血壓藥物與安慰劑、無抗高血壓藥物或是與另一種抗高血壓藥物比較,且治療需計畫持續至少7天。

資料收集與分析

兩位審閱作者獨立的摘錄數據。

主要結論

包含有46個試驗(4282名婦女)。28個試驗比較一種抗高血壓藥物與安慰劑/無抗高血壓藥物(3200名婦女)。發展出嚴重高血壓的風險減半與抗高血壓藥物使用有關 (19個試驗,2409名婦女; RR 0.50; 95%CI 0.41 to 0.61; 風險差(RD) -0.10 (-0.12 to -0.07); 益一需治數(Number Needed to Treat; NNT) 10 (8 to 13)),但妊娠毒血風險差異具有少量證據 (22個試驗,2702名婦女; RR 0.97; 95% CI 0.83 to 1.13)。類似的,在嬰兒死亡 (26個試驗3081名婦女; RR 0.73; 95% CI 0.50 to 1.08)、早產(14個試驗, 1992名婦女; RR 1.02; 95 % CI 0.89 to 1.16)、或小於妊娠年齡嬰兒 (19個試驗, 2437名婦女; RR 1.04; 95 % CI 0.84 to 1.27) 風險上無明確影響。任何其他成果中沒有明確差異。

19個試驗(1282名婦女)比較一種抗高血壓藥物與另一個。Beta 阻斷劑似乎較methyldopa 在降低嚴重高血壓風險上的效果好 (10個試驗,539名婦女,RR 0.75 (95 % CI 0.59 to 0.94); RD -0.08 (-0.14 to 0.02); 益一需治數 12 (6 to 275))。任何替代藥物間在發展出蛋白尿/妊娠毒血的風險上沒有明確差異。其他成果僅有小比例的研究報告,且沒有明確的差異。

作者結論

仍舊不確定抗高血壓藥物治療對孕期中的輕到中度高血壓是否有意義。

[注意事項:審閱等候分級小節中的23個引用一但經過評估,或可改變審閱結論。]

 

一般語言總結

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

孕期輕到中度高血壓的抗高血壓藥物療法

抗高血壓藥物治療孕期中輕微到中度的高血壓

沒有足夠的證據顯示抗高血壓藥物治療對孕期中的輕到中度高血壓是否有意義。

在正常懷孕的前幾周,血壓下降,並於之後的孕期中緩慢上升以於足月時達到懷孕前水準。輕到中度高血壓(高血壓) 是孕期常見問題。在某些婦女身上,情形會變的嚴重,導致住院治療、妊娠毒血 (一種懷孕的併發症,其中包含高血壓)與可能的早產。通常使用抗高血壓藥物下降血壓,相信此法可避免這樣的進展。46個試驗的審閱包含4282名婦女,發現沒有充足的證據顯示抗高血壓藥物治療孕期中輕到中度高血壓的益處。需要更多研究。

譯註

East Asian Cochrane Alliance 翻譯
翻譯由 台灣衛生福利部/台北醫學大學實證醫學研究中心 資助