Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

Abstract

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. To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during pregnancy. 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. 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. Two review authors independently extracted data. 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. 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.] 孕期輕到中度高血壓的抗高血壓藥物療法 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。 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。 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。 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。 兩位審閱作者獨立的摘錄數據。 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。 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。]