Wirix Aleid J G, Verheul Jelle, Groothoff Jaap W, Nauta Jeroen, Chinapaw Mai J M, Kist-van Holthe Joana E
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands.
Department of Paediatric Nephrology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
J Nephrol. 2017 Feb;30(1):119-125. doi: 10.1007/s40620-016-0277-6. Epub 2016 Mar 3.
Hypertension in obese children may require a different diagnostic and treatment approach from that for children with secondary hypertension, yet there is neither consensus nor a clear guideline. The aim of this study was to assess how obese children with hypertension are currently diagnosed and treated by paediatric nephrologists, what obstacles exist and what can be improved. In the period May-November 2014, an online questionnaire was sent to all members of the European Society for Paediatric Nephrology (n = 2148). Questions focused on current practices and obstacles regarding screening, diagnosis and treatment of hypertension in obese children. A total of 214 paediatric nephrologists responded. Although nearly 100 % agreed that screening of obese children for hypertension is indicated, it was current practice in only 56 % of participating countries; 88 % of respondents diagnosed hypertension with 24-h ambulatory blood pressure measurement. Diagnostics used to rule out causes or consequences of hypertension varied among the respondents; they included, in particular, the use of serum renin/aldosterone, urine sodium/potassium, and dimercaptosuccinic acid scan. Concerning treatment, 45 % of respondents preferred to start treatment with a lifestyle program, 2 % with antihypertensive medication, and 40 % with both. For 73 % of respondents, angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers were the drugs of first choice. The findings of this study emphasize the urgent need for an international guideline for screening, diagnosis and treatment of hypertension in obese children.
肥胖儿童的高血压可能需要与继发性高血压儿童不同的诊断和治疗方法，但目前尚无共识，也缺乏明确的指南。本研究的目的是评估儿科肾病学家目前如何诊断和治疗肥胖高血压儿童，存在哪些障碍以及哪些方面可以改进。在2014年5月至11月期间，向欧洲儿科肾脏病学会的所有成员（n = 2148）发送了一份在线问卷。问题集中在肥胖儿童高血压筛查、诊断和治疗的当前做法及障碍。共有214名儿科肾病学家回复。尽管近100%的人认为应对肥胖儿童进行高血压筛查，但只有56%的参与国将其作为当前做法；88%的受访者通过24小时动态血压测量来诊断高血压。受访者用于排除高血压病因或后果的诊断方法各不相同；尤其包括使用血清肾素/醛固酮、尿钠/钾以及二巯基丁二酸扫描。关于治疗，45%的受访者倾向于先采用生活方式干预，2%倾向于使用抗高血压药物，40%倾向于两者并用。对于73%的受访者来说，血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂是首选药物。本研究结果强调迫切需要制定肥胖儿童高血压筛查、诊断和治疗的国际指南。
