Wiesen Jonathan, Adkins Matthew, Fortune Sherwin, Horowitz Judah, Pincus Nava, Frank Rachel, Vento Suzanne, Hoffman Cathy, Goilav Beatrice, Trachtman Howard
Division of Nephrology, Department of Pediatrics, Schneider Children's Hospital of North Shore-LIJ Health System, Long Island Campus, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.
Pediatrics. 2008 Nov;122(5):e988-93. doi: 10.1542/peds.2008-0365.
Children and adolescents with newly diagnosed hypertension undergo various tests to define the cause and target organ consequences of the elevated blood pressure. We tested the hypothesis that the diagnostic yield of individual components of the currently recommended assessment does not justify performance for all patients with mild-to-moderate hypertension.
A retrospective chart review was conducted of patients who were referred between July 2002 and June 2007 for mild-to-moderate hypertension, defined as maximum blood pressure at >or=95% + 20/10 mmHg. The assessment included history and physical examination, nutritional assessment, urinalysis, biochemical and fasting lipid profile, renal ultrasound, echocardiogram, and 24-hour ambulatory blood pressure monitoring.
A total of 249 patients were identified, and charts for 220 (88%) were available for review. There were 156 boys and 64 girls aged 13.3 +/- 4.4 years. BMI was 26.1 +/- 6.7 kg/m(2), and 143 (65%) had a BMI of >or=90%. Results of urinalysis and serum biochemical testing were clinically normal in all cases. Among those with a lipid profile, 59 (42%) had total cholesterol values of >170 mg/dL, and 26 (19%) had severe hypercholesterolemia (>200 mg/dL). Renal sonography revealed findings plausibly associated with hypertension in 14 (8%) patients; 4 (2%) had renovascular abnormalities. Yield of echocardiography was 17%. On ambulatory blood pressure monitoring, 47 (60%) children had systolic readings of >95% at least 20% of the time, and 28 (36%) had diastolic readings of >95% at least 20% of the time.
For children and adolescents with mild-to-moderate hypertension, on the basis of a cutoff of 5% to 20% abnormal results to define a useful test, the initial evaluation can range from a serum cholesterol level and ambulatory blood pressure monitoring to a panel that consists of a fasting lipid profile, renal ultrasound, echocardiogram, and ambulatory blood pressure monitoring. Additional assessment should be guided by specific clinical features and the nature of the patient population.
新诊断为高血压的儿童和青少年需接受各种检查，以明确血压升高的原因及对靶器官的影响。我们检验了如下假设：当前推荐评估中各个组成部分的诊断价值，并不足以证明所有轻至中度高血压患者都需进行这些检查。
对2002年7月至2007年6月间因轻至中度高血压（定义为收缩压≥95% + 20/10 mmHg）前来就诊的患者进行回顾性病历审查。评估内容包括病史与体格检查、营养评估、尿液分析、生化及空腹血脂检查、肾脏超声、超声心动图以及24小时动态血压监测。
共确定了249例患者，其中220例（88%）的病历可供审查。有156名男孩和64名女孩，年龄为13.3 ± 4.4岁。体重指数（BMI）为26.1 ± 6.7 kg/m²，143例（65%）的BMI≥90%。所有病例的尿液分析和血清生化检查结果在临床上均正常。在进行血脂检查的患者中，59例（42%）的总胆固醇值>170 mg/dL，26例（19%）患有严重高胆固醇血症（>200 mg/dL）。肾脏超声检查发现14例（8%）患者有可能与高血压相关的表现；4例（2%）有肾血管异常。超声心动图检查的阳性率为17%。在动态血压监测中，47例（60%）儿童至少20%的时间收缩压读数>95%，28例（36%）儿童至少20%的时间舒张压读数>95%。
对于轻至中度高血压的儿童和青少年，基于5%至20%的异常结果作为界定有效检查的标准，初始评估范围可从血清胆固醇水平和动态血压监测，到包括空腹血脂检查、肾脏超声、超声心动图及动态血压监测的一组检查。进一步的评估应根据具体临床特征和患者群体的性质来指导。
