Flechtner-Mors Marion, Neuhauser Hannelore, Reinehr Thomas, Roost Hans-Peter, Wiegand Susanna, Siegfried Wolfgang, Zwiauer Karl, Molz Esther, Holl Reinhard W
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany.
Robert Koch-Institute, Berlin, Germany.
Am J Cardiol. 2015 Jun 1;115(11):1587-94. doi: 10.1016/j.amjcard.2015.02.063. Epub 2015 Mar 14.
The aim of this study was to determine the prevalence of hypertension in overweight or obese pediatric subjects using different national or international references, which are based either on the entire population or on normal weight children only: 188 centers from Germany, Austria, and Switzerland participated in the Adipositas Patienten Verlaufsbeobachtung initiative. Data from 57,915 children aged 6 to 18 years who are overweight or obese were used to determine the prevalence of prehypertension and hypertension based on Second Task Force, European pooled data, Fourth Report all and Fourth Report nonoverweight, or German Health Interview and Examination Survey for Children and Adolescents (KiGGS) references. Three references included overweight children, whereas 2 (Fourth Report nonoverweight and KiGGS) were based on nonoverweight children only. Based on KiGGS, Fourth Report nonoverweight, Fourth Report all, European pooled data, or Second Task Force, the prevalence of hypertension was 47%, 42%, 36%, 32%, and 27%, respectively. Recent references classified more children as hypertensive, whereas fewer children fell into the prehypertensive group. Only 22% of children were classified as hypertensive by each of the 5 references (8% as prehypertensive). The prevalence of normal blood pressure was independent of the reference applied. Hypertension as defined by the different reference systems was significantly correlated, and all methods were significantly associated with impaired glucose metabolism or dyslipidemia, without significant differences in methods. In conclusion, the diagnosis of elevated blood pressure depends on the reference population used. A nonoverweight reference population substantially increases the prevalence of hypertension in children and adolescents who are overweight or obese. The choice of the reference has significant implications for risk stratification and treatment decisions.
本研究的目的是使用不同的国家或国际参考标准，确定超重或肥胖儿童受试者中高血压的患病率，这些参考标准要么基于全体人群，要么仅基于正常体重儿童：来自德国、奥地利和瑞士的188个中心参与了肥胖患者病程观察倡议。对57915名6至18岁超重或肥胖儿童的数据进行分析，以根据第二次特别工作组标准、欧洲汇总数据、第四次报告全部数据和第四次报告非超重数据，或德国儿童和青少年健康访谈与检查调查（KiGGS）参考标准来确定高血压前期和高血压的患病率。其中三个参考标准纳入了超重儿童，而另外两个（第四次报告非超重数据和KiGGS）仅基于非超重儿童。基于KiGGS、第四次报告非超重数据、第四次报告全部数据、欧洲汇总数据或第二次特别工作组标准，高血压患病率分别为47%、42%、36%、32%和27%。最近的参考标准将更多儿童归类为高血压患者，而属于高血压前期组的儿童较少。只有22%的儿童在所有5种参考标准下都被归类为高血压患者（8%为高血压前期）。正常血压的患病率与所采用的参考标准无关。不同参考系统定义的高血压之间存在显著相关性，并且所有方法都与糖代谢受损或血脂异常显著相关，各方法之间无显著差异。总之，血压升高的诊断取决于所使用的参考人群。以非超重人群为参考标准会大幅提高超重或肥胖儿童及青少年中高血压的患病率。参考标准的选择对风险分层和治疗决策具有重大影响。
