Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas Health Science Center at Houston, 6431 Fannin (MSB 3.121), Houston, TX 77030, USA.
Pediatr Nephrol. 2011 Dec;26(12):2211-7. doi: 10.1007/s00467-011-1972-0. Epub 2011 Aug 22.
The American Heart Association has included alternate ambulatory blood pressure (ABP) limits for children published by Wühl in 2002. These updated limits employ the same pediatric cohort data as the previous ABP limits published by Soergel in 1997 but differ in analysis technique. The implications of changing ABP limit source on the diagnosis of hypertension has yet to be examined in a large pediatric cohort. We reviewed 741 ABP monitorings performed in children referred to our hypertension clinic between 1991-2007. Hypertension was defined as 24-h mean blood pressure ≥ 95 th percentile or 24-h blood pressure load ≥ 25%, by Soergel and Wühl limits separately. Six hundred seventy-three (91%) children were classified the same by both limit sources. Wühl limits were more likely than Soergel to classify a child as hypertensive (443 vs. 409, respectively). There was an increased classification of prehypertension and decreased white-coat hypertension by the Wühl method, whereas ambulatory and severe hypertension counts remained relatively the same by both limits sources. The use of either limit source will not significantly affect most clinical outcomes but should remain consistent over long-term research projects. Collection of new normative data from a larger, multiethnic population is needed for better measurement of ABP in children.
美国心脏协会（AHA）纳入了 2002 年 Wühl 发表的儿童动态血压（ABP）的替代参考范围。这些更新的参考范围采用了与 Soergel 1997 年发表的 ABP 参考范围相同的儿科队列数据，但在分析技术上有所不同。改变 ABP 参考范围来源对高血压诊断的影响尚未在大型儿科队列中进行研究。我们回顾了 1991 年至 2007 年期间在我们高血压诊所就诊的 741 名儿童进行的 ABP 监测。根据 Soergel 和 Wühl 两种参考范围，高血压分别定义为 24 小时平均血压≥第 95 百分位数或 24 小时血压负荷≥25%。两种参考范围来源将 673 名（91%）儿童分类相同。与 Soergel 相比，Wühl 参考范围更有可能将儿童归类为高血压（分别为 443 名和 409 名）。Wühl 方法分类出更多的高血压前期和白大衣高血压，而 ABP 和严重高血压的计数在两种参考范围来源中基本保持不变。两种参考范围来源的使用不会显著影响大多数临床结局，但在长期研究项目中应保持一致。需要从更大的多民族人群中收集新的正常参考数据，以便更好地测量儿童的 ABP。
