The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
Nat Rev Cardiol. 2010 Mar;7(3):155-63. doi: 10.1038/nrcardio.2009.231. Epub 2010 Jan 12.
The epidemic of overweight and obesity in youth is increasing the prevalence of prehypertension and hypertension among children and adolescents. The younger the child is at presentation and the more severe the blood pressure abnormality, the more likely a secondary cause of hypertension is to be present. Measurement of blood pressure in children requires adaptation to the age and size of the child. Interpretation must be related to normative values specific for age, sex, and height. Evaluation is primarily aimed at identifying secondary causes of hypertension, associated comorbidities, additional risk factors, and evidence of target-organ damage. Ambulatory blood pressure monitoring is emerging as a useful tool for evaluation of some patients, particularly for those with suspected 'white coat' hypertension. Management of prehypertension and hypertension is directed at the underlying cause, exacerbating factors, and the magnitude of the blood pressure abnormality. Healthy behavioral changes are a primary management tool for treating hypertension and, more particularly, prehypertension and for addressing other cardiovascular risk factors, such as obesity. Pharmacological management is reserved for patients with hypertension who do not respond to behavioral changes, have additional cardiovascular risk factors or diabetes, are symptomatic, or have developed target-organ damage.
超重和肥胖在青少年中的流行导致儿童和青少年中前期高血压和高血压的患病率增加。儿童就诊时年龄越小，血压异常越严重，高血压的继发原因越有可能存在。儿童血压的测量需要适应儿童的年龄和体型。解释必须与特定年龄、性别和身高的规范值相关。评估主要旨在确定高血压的继发原因、相关合并症、其他危险因素以及靶器官损伤的证据。动态血压监测作为评估某些患者的有用工具正在出现，特别是对于那些疑似“白大衣”高血压的患者。前期高血压和高血压的治疗主要针对潜在病因、加重因素以及血压异常的严重程度。健康的行为改变是治疗高血压的主要管理工具，更特别是治疗前期高血压和解决其他心血管危险因素，如肥胖。对于对行为改变无反应、有其他心血管危险因素或糖尿病、有症状或已发生靶器官损伤的高血压患者，保留药物治疗。
