Kollias Anastasios, Dafni Maria, Poulidakis Emmanouil, Ntineri Angeliki, Stergiou George S
Hypertension Center, STRIDE Hellas-7, Third University Department of Medicine, Sotiria Hospital, University of Athens, Athens, Greece.
J Hypertens. 2014 Dec;32(12):2315-31; discussion 2331. doi: 10.1097/HJH.0000000000000384.
In children, out-of-office blood pressure (BP) assessment (especially ambulatory monitoring) is regarded as indispensable for accurate hypertension diagnosis. This article reviewed the evidence on the association between out-of-office BP measurements and preclinical organ damage indices in children.
A systematic review and meta-analysis of 93 relevant articles (1974-2012) was performed.
Analysis of 10 studies (n = 480, pooled age 14.4 years, with hypertension 33%, renal disease 27%, type 1 diabetes 10%) revealed a significant association between systolic ambulatory BP and left ventricular mass index (LVMI), with pooled correlation coefficient r = 0.40 [95% confidence interval (CI) 0.30-0.50]. Eleven studies reported data on LVMI differences between normotensive (n = 428) and hypertensive children (n = 432), with higher values in the latter group by 6.53 g/m(2.7) (95% CI 4.73-8.33). A moderate association was found between systolic ambulatory BP and carotid intima-media thickness (three studies, n = 231, age 13.3 years, pooled r = 0.32, 95% CI 0.21-0.44), as well as between diastolic ambulatory BP and urine albumin excretion (five studies, n = 355, age 13.1 years, type 1 diabetes 42%, reflux nephropathy 28%, pooled r = 0.32, 95% CI 0.05-0.58). Two studies reported on the association between home BP and LVMI, with one of them showing comparable coefficients as for ambulatory monitoring.
The available evidence suggests a moderate but significant association between ambulatory BP and preclinical organ damage, mainly based on studies in nephropathy and/or diabetes. More data are needed in essential hypertension without nephropathy or diabetes, as well as with home measurements.
在儿童中，非诊室血压（BP）评估（尤其是动态血压监测）被视为准确诊断高血压不可或缺的手段。本文综述了关于儿童非诊室血压测量与临床前器官损害指标之间关联的证据。
对93篇相关文章（1974 - 2012年）进行了系统综述和荟萃分析。
对10项研究（n = 480，汇总年龄14.4岁，高血压患者占33%，肾病患者占27%，1型糖尿病患者占10%）的分析显示，动态收缩压与左心室质量指数（LVMI）之间存在显著关联，汇总相关系数r = 0.40 [95%置信区间（CI）0.30 - 0.50]。11项研究报告了正常血压儿童（n = 428）和高血压儿童（n = 432）之间LVMI差异的数据，后一组的值高6.53 g/m(2.7)（95% CI 4.73 - 8.33）。发现动态收缩压与颈动脉内膜中层厚度之间存在中度关联（三项研究，n = 231，年龄13.3岁，汇总r = 0.32，95% CI 0.21 - 0.44），以及动态舒张压与尿白蛋白排泄之间存在中度关联（五项研究，n = 355，年龄13.1岁，1型糖尿病患者占42%，反流性肾病患者占28%，汇总r = 0.32，95% CI 0.05 - 0.58）。两项研究报告了家庭血压与LVMI之间的关联，其中一项显示出与动态血压监测相当的系数。
现有证据表明动态血压与临床前器官损害之间存在中度但显著的关联，主要基于肾病和/或糖尿病方面的研究。对于无肾病或糖尿病的原发性高血压以及家庭血压测量，还需要更多数据。
