Department of Pediatrics, University Hospital Motol, Charles University Prague, Second Medical School, Prague, Czech Republic.
Am J Hypertens. 2012 Mar;25(3):389-95. doi: 10.1038/ajh.2011.218. Epub 2011 Nov 17.
The aim of our study was to investigate the control of hypertension (HT) in treated children using ambulatory blood pressure (BP) monitoring (ABPM).
We retrospectively reviewed all ABPM studies in our center. Controlled HT was defined as systolic and diastolic BP index (patients' BP divided by the 95th percentile) at daytime and nighttime <1.0 or alternatively as BP load (percentage of BP readings above the 95th percentile) <25% in children on antihypertensive therapy.
A total of 195 ABPM studies were included. The mean age was 13.6 ± 4.0 years. One hundred and thirty two children had renoparenchymal HT, 10 renovascular (RVH), 10 endocrine, 4 cardiovascular, 29 primary (PH) and 5 children other forms of HT. 53% of all children had controlled HT. There was no difference in the prevalence of controlled HT between primary and secondary HT (52% and 53%) using the BP index criterion. Children with renoparenchymal HT had significantly better control of HT than children with RVH (58% vs. 20% P = 0.02). The use of angiotensin-converting enzyme inhibitors (ACEI) monotherapy was significantly more effective in controlling HT than the use of calcium-channel blockers (CCB, P = 0.02). The prevalence of left ventricular hypertrophy in children with uncontrolled HT (assessed in 58 patients) was significantly higher than in children with controlled HT (46% vs. 13%, P < 0.01).
This is the first pediatric study, to our knowledge, on BP control in hypertensive children using ABPM. It indicates that control of HT is inadequate in ~50% of treated children. Inadequate control of HT is associated with target organ damage in this population.
本研究旨在通过动态血压监测（ABPM）探讨治疗儿童高血压（HT）的血压控制情况。
我们回顾性分析了本中心所有 ABPM 研究。通过日间和夜间收缩压和舒张压指数（患者血压除以第 95 百分位数）<1.0 或降压治疗患儿的血压负荷（血压读数超过第 95 百分位数的百分比）<25%来定义血压控制。
共纳入 195 项 ABPM 研究。平均年龄为 13.6±4.0 岁。132 例患儿为肾实质 HT，10 例为肾血管性高血压（RVH），10 例为内分泌性，4 例为心血管性，29 例为原发性高血压（PH），5 例为其他类型 HT。所有患儿中 53%血压控制良好。使用血压指数标准，原发性和继发性 HT 患儿血压控制良好的比例无差异（分别为 52%和 53%）。与 RVH 患儿相比，肾实质 HT 患儿的 HT 控制明显更好（58%比 20%，P=0.02）。与钙通道阻滞剂（CCB）相比，血管紧张素转换酶抑制剂（ACEI）单药治疗在控制 HT 方面更为有效（P=0.02）。在未控制 HT 的患儿（58 例）中，左心室肥厚的发生率明显高于控制 HT 的患儿（46%比 13%，P<0.01）。
这是我们所知的第一项使用 ABPM 研究儿童高血压患儿血压控制情况的儿科研究。它表明，约 50%的治疗儿童 HT 控制不佳。该人群中 HT 控制不佳与靶器官损害有关。
