Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
Pediatrics. 2013 Feb;131(2):e415-24. doi: 10.1542/peds.2012-1292. Epub 2013 Jan 28.
To examine the prevalence of prehypertension and hypertension among children receiving well-child care in community-based practices.
Children aged 3 to 17 years with measurements of height, weight, and blood pressure (BP) obtained at an initial (index) well-child visit between July 2007 and December 2009 were included in this retrospective cohort study across 3 large, integrated health care delivery systems. Index BP classification was based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents: normal BP, <90th percentile; prehypertension, 90th to 94th percentile; hypertension, 3 BP measurements ≥95th percentile (index and 2 subsequent consecutive visits).
The cohort included 199 513 children (24.3% aged 3-5 years, 34.5% aged 6-11 years, and 41.2% aged 12-17 years) with substantial racial/ethnic diversity (35.9% white, 7.8% black, 17.6% Hispanic, 11.7% Asian/Pacific Islander, and 27.0% other/unknown race). At the index visit, 81.9% of participants were normotensive, 12.7% had prehypertension, and 5.4% had a BP in the hypertension range (≥95th percentile). Of the 10 848 children with an index hypertensive BP level, 3.8% of those with a follow-up BP measurement had confirmed hypertension (estimated 0.3% prevalence). Increasing age and BMI were significantly associated with prehypertension and confirmed hypertension (P < .001 for trend). Among racial/ethnic groups, blacks and Asians had the highest prevalence of hypertension.
The prevalence of hypertension in this community-based study is lower than previously reported from school-based studies. With the size and diversity of this cohort, these results suggest the prevalence of hypertension in children may actually be lower than previously reported.
研究社区医疗实践中接受常规儿童保健的儿童中高血压前期和高血压的患病率。
本回顾性队列研究纳入了 2007 年 7 月至 2009 年 12 月期间在 3 个大型综合医疗服务系统中进行的初始（索引）常规儿童保健就诊时测量身高、体重和血压（BP）的 3 至 17 岁儿童。索引 BP 分类基于《儿童和青少年高血压诊断、评估和治疗第四次报告》：正常 BP，<90 百分位；高血压前期，90 至 94 百分位；高血压，3 次 BP 测量≥95 百分位（索引和 2 次连续就诊）。
队列包括 199513 名儿童（24.3%年龄为 3-5 岁，34.5%年龄为 6-11 岁，41.2%年龄为 12-17 岁），种族/族裔差异较大（35.9%为白人，7.8%为黑人，17.6%为西班牙裔，11.7%为亚洲/太平洋岛民，27.0%为其他/未知种族）。在索引就诊时，81.9%的参与者血压正常，12.7%的参与者高血压前期，5.4%的参与者血压处于高血压范围（≥95 百分位）。在 10848 名索引 BP 水平升高的儿童中，有 3.8%的儿童随访 BP 测量值确认患有高血压（估计患病率为 0.3%）。年龄和 BMI 的增加与高血压前期和确诊高血压显著相关（趋势 P<0.001）。在种族/族裔群体中，黑人高血压患病率最高，其次是亚洲人。
与之前基于学校的研究相比，本社区研究中高血压的患病率较低。由于该队列的规模和多样性，这些结果表明儿童高血压的患病率可能实际上低于之前的报告。
