Department of Pediatrics, The Penn State College of Medicine, The Milton S. Hershey Medical Center, PO Box 850, Hershey, PA 17033, USA.
Pediatr Nephrol. 2009 Dec;24(12):2421-8. doi: 10.1007/s00467-009-1297-4.
We present data on presentation, treatment, and follow-up of 65 pediatric patients with primary hypertension treated over the past 12 years, including initial anthropometric data, pharmacologic treatment, time to control for both systolic and diastolic blood pressure (SBP/DBP), and maintenance of control over time. Data was normalized to standard deviation scores (SDS) for mathematical analysis, and antihypertensive medication dosages were converted to dosage equivalents for a single member of each antihypertensive class. We used multiple regression analysis and Kaplan- Meier survival curves to determine the time to control, medication, and dose effectiveness. Patients were seen for an average of seven visits over 25 months. Initial BPs averaged 134/71 mmHg (2.1/0.6 SDS). Patients were taller, heavier, and had higher body mass index than average for age and sex. By the fourth visit, SBP was <90th percentile in 79%. Ninety percent could be controlled, although 32 lost control at some point (at least 16 due to noncompliance). At the last visit, 46 were controlled, and 5/8 patients off medication remained normotensive. Only angiotensin-converting enzyme inhibitors and beta-blockers demonstrated significant association with BP control. This is the first study to document the time to control of BP, and it can serve as an initial standard for quality assessment.
我们呈现了过去 12 年来治疗的 65 例原发性高血压儿科患者的表现、治疗和随访数据，包括初始人体测量数据、药物治疗、收缩压和舒张压（SBP/DBP）控制时间以及随时间的控制维持情况。数据经过标准化处理，以标准偏差分数（SDS）进行数学分析，抗高血压药物剂量转换为每个抗高血压类别的单个成员的剂量等效物。我们使用多元回归分析和 Kaplan-Meier 生存曲线来确定控制时间、药物和剂量的有效性。患者平均在 25 个月内接受了 7 次就诊。初始血压平均为 134/71mmHg（2.1/0.6 SDS）。患者比同龄同性别人群更高、更重，体重指数更高。到第四次就诊时，79%的患者 SBP<90%。90%的患者可以得到控制，尽管有 32 名患者在某个时间点失去了控制（至少有 16 名是由于不遵医嘱）。在最后一次就诊时，46 名患者得到了控制，5/8 名停药的患者仍保持正常血压。只有血管紧张素转换酶抑制剂和β受体阻滞剂与血压控制有显著关联。这是第一项记录血压控制时间的研究，它可以作为质量评估的初始标准。
