モリモト　サトシ   Morimoto Satoshi   森本　聡    所属   医学部 医学科（東京女子医科大学病院）    職種   准教授
論文種別	総説
言語種別	英語
査読の有無	査読あり
表題	Optimal blood pressure target to prevent severe hypertension in pregnancy: A systematic review and meta-analysis.
掲載誌名	正式名：Hypertension research : official journal of the Japanese Society of Hypertension 略　 称：Hypertens Res ISSNコード：13484214/09169636
掲載区分	国外
巻・号・頁	45(5),pp.887-899
著者・共著者	Abe Makiko, Arima Hisatomi, Yoshida Yuichi, Fukami Ako, Sakima Atsushi, Metoki Hirohito, Tada Kazuhiro, Mito Asako, Morimoto Satoshi, Shibata Hirotaka, Mukoyama Masashi
発行年月	2022/05
概要	Severe hypertension in pregnancy is a hypertensive crisis that requires urgent and intensive care due to its high maternal and fetal mortality. However, there is still a conflict of opinion on the recommendations of antihypertensive therapy. This study aimed to identify the optimal blood pressure (BP) levels to prevent severe hypertension in pregnant women with nonsevere hypertension. Ovid MEDLINE and the Cochrane Library were searched, and only randomized controlled trials (RCTs) were included if they compared the effects of antihypertensive drugs and placebo/no treatment or more intensive and less intensive BP-lowering treatments in nonsevere hypertensive pregnant patients. A random effects model meta-analysis was performed to estimate the pooled risk ratio (RR) for the outcomes. Forty RCTs with 6355 patients were included in the study. BP-lowering treatment significantly prevented severe hypertension (RR, 0.46; 95% CI, 0.37-0.56), preeclampsia (RR, 0.82; 95% CI, 0.69-0.98), severe preeclampsia (RR, 0.38; 95% CI, 0.17-0.84), placental abruption (RR, 0.52; 95% CI, 0.32-0.86), and preterm birth (< 37 weeks; RR, 0.81; 95% CI, 0.71-0.93), while the risk of small for gestational age infants was increased (RR, 1.25; 95% CI, 1.02-1.54). An achieved systolic blood pressure (SBP) of < 130 mmHg reduced the risk of severe hypertension to nearly one-third compared with an SBP of ≥ 140 mmHg, with a significant interaction of the BP levels achieved with BP-lowering therapy. There was no significant interaction between the subtypes of hypertensive disorders of pregnancy and BP-lowering treatment, except for placental abruption. BP-lowering treatment aimed at an SBP < 130 mmHg and accompanied by the careful monitoring of fetal growth might be recommended to prevent severe hypertension.
DOI	10.1038/s41440-022-00853-z
PMID	35136186