儿童高血压的临床分析：一项印度城市研究

Kota Sunil K, Kota Siva K, Meher Lalit K, Sruti Jammula, Kotni Gayatri, Panda Sandip, Tripathy Prabhas R, Modi Kirtikumar

Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India.

Saudi J Kidney Dis Transpl. 2013 Jul;24(4):844-52. doi: 10.4103/1319-2442.113919.

Hypertension in children, although an uncommon entity, is associated with end-organ damage. We tried to study the clinical profile of hypertension in children presented to our hospital. The medical records from January 1990 to December 2010 of all children aged 18 years and younger with hypertension were studied. The patients were divided into four age groups (infants, pre-school age, school age and adolescents) Presenting symptoms and other clinical parameters were thoroughly evaluated. The results were compared with previous studies on hypertension in children. A total of 135 patients were selected (male:female 103:32), with mean age of 0.4 ± 2.1 years (range: six months to 17 years). The most common age group affected was the adolescents group (42.9%). The most common clinical feature at presentation was dizziness (30.3%), followed by headache and chest discomfort (22.9%). Transient hypertension was detected in 34 patients (25.2%), and was most common in the adolescent age group, whereas sustained hypertension was noticed in 101 patients (74.8%) and was the most common in the school age group (36/45, 80%). Forty-two patients (31.1%) presented with hypertensive crisis. Nine patients were considered to have essential hypertension. The chief causes included chronic glomerulonephritis in 56 (41.5%), endocrine disorders in 21 (15.5%), obstructive uropathy in 16 (11.8%), reflux nephropathy in 12 (8.8%) and renovascular disease in 5 (3.7%). Takayasu's disease was the most common cause of renovascular hypertension. Coarctation of aorta was the most common cause of hypertension in infancy, being present in 40% of the cases. Hypertension in children may be easily underestimated but is a potentially life-threatening problem. Most of them are asymptomatic and a large chunk has an underlying etiology. Primary care clinicians should promptly identify patients with hypertension and treat them immediately and appropriately to prevent damage to the cardiovascular organs.

儿童高血压虽然并不常见，但与靶器官损害相关。我们试图研究我院收治的儿童高血压的临床特征。对1990年1月至2010年12月期间所有18岁及以下高血压儿童的病历进行了研究。将患者分为四个年龄组（婴儿、学龄前、学龄和青少年），对其出现的症状和其他临床参数进行了全面评估。并将结果与先前关于儿童高血压的研究进行了比较。共选取了135例患者（男∶女为103∶32），平均年龄为0.4±2.1岁（范围：6个月至17岁）。受影响最常见的年龄组是青少年组（42.9%）。就诊时最常见的临床特征是头晕（30.3%），其次是头痛和胸部不适（22.9%）。34例患者（25.2%）检测到短暂性高血压，在青少年年龄组最为常见，而101例患者（74.8%）出现持续性高血压，在学龄组最为常见（36/45，80%）。42例患者（31.1%）出现高血压危象。9例患者被认为患有原发性高血压。主要病因包括慢性肾小球肾炎56例（41.5%）、内分泌疾病21例（15.5%）、梗阻性尿路病16例（11.8%）、反流性肾病12例（8.8%）和肾血管疾病5例（3.7%）。大动脉炎是肾血管性高血压最常见的病因。主动脉缩窄是婴儿期高血压最常见的病因，占病例的40%。儿童高血压可能很容易被低估，但却是一个潜在的危及生命的问题。他们中的大多数没有症状，且很大一部分有潜在病因。基层医疗临床医生应及时识别高血压患者并立即进行适当治疗，以防止心血管器官受损。