THE ANGIOTENSIN SENSITIVITY TEST AND LOW-DOSE ASPIRIN ARE INEFFECTIVE METHODS TO PREDICT AND PREVENT HYPERTENSIVE DISORDERS IN NULLIPAROUS PREGNANCY

被引：47

作者：

KYLE, PM ^{[1
]}

KISSANE, J ^{[1
]}

DESWIET, M ^{[1
]}

REDMAN, CWG ^{[1
]}

机构：

[1] JOHN RADCLIFFE HOSP, DEPT OBSTET & GYNAECOL, OXFORD OX3 9DU, ENGLAND

来源：

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY | 1995年 / 173卷 / 03期

关键词：

PREECLAMPSIA; ANGIOTENSIN II; ASPIRIN; SCREENING; PREVENTION;

D O I：

10.1016/0002-9378(95)90356-9

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

OBJECTIVE: Our purpose was to assess the efficiency of the angiotensin sensitivity test as a predictive test for preeclampsia and the effectiveness of low-dose aspirin to prevent preeclampsia when commenced at 28 weeks' gestation in angiotensin II-sensitive women. STUDY DESIGN: A total of 495 healthy nulliparous women underwent the angiotensin sensitivity test at 28 weeks' gestation. The angiotensin II-sensitive women were randomized to 60 mg of aspirin or placebo as a subset of a large multicenter, randomized, controlled trial of low-dose aspirin therapy in pregnancy. Assessment of the efficiency of the angiotensin sensitivity test and low-dose aspirin in pregnancy was performed after detailed review of case notes after delivery. The Oxford definition of preeclampsia was used. This includes women without proteinuria but requires blood pressure increments that have been validated to bias the selection to primigravid women. RESULTS: Five women had proteinuric preeclampsia in the angiogensin II-sensitive group randomized to aspirin compared with none in the group randomized to placebo. Overall, 11 (25%) of the women randomized to aspirin had preeclampsia compared with four (11%) randomized to placebo (p > 0.05, not significant). The positive and negative predictive values for the angiotensin sensitivity test were 19% and 87%, respectively. CONCLUSION: The angiotensin sensitivity test is not an effective screening test for preeclampsia, and low-dose aspirin does not prevent preeclampsia when commenced at 28 weeks' gestation in angiotensin II-sensitive women.

引用

页码：865 / 872

页数：8

共 15 条

[1] Talledo, Chesley, Zuspan, Renin-angiotensin system in normal and toxemic pregnancies, Am J Obstet Gynecol, 100, pp. 218-221, (1968)
[2] Grant, Daley, Chand, Whalley, MacDonald, A Study of Angiotensin II Pressor Response throughout Primigravid Pregnancy, Journal of Clinical Investigation, 52, pp. 2682-2689, (1973)
[3] Morris, O'Grady, Hamilton, Davidson, Vascular reactivity to angiotensin II infusion during gestation, Am J Obstet Gynecol, 130, pp. 379-384, (1978)
[4] Orozco, Pinsker, Hernandez, Karchmer, Valor de la prueba de la angiotensina II y del “roll over test” como métodos predictivos de la enfermedad hipersentiva aguda del embarazo (preeclampsia/eclampsia), Ginecol Obstet Mex, 46, pp. 235-244, (1979)
[5] Oney, Kaulhausen, The value of the angiotensin sensitivity test in the early diagnosis of hypertensive disorders in pregnancy, Am J Obstet Gynecol, 142, pp. 17-20, (1982)
[6] Nakamura, Ito, Matsui, Yoshimura, Kawasaki, Maeyama, Significance of angiotensin sensitivity test for prediction of pregnancy-induced hypertension, Obstet Gynecol, 67, pp. 388-394, (1986)
[7] Dekker, Makovitz, Wallenburg, Prediction of pregnancy-induced hypertensive disorders by angiotensin II sensitivity and supine pressor test, Br J Obstet Gynaecol, 97, pp. 817-821, (1990)
[8] Baker, Broughton Pipkin, Symonds, Comparative study of platelet angiotensin II binding and the angiotensin II sensitivity test as predictors of pregnancy-induced hypertension, Clin Sci, 83, pp. 89-95, (1992)
[9] Wallenburg, Dekker, Makovitz, Rotmans, Low-dose aspirin prevents pregnancy-induced hypertension and pre-eclampsia in angiotensin-sensitive primigravidae, Lancet, 1, pp. 1-3, (1986)
[10] CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women, Lancet, 343, pp. 619-629, (1994)

← 1 2 →