Koshy Susan, Macarthur Colin, Luthra Sanjeev, Gajaria Mukesh, Geary Denis
Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Pediatr Nephrol. 2005 Oct;20(10):1484-6. doi: 10.1007/s00467-005-2014-6. Epub 2005 Aug 4.
Ambulatory blood pressure monitoring (ABPM) is commonly used to diagnose pediatric hypertension. Using ABPM, hypertension is usually defined as a mean BP greater than the 95th percentile for height. A BP load >30% (% of BP readings greater than the 95th percentile) is also used for the diagnosis of hypertension. The objective of this study was to determine the agreement between mean BP greater than the 95th percentile and 30% BP load for the diagnosis of hypertension using ABPM. All ABPM records (n =1,009) of patients referred for hypertension to a pediatric center were retrieved. Scans were excluded if: age was >19 and height <115 cm or >185 cm. Mean BP and BP loads were calculated for 728 scans. Agreement between mean BP greater than the 95th percentile for height and various BP loads were calculated using the kappa coefficient. The kappa coefficient of agreement between mean BP greater than the 95th percentile and 30% BP load was 0.56 and 0.57 for daytime systolic and diastolic BP, respectively. The agreement between mean night-time BP greater than the 95th percentile and 30% BP load was 0.70 and 0.66 for systolic and diastolic BP, respectively. Agreement between mean BP greater than the 95th percentile and 30% BP load is only moderate to good. Maximum agreement between mean BP greater than the 95th percentile and BP load is achieved at 50% BP load.
动态血压监测（ABPM）常用于诊断儿童高血压。使用ABPM时，高血压通常定义为平均血压高于身高对应的第95百分位数。血压负荷>30%（血压读数高于第95百分位数的百分比）也用于高血压的诊断。本研究的目的是确定使用ABPM诊断高血压时，平均血压高于第95百分位数与30%血压负荷之间的一致性。检索了转诊至儿科中心的高血压患者的所有ABPM记录（n = 1009）。如果符合以下情况则排除扫描记录：年龄>19岁且身高<115 cm或>185 cm。对728份扫描记录计算了平均血压和血压负荷。使用kappa系数计算身高对应的平均血压高于第95百分位数与各种血压负荷之间的一致性。平均血压高于第95百分位数与30%血压负荷之间的kappa一致性系数，白天收缩压和舒张压分别为0.56和0.57。夜间平均血压高于第95百分位数与30%血压负荷之间的一致性，收缩压和舒张压分别为0.70和0.66。平均血压高于第95百分位数与30%血压负荷之间的一致性仅为中等至良好。平均血压高于第95百分位数与血压负荷之间的最大一致性在血压负荷为50%时达到。
