Seeman Tomás, Simková Eva, Kreisinger Jirí, Vondrák Karel, Dusek Jirí, Gilík Jirí, Feber Janusz, Dvorák Pavel, Janda Jan
Department of Pediatrics, University Hospital Motol, Charles University Prague, Prague, Czech Republic.
Pediatr Transplant. 2006 May;10(3):316-22. doi: 10.1111/j.1399-3046.2005.00468.x.
The aim of this cross-sectional single-center study was to investigate the efficacy of hypertension control in children who underwent transplantation using ambulatory blood pressure (BP) monitoring, and to determine the risk factors associated with poor control of hypertension. Thirty-six children fulfilled the inclusion criteria. The mean age was 13.9+/-4.4 yr; the mean time after renal transplantation was 2.7+/-2.4 yr (0.5-10.1). Hypertension was defined as a mean ambulatory BP > or =95th centile for healthy children and/or requiring antihypertensive drugs. Hypertension was regarded as controlled if the mean ambulatory BP was <95th centile in children already on antihypertensive drugs, or uncontrolled if the mean ambulatory BP was > or =95th centile in treated children. Hypertension was present in 89% of children. Seventeen children (47%) had controlled hypertension, and 14 (39%) had uncontrolled hypertension. One child (3%) had untreated hypertension, and only four children (11%) showed normal BP without antihypertensive drugs. The efficacy of hypertensive control was 55% (17 of 31 children on antihypertensive drugs had a BP<95th centile), i.e. 45% of treated children still had hypertension. Children with uncontrolled hypertension had significantly higher cyclosporine doses (6.1 vs. 4.3 mg/kg/day, p=0.01) and tacrolimus levels (9.2 vs. 6.1 microg/L, p<0.05), and there was a tendency toward use of lower number of antihypertensive drugs (2.0 vs. 1.5 drugs/patient, p=0.06) and lower use of angiotensin-converting enzyme (ACE) inhibitors (7 vs. 35%, p=0.09) and diuretics (29 vs. 59%, p=0.14) than in children with controlled hypertension. In conclusion, nearly 90% of our children after renal transplantation are hypertensive and the control of hypertension is unsatisfactorily low. The control of hypertension could be improved by increasing the number of prescribed antihypertensive drugs, especially ACE inhibitors, and diuretics, or by using higher doses of currently used antihypertensives.
这项横断面单中心研究的目的是通过动态血压监测来调查接受移植的儿童高血压控制的疗效，并确定与高血压控制不佳相关的危险因素。36名儿童符合纳入标准。平均年龄为13.9±4.4岁；肾移植后的平均时间为2.7±2.4年（0.5 - 10.1年）。高血压定义为动态平均血压高于或等于健康儿童的第95百分位数和/或需要使用抗高血压药物。如果正在服用抗高血压药物的儿童动态平均血压低于第95百分位数，则高血压被视为得到控制；如果接受治疗的儿童动态平均血压高于或等于第95百分位数，则高血压被视为未得到控制。89%的儿童存在高血压。17名儿童（47%）高血压得到控制，14名（39%）未得到控制。1名儿童（3%）未治疗高血压，只有4名儿童（11%）血压正常且未服用抗高血压药物。高血压控制的有效率为55%（31名服用抗高血压药物的儿童中有17名血压低于第95百分位数），即45%的接受治疗儿童仍患有高血压。未得到控制高血压的儿童环孢素剂量显著更高（6.1 vs. 4.3 mg/kg/天，p = 0.01）和他克莫司水平更高（9.2 vs. 6.1 μg/L，p < 0.05），并且与高血压得到控制的儿童相比，使用抗高血压药物的数量有减少趋势（2.0 vs. 1.5种药物/患者，p = 0.06），血管紧张素转换酶（ACE）抑制剂的使用比例更低（7% vs. 35%，p = 0.09），利尿剂的使用比例更低（29% vs. 59%，p = 0.14）。总之，我们肾移植后的儿童中近90%患有高血压，高血压控制率低得令人不满意。通过增加抗高血压药物的处方数量，尤其是ACE抑制剂和利尿剂，或者通过增加当前使用的抗高血压药物的剂量，可以改善高血压的控制。
