Kim Hyun Jung, Kim Kyung Hee, Kil Hong Ryang
Department of Pediatrics, Eulji Universitiy School of Medicine, Daejeon, Korea.
Department of Pediatrics, Chungnam University School of Medicine, Daejeon, Korea.
Korean J Pediatr. 2014 Sep;57(9):403-9. doi: 10.3345/kjp.2014.57.9.403. Epub 2014 Sep 30.
Although high morning blood pressure (BP) is known to be associated with the onset of cardiovascular events in adults, data on its effects in children with hypertension are limited. Our retrospective study aimed to define the clinical characteristics of children with morning hypertension (MH) and to determine its associated factors.
We reviewed 31 consecutive patients with hypertension, confirmed by the ambulatory blood pressure monitoring (ABPM). We divided these patients into 2 groups: the MH group (n=21, 67.7%), morning BP above the 95th percentile for age and height (2 hours on average after waking up) and the normal morning BP group (n=10, 32.3%). We compared the clinical manifestations, laboratory results, and echocardiographic findings including left ventricular hypertrophy (LVH) between the groups.
The early/atrial (E/A) mitral flow velocity ratio in the MH group was significantly lower than that in the normal morning BP group. In addition, LV mass was higher in the MH group than in the normal morning BP group, although the difference was not statistically significant. The age at the time of hypertension diagnosis was significantly higher in the MH group than in the normal morning BP group (P=0.003). The incidence of hyperuricemia was significantly higher in the MH group than in the normal morning BP group.
Older patients and those with hyperuricemia are at higher risk for MH. The rise in BP in the morning is an important factor influencing the development of abnormal relaxation, as assessed by echocardiography. Clinical trials with longer follow-up periods and larger sample sizes are needed to clarify the clinical significance of MH.
虽然已知清晨高血压与成人心血管事件的发生有关，但关于其在儿童高血压患者中的影响的数据有限。我们的回顾性研究旨在确定清晨高血压（MH）患儿的临床特征并确定其相关因素。
我们回顾了连续31例经动态血压监测（ABPM）确诊的高血压患者。我们将这些患者分为两组：MH组（n = 21，67.7%），清晨血压高于年龄和身高的第95百分位数（醒来后平均2小时），以及清晨血压正常组（n = 10，32.3%）。我们比较了两组之间的临床表现、实验室检查结果以及包括左心室肥厚（LVH）在内的超声心动图检查结果。
MH组二尖瓣血流速度早期/心房（E/A）比值显著低于清晨血压正常组。此外，MH组的左心室质量高于清晨血压正常组，尽管差异无统计学意义。MH组高血压诊断时的年龄显著高于清晨血压正常组（P = 0.003）。MH组高尿酸血症的发生率显著高于清晨血压正常组。
年龄较大的患者和高尿酸血症患者发生MH的风险更高。清晨血压升高是影响超声心动图评估的舒张功能异常发展的重要因素。需要进行更长随访期和更大样本量的临床试验来阐明MH的临床意义。
