Department of Pediatrics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic.
Pediatr Nephrol. 2013 Jul;28(7):1105-12. doi: 10.1007/s00467-012-2382-7. Epub 2013 Jan 24.
The diagnosis of hypertension (HTN)/normotension (NT) on ambulatory blood pressure monitoring (ABPM) is usually based on systolic (SBP) or diastolic blood pressure (DBP). The goal of this study was to analyze whether inclusion of mean arterial pressure (MAP) improves the detection of HTN on ABPM.
We retrospectively studied ABPM records in 229 children (116 boys, median age = 15.3 years) who were referred for evaluation of HTN. A diagnosis of HTN was made if: (A) MAP or SBP or DBP was ≥ 1.65 SDS (95th percentile); (B) SBP or DBP was ≥ 1.65 SDS (95th percentile), during 24-h or daytime or night-time in both definitions.
Using definition A, 46/229 patients had HTN compared to definition B by which only 37/229 patients had HTN (p = 0.001). The level of agreement between the two definitions was very good (kappa = 0.86 ± 0.04), however nine patients (19.5 %) were missed by not using MAP in the definition of HTN. These nine patients had only mild HTN with a median Z score of 1.69.
The inclusion of MAP in the definition of ambulatory HTN significantly increased the number of hypertensive patients. MAP may be very helpful in detecting mild HTN in patients with normal/borderline SBP and DBP.
在动态血压监测（ABPM）中，高血压（HTN）/正常血压（NT）的诊断通常基于收缩压（SBP）或舒张压（DBP）。本研究的目的是分析平均动脉压（MAP）的纳入是否能提高 ABPM 中 HTN 的检出率。
我们回顾性研究了 229 名（男 116 名，中位年龄 15.3 岁）因 HTN 评估而接受 ABPM 检查的儿童的 ABPM 记录。如果符合以下条件，则诊断为 HTN：（A）MAP 或 SBP 或 DBP 升高至≥1.65 SDS（95 百分位）；（B）SBP 或 DBP 升高至≥1.65 SDS（95 百分位），在 24 小时、白天或夜间的两种定义中均如此。
使用定义 A，229 例患者中有 46 例患有 HTN，而使用定义 B，仅有 37 例患者患有 HTN（p=0.001）。两种定义之间的一致性水平非常好（kappa=0.86±0.04），但有 9 例患者（19.5%）因未在 HTN 定义中使用 MAP 而漏诊。这 9 例患者的 HTN 仅为轻度，中位数 Z 评分 1.69。
在 ABPM 中 HTN 的定义中纳入 MAP 可显著增加高血压患者的数量。MAP 可能非常有助于检测 SBP 和 DBP 正常/临界的患者中的轻度 HTN。
