Cantinotti Massimiliano, Giordano Raffaele, Scalese Marco, Molinaro Sabrina, Murzi Bruno, Assanta Nadia, Crocetti Maura, Marotta Marco, Ghione Sergio, Iervasi Giorgio
Department of Pediatric Cardiology and Cardic Surgery, Tuscany Foundation G. Monasterio, Massa, Italy.
Department of Cardiology, Institute of Clinical Physiology, Pisa, Italy.
Hypertens Res. 2015 Sep;38(9):577-87. doi: 10.1038/hr.2015.45. Epub 2015 Apr 16.
The availability of robust nomograms is essential for the correct evaluation of blood pressure (BP) values in children. A literature search was conducted by accessing the National Library of Medicine by using the keywords BP, pediatric and reference values/nomograms. A total of 43 studies that evaluated pediatric BP nomograms were included in this review. Despite the accuracy of the latest studies, many numerical and methodological limitations still remain. The numerical limitations include the paucity of data for neonates/infants and for some geographic areas (Africa/South America/East Europe/Asia) and ethnicities. Furthermore, the data on ambulatory BP and response to exercise are extremely limited, and the criteria for stress-test interruption are lacking. There was heterogeneity in the methodologies employed to perform the measurements, in the inclusion/exclusion criteria (often not reported), in the data normalization and the data expression (Z-scores/percentiles/mean values). Although most studies adjusted the measurements for age and/or height, the classification by specific age/height subgroups varied. Gender differences were generally considered, whereas other confounders (that is, ethnicity/geographic area/environment) were seldom evaluated. As a result, nomograms were heterogeneous, and when comparable, at times showed widely different confidence intervals. These differences are most likely because of both methodological limitations and differences among the populations studied. Some robust nomograms exist (particularly those from the USA); however, it has been demonstrated that if adopted in other countries/continents, they may generate an unpredictable bias in the evaluation of BP values in children. Actual pediatric BP nomograms present consistent limitations that affect the evaluation of BP in children. Comprehensive nomograms, which are based on a large population of healthy children (including neonates/infants) and use standardized methodology, are warranted for every country/region.
强大的列线图对于正确评估儿童血压值至关重要。通过使用关键词“血压”“儿科”和“参考值/列线图”访问美国国立医学图书馆进行了文献检索。本综述共纳入43项评估儿科血压列线图的研究。尽管最新研究具有准确性，但仍存在许多数值和方法学上的局限性。数值局限性包括新生儿/婴儿以及某些地理区域（非洲/南美洲/东欧/亚洲）和种族的数据匮乏。此外，动态血压和运动反应的数据极其有限，且缺乏压力测试中断标准。在进行测量所采用的方法、纳入/排除标准（通常未报告）、数据标准化和数据表达（Z分数/百分位数/平均值）方面存在异质性。尽管大多数研究对年龄和/或身高进行了测量调整，但按特定年龄/身高亚组的分类各不相同。一般考虑了性别差异，而其他混杂因素（即种族/地理区域/环境）很少被评估。结果，列线图存在异质性，并且在可比时，有时显示出差异很大的置信区间。这些差异很可能是由于方法学局限性和所研究人群之间的差异。存在一些强大的列线图（特别是来自美国的那些）；然而，已经证明，如果在其他国家/大陆采用，它们可能会在儿童血压值评估中产生不可预测的偏差。实际的儿科血压列线图存在一致影响儿童血压评估的局限性。每个国家/地区都需要基于大量健康儿童（包括新生儿/婴儿）并使用标准化方法的综合列线图。
