Data from: Postpartum management of hypertensive disorders of pregnancy: a systematic review

Objectives
Hypertensive disorders of pregnancy (HDP) affect one in ten pregnancies and often persist postpartum when complications can occur. We aimed to determine the effectiveness and safety of pharmacologic interventions, other interventions, and different care models for postpartum hypertension management.
Design
A systematic review was undertaken. Nine electronic databases, including Medline, were searched from inception to 16/03/2017. After duplicate removal, 4,561 records were screened. Two authors independently selected studies, extracted study characteristics and data, and assessed methodological quality.
Setting
Randomised controlled trials, case-control studies, and cohort studies from any country and healthcare setting.
Participants
Postnatal women with HDP.
Interventions
Therapeutic intervention for management of hypertension, compared with another intervention, placebo, or no intervention.
Primary and secondary outcome measures
Outcome data were collected for maternal mortality and severe morbidity; systolic, diastolic and mean arterial blood pressure (BP) control; and safety data. Secondary outcome data collected included the length of postnatal hospital stay and laboratory values.
Results
39 studies were included (n=2,901). Results were heterogeneous in terms of intervention, comparison and outcome requiring a narrative approach. There were insufficient data to recommend any single pharmacologic intervention. 18 studies reported calcium-channel blockers, vasodilators and beta-blockers lowered BP postpartum. 12 of these reported safety data. Limited data existed regarding management in the weeks following hospital discharge. Neither loop diuretics (three studies) nor corticosteroids (one study) produced clinical benefit. Uterine curettage significantly reduced BP over the first 48 hours postpartum (range 6-13mmHg) compared to standard care (eight studies), with safety data only reported by 4/8 studies.
Conclusion
There was insufficient evidence to recommend a particular BP threshold, agent, or model of care but three classes of antihypertensive appeared variably effective. Further comparative research, including robust safety data, is required. Curettage reduced BP, but without adequate reporting of harms, so cannot currently be recommended.

【研究目标】 妊娠高血压疾病（Hypertensive disorders of pregnancy, HDP）约占所有妊娠的十分之一，且常于产后持续存在，此时可发生各类并发症。本研究旨在评估药物干预、其他干预手段及不同照护模式在产后高血压管理中的有效性与安全性。
【研究设计】 本研究为系统综述。检索了包括Medline在内的9个电子数据库，检索时限为建库至2017年3月16日。去除重复文献后，共筛选出4561条记录。由2名研究者独立完成文献筛选、研究特征与数据提取，以及方法学质量评价。
【研究纳入范围】 纳入来自任何国家、任何医疗场景的随机对照试验（randomised controlled trial）、病例对照研究（case-control study）及队列研究（cohort study）。
【研究对象】 确诊妊娠高血压疾病的产后女性。
【干预措施】 用于高血压管理的治疗性干预手段，与其他干预手段、安慰剂或无干预措施进行对照。
【主要与次要结局指标】 收集的结局数据包括孕产妇死亡率、严重不良事件发生率、收缩压、舒张压及平均动脉压（blood pressure, BP）控制情况，以及安全性数据。次要结局指标涵盖产后住院时长与实验室检测指标。
【研究结果】 最终纳入39项研究，共计2901名受试者。由于干预措施、对照方式及结局指标存在异质性，故采用叙述性综述方法进行分析。现有数据不足以支持推荐任何单一药物干预手段。18项研究结果显示，钙通道阻滞剂（calcium-channel blockers）、血管扩张剂（vasodilators）及β受体阻滞剂（beta-blockers）可有效降低产后血压，其中12项研究报告了安全性数据。关于出院后数周内的产后高血压管理，现有数据极为有限。袢利尿剂（loop diuretics，纳入3项研究）与糖皮质激素（corticosteroids，纳入1项研究）均未产生临床获益。与标准照护相比，刮宫术（uterine curettage）可在产后48小时内显著降低血压（降幅范围6~13mmHg，共纳入8项研究），但仅4项研究报告了其安全性数据。
【研究结论】 现有证据不足以支持推荐特定的血压控制阈值、降压药物或照护模式，但三类降压药物均表现出不同程度的有效性。未来仍需开展更多对比研究，且需包含充分且可靠的安全性数据。刮宫术虽可降低产后血压，但未充分报告其不良事件，因此目前暂不推荐使用。