Department of Pediatrics, University Hospital Motol, Charles University Prague, Second Medical School, Czech Republic and Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic.
Am J Hypertens. 2013 Jul;26(7):939-45. doi: 10.1093/ajh/hpt048. Epub 2013 May 3.
Short-term therapy can decrease blood pressure (BP) to less than the 95th percentile in only about 50% of children. The aim of our study was to investigate the long-term control of hypertension (HT) in children using ambulatory BP monitoring (ABPM).
We analyzed data from all children who started ramipril monotherapy in our center. Controlled HT was defined according to the most current guidelines as systolic and diastolic BP at daytime and nighttime <90th percentile in primary HT and <75th percentile in renoparenchymal HT.
Thirty-eight children who were on therapy ≥1 year were included. Thirty-two children had renoparenchymal, and 6 had primary HT. The median age at the beginning of therapy was 13.6 years (range = 4.1-18.0 years), and the median time of antihypertensive therapy was 2.6 years (range = 1.0-11.8 years). Thirty-four percent of children received combination therapy; the median number of antihypertensive drugs was 1.5 drugs/patient (range = 1-4). Sixty-eight percent of children had BP <95th percentile, but only 34% of the children had controlled HT. Children with uncontrolled HT had a tendency to have a higher daytime diastolic BP index before the start of therapy than children with controlled HT (0.99±0.11 vs. 0.94±0.11; P = 0.09). There was a significant decrease in prevalence of nondipping (from 47% to 16%; P = 0.006) with therapy.
This first pediatric study focusing on long-term control of HT using ABPM showed that long-term control of HT is better than short-term control, but still only one-third of children achieve the new BP goals. The low control of HT might be improved by more intensive therapy.
短期治疗只能使大约 50%的儿童的血压（BP）降至低于第 95 百分位数。我们研究的目的是通过使用动态血压监测（ABPM）来研究儿童高血压（HT）的长期控制情况。
我们分析了在我们中心开始依那普利单药治疗的所有儿童的数据。根据最新指南，原发性 HT 时日间和夜间收缩压和舒张压<90 百分位数，肾实质 HT 时<75 百分位数，将控制良好的 HT 定义为。
纳入了 38 名治疗时间≥1 年的儿童。32 名儿童患有肾实质疾病，6 名患有原发性 HT。开始治疗时的中位年龄为 13.6 岁（范围=4.1-18.0 岁），抗高血压治疗的中位时间为 2.6 年（范围=1.0-11.8 年）。34%的儿童接受联合治疗；中位降压药物数量为 1.5 种/患者（范围=1-4）。68%的儿童血压<95 百分位数，但只有 34%的儿童血压控制良好。与血压控制良好的儿童相比，血压控制不佳的儿童在开始治疗前的日间舒张压指数有偏高的趋势（0.99±0.11 比 0.94±0.11；P=0.09）。治疗后非杓型的发生率显著下降（从 47%降至 16%；P=0.006）。
这项首次使用 ABPM 关注儿童 HT 长期控制的儿科研究表明，HT 的长期控制优于短期控制，但仍只有三分之一的儿童达到新的血压目标。通过更强化的治疗，HT 的低控制率可能会得到改善。
