Flynn Joseph T, Alderman Michael H
Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
Pediatr Nephrol. 2005 Jul;20(7):961-6. doi: 10.1007/s00467-005-1855-3. Epub 2005 Apr 27.
Primary hypertension is well known to occur in children, but the characteristics of such children are changing due to the influence of the obesity epidemic. In view of this, we conducted a cross-sectional study of 70 children [age 13.3+/-4 years (mean +/- SD)] with primary hypertension referred to a specialized pediatric hypertension clinic. Secondary hypertension had been excluded after a standardized diagnostic evaluation. Isolated systolic hypertension was present in 62.9% of subjects. Family history of hypertension was present in 86.2%, and 52.9% were obese (BMI > or =95th percentile). BMI was weakly correlated with systolic BP (r =0.28,P =0.10) and was significantly correlated with total cholesterol (r =0.36,P =0.005) and triglycerides (r =0.42,P =0.01). Mean plasma renin activity (PRA) was 3.1+/-2.7 ng/ml/h. PRA was correlated with diastolic but not systolic BP. Patients with high PRA had higher diastolic BP and lower BMI compared to those with low PRA. Left ventricular hypertrophy was present in 24%. Mean 24-h systolic BP load by ambulatory BP monitoring was 52+/-24%; mean 24-h diastolic BP load was 18+/-16%; BP loads were greater in patients with high PRA. These data suggest that primary hypertension in children is characterized by systolic BP elevation, positive family history and obesity. Hyperlipidemia accompanies primary hypertension in obese children, and left ventricular hypertrophy is common. Patients with high PRA have more severe BP elevation. Future studies should focus on further defining the pathophysiology of primary hypertension in children, including the roles of renin and insulin resistance, so that improved methods of prevention and treatment can be developed.
原发性高血压在儿童中很常见，但由于肥胖流行的影响，这类儿童的特征正在发生变化。鉴于此，我们对70名转诊至专业儿科高血压诊所的原发性高血压儿童[年龄13.3±4岁（均值±标准差）]进行了一项横断面研究。经过标准化诊断评估后，已排除继发性高血压。62.9%的受试者存在单纯收缩期高血压。86.2%有高血压家族史，52.9%为肥胖（BMI≥第95百分位数）。BMI与收缩压呈弱相关（r =0.28，P =0.10），与总胆固醇呈显著相关（r =0.36，P =0.005），与甘油三酯呈显著相关（r =0.42，P =0.01）。平均血浆肾素活性（PRA）为3.1±2.7 ng/ml/h。PRA与舒张压相关，但与收缩压无关。与低PRA患者相比，高PRA患者的舒张压更高，BMI更低。24%存在左心室肥厚。通过动态血压监测，平均24小时收缩压负荷为52±24%；平均24小时舒张压负荷为18±16%；高PRA患者的血压负荷更大。这些数据表明，儿童原发性高血压的特征为收缩压升高、家族史阳性和肥胖。肥胖儿童的原发性高血压伴有高脂血症，左心室肥厚很常见。高PRA患者的血压升高更严重。未来的研究应集中于进一步明确儿童原发性高血压的病理生理学，包括肾素和胰岛素抵抗的作用，以便开发出更好的预防和治疗方法。
