Seeman Tomáš, Hradský Ondřej, Gilík Jiří
Department of Pediatrics, Second Medical School, University Hospital Motol, Charles University Prague, V Úvalu 84, 15006, Prague, Czech Republic.
Kardiocentrum and Centre for Cardiovascular Research, University Hospital Motol, Prague, Czech Republic.
Eur J Pediatr. 2016 Aug;175(8):1091-7. doi: 10.1007/s00431-016-2749-z. Epub 2016 Jun 25.
The aim of our study was to investigate whether nocturnal blood pressure (BP) dip is associated with increased left ventricular mass index and hypertrophy in children with hypertension (HT). We retrospectively reviewed data from all children with confirmed ambulatory HT in our center and performed ambulatory blood pressure monitoring (ABPM) and echocardiography at the same time. Left ventricular hypertrophy (LVH) was defined as left ventricular mass index (LVMI) ≥95th centile. Non-dipping phenomenon was defined as nocturnal BP dip <10 %. A total of 114 ABPM studies were included, the median age of children was 15.3 years (3.8-18.9), 80 children had renoparenchymal HT without end-stage renal failure, 34 had primary HT, and 27 studies were done on untreated children and 87 on treated children. Non-dipping phenomenon was present in 63 (55 %) studies (non-dippers). The LVMI adjusted for age was not significantly different between non-dippers and dippers (0.87 ± 0.03 vs. 0.81 ± 0.02, p = 0.13). Left ventricular hypertrophy was not significantly higher in non-dippers than in dippers (20 vs. 9 %, p = 0.12).
Hypertensive children without end-stage renal failure with non-dipping phenomenon do not have increased prevalence of LVH or higher LVMI adjusted for age than hypertensive children with preserved nocturnal BP dip.
• Adult and pediatric hypertensive patients with end-stage renal failure have often nocturnal blood pressure non-dipping phenomenon. • Non-dipping phenomenon is in patients with end-stage renal failure associated with increased prevalence of left ventricular hypertrophy. What is New: • Pediatric hypertensive patients without end-stage renal failure with blood pressure non-dipping phenomenon do not have increased prevalence of left ventricular hypertrophy.
我们研究的目的是调查夜间血压下降是否与高血压(HT)儿童的左心室质量指数增加和肥厚有关。我们回顾性分析了本中心所有确诊为动态高血压儿童的数据,并同时进行了动态血压监测(ABPM)和超声心动图检查。左心室肥厚(LVH)定义为左心室质量指数(LVMI)≥第95百分位数。非勺型现象定义为夜间血压下降<10%。共纳入114项ABPM研究,儿童的中位年龄为15.3岁(3.8 - 18.9岁),80名儿童患有肾实质HT且无终末期肾衰竭,34名患有原发性HT,27项研究针对未治疗儿童,87项针对已治疗儿童。63项(55%)研究存在非勺型现象(非勺型者)。非勺型者和勺型者经年龄调整后的LVMI无显著差异(0.87±0.03 vs. 0.81±0.02,p = 0.13)。非勺型者的左心室肥厚并不比勺型者显著更高(20% vs. 9%,p = 0.12)。
无终末期肾衰竭的高血压儿童中,出现非勺型现象者与夜间血压下降正常的高血压儿童相比,左心室肥厚的患病率并未增加,且经年龄调整后的LVMI也未更高。
• 患有终末期肾衰竭的成人和儿童高血压患者常出现夜间血压非勺型现象。• 终末期肾衰竭患者的非勺型现象与左心室肥厚患病率增加有关。新发现:• 无终末期肾衰竭的儿童高血压患者出现血压非勺型现象时,左心室肥厚的患病率并未增加。