Sharma Ajay P, Mohammed Javed, Thomas Benson, Singh Ram N, Filler Guido
Division of Nephrology, Western University, Children's Hospital, London Health Sciences Centre, London, Ontario ; Department of Pediatrics, Western University, Children's Hospital, London Health Sciences Centre, London, Ontario.
Department of Pediatrics, Western University, Children's Hospital, London Health Sciences Centre, London, Ontario.
Paediatr Child Health. 2015 Aug-Sep;20(6):297-301. doi: 10.1093/pch/20.6.297.
Recent studies have revealed that hypertension remains underdiagnosed in a significant number of children despite their recorded office blood pressure (OBP) exceeding the recommended fourth report OBP thresholds. Simplified OBP thresholds have been proposed to reduce this underdiagnosis of hypertension in children. In clinical practice, OBP screened as elevated according to the fourth report OBP thresholds are referred for ambulatory blood pressure (ABP) monitoring to rule out 'white coat' hypertension.
The present study tested the usefulness of simplified OBP thresholds to screen abnormal OBP for ABP monitoring referral.
A total of 155 subjects were retrospectively analyzed with paired OBP and ABP recordings obtained from an outpatient referral clinic. OBP recordings were classified as abnormal according to the simplified and fourth report OBP thresholds. ABP measurements were classified as abnormal according to the ABP reference tables.
Simplified blood pressure (BP) tables correctly identified all OBP classified as abnormal according to fourth report BP thresholds (kappa [κ] 0.72 [95% CI 0.61 to 0.83]) for systolic OBP; κ 0.92 [95% CI 0.86 to 0.99] for diastolic OBP). OBP classified as abnormal by the simplified BP thresholds and by the fourth report BP thresholds performed similarly for correctly identifying abnormal ABP measurements as per ABP references (overlapping 95% CIs of the sensitivity, specificity and predictive values and likelihood ratios).
Simplified BP tables, proposed to reduce the underdiagnosis of hypertension in children, can serve as a useful screening tool to decide a referral for ABP monitoring. Future prospective studies are needed to establish these findings.
近期研究表明，尽管许多儿童的诊室血压（OBP）记录超过了第四次报告的OBP阈值推荐水平，但高血压在相当数量的儿童中仍未得到充分诊断。已提出简化的OBP阈值以减少儿童高血压的这种漏诊情况。在临床实践中，根据第四次报告的OBP阈值筛查出升高的OBP会被转诊进行动态血压（ABP）监测，以排除“白大衣”高血压。
本研究测试简化的OBP阈值用于筛查异常OBP以转诊进行ABP监测的有效性。
对从门诊转诊诊所获得的155名受试者的配对OBP和ABP记录进行回顾性分析。根据简化和第四次报告的OBP阈值将OBP记录分类为异常。根据ABP参考表将ABP测量分类为异常。
简化血压（BP）表正确识别了所有根据第四次报告的BP阈值分类为异常的OBP（收缩压OBP的kappa [κ]为0.72 [95% CI 0.61至0.83]；舒张压OBP的κ为0.92 [95% CI 0.86至0.99]）。根据简化BP阈值和第四次报告BP阈值分类为异常的OBP在根据ABP参考正确识别异常ABP测量方面表现相似（敏感性、特异性、预测值和似然比的95% CI重叠）。
为减少儿童高血压漏诊而提出的简化BP表可作为决定转诊进行ABP监测的有用筛查工具。需要未来的前瞻性研究来证实这些发现。
