Gupta-Malhotra Monesha, Devereux Richard B, Dave Archana, Bell Cynthia, Portman Ronald, Milewicz Diana
Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School at Houston, Houston, TX, USA.
Division of Cardiology, Weill Cornell Medical College, New York, NY, USA.
J Am Soc Hypertens. 2014 Apr;8(4):239-45. doi: 10.1016/j.jash.2014.01.002. Epub 2014 Jan 9.
The aim of the study was to determine the presence of aortic dilatation in hypertensive children, the prevalence of which is 4% to 10% in hypertensive adults. Prospectively enrolled multiethnic children, untreated for their hypertension, underwent an echocardiogram to exclude congenital heart disease and evaluate for end-organ damage and aortic size. The aorta was measured in the parasternal long-axis view at three levels: the sinus of Valsalva, supra-tubular junction, and the ascending aorta. Aortic dilatation was determined by z-score >2 at any one of the levels measured. Hypertension was defined as blood pressure above the 95th percentile based on the Fourth Working Group criteria confirmed by 24-hour ambulatory blood pressure monitoring. Among 142 consecutive hypertensive children (median age, 14 years; 45% females) aortic dilatation was detected in 2.8% (95% confidence interval, 1%-7%; median age, 16 years; 100% females). Children with aortic dilatation, when compared with those without, had significantly more aortic valve insufficiency (P = .005) and left ventricular hypertrophy (P = .018). Prevalence of aortic dilatation was 2.8% and was associated with significantly more aortic insufficiency and left ventricular hypertrophy in comparison to those without aortic dilatation.
该研究的目的是确定高血压儿童中主动脉扩张的情况，其在高血压成人中的患病率为4%至10%。前瞻性纳入未经治疗的多民族高血压儿童，进行超声心动图检查以排除先天性心脏病，并评估终末器官损害和主动脉大小。在胸骨旁长轴视图中于三个水平测量主动脉：主动脉瓣窦、管上交界处和升主动脉。在任何一个测量水平上，z评分>2即判定为主动脉扩张。根据第四届工作组标准，经24小时动态血压监测确认，高血压定义为血压高于第95百分位数。在142例连续的高血压儿童（中位年龄14岁；45%为女性）中，2.8%（95%置信区间，1%-7%；中位年龄16岁；100%为女性）检测到主动脉扩张。与未发生主动脉扩张的儿童相比，发生主动脉扩张的儿童主动脉瓣关闭不全（P = 0.005）和左心室肥厚（P = 0.018）显著更多。主动脉扩张的患病率为2.8%，与未发生主动脉扩张的儿童相比，主动脉关闭不全和左心室肥厚显著更多。
