Silverstein Douglas M, Champoux Edward, Aviles Diego H, Vehaskari V Matti
Department of Pediatrics, Division of Nephrology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Pediatr Nephrol. 2006 Jun;21(6):820-7. doi: 10.1007/s00467-006-0087-5. Epub 2006 Apr 20.
The incidence of pediatric hypertension (HTN) is increasing, mainly due to an increase in primary (essential) HTN, or PH. There are only a limited number of studies assessing the characteristics and treatment efficacy of PH versus secondary HTN (SH). We conducted a retrospective analysis of 158 pediatric patients (mean age: 10.8 years; sex ratio: 51.1% female, 48.9% male) with HTN of whom 34.4% had PH and 65.6% had SH. The vast majority were either African-American or Caucasian. Among all patients, therapy induced a significant decrease in systolic blood pressure (SBP) and diastolic BP (DBP) (both p<0.0001). SBP (p<0.0001) and DBP (p=0.002) declined significantly in PH patients. PH and SH patients with a body mass index (BMI) >95th percentile (%) had a significantly higher post-therapy SBP (both p<0.05) than those with a BMI <95th%. SBP declined similarly in PH patients treated with calcium-channel blockers (CCB) and angiotensin-converting enzyme inhibitors (ACEI). DBP declined only in PH patients treated with ACEI. SBP and DBP (both p<0.0001) declined significantly in SH patients. Post-therapy BP was similar in SH patients treated with either CCB or ACEI. Post-therapy SBP and DBP were significantly lower in SH patients than in PH patients; moreover, therapy induced a greater decline in SBP and DBP in the SH patients. Compared to PH patients, SH patients were twofold more likely to achieve a SBP less than the 95th% after therapy. We conclude that (1) significant lowering of BP with either CCB or ACEI is achievable in most children with HTN, and (2) SH patients respond better to therapy than those with PH.
儿童高血压（HTN）的发病率正在上升，主要原因是原发性（特发性）高血压（PH）的增加。评估PH与继发性高血压（SH）的特征和治疗效果的研究数量有限。我们对158例高血压儿科患者（平均年龄：10.8岁；性别比例：女性51.1%，男性48.9%）进行了回顾性分析，其中34.4%患有PH，65.6%患有SH。绝大多数患者为非裔美国人或白种人。在所有患者中，治疗导致收缩压（SBP）和舒张压（DBP）显著降低（均p<0.0001）。PH患者的SBP（p<0.0001）和DBP（p=0.002）显著下降。体重指数（BMI）>第95百分位数（%）的PH和SH患者治疗后的SBP显著高于BMI<第95百分位数的患者（均p<0.05）。使用钙通道阻滞剂（CCB）和血管紧张素转换酶抑制剂（ACEI）治疗的PH患者SBP下降情况相似。仅使用ACEI治疗的PH患者DBP下降。SH患者的SBP和DBP（均p<0.0001）显著下降。使用CCB或ACEI治疗的SH患者治疗后的血压相似。SH患者治疗后的SBP和DBP显著低于PH患者；此外，治疗导致SH患者的SBP和DBP下降幅度更大。与PH患者相比，SH患者治疗后SBP低于第95百分位数的可能性高出两倍。我们得出结论：（1）大多数高血压儿童使用CCB或ACEI均可显著降低血压；（2）SH患者对治疗的反应优于PH患者。
