Dibeklioglu Saime Ergen, Çevik Berna Şaylan, Acar Banu, Özçakar Zeynep Birsin, Uncu Nermin, Kara Nazlı, Çaycı Şemsa, Çakar Nilgün
J Pediatr Endocrinol Metab. 2017 Feb 1;30(2):167-174. doi: 10.1515/jpem-2016-0170.
Obesity and hypertension (HT) are well known cardiac risk factors. Our goal was to show that even if arterial blood pressure (BP) measurements of obese adolescents are normal during clinical examination, ambulatory blood pressure monitoring (ABPM) can be high, may include cardiac involvement and can also detect left ventricular mass indices (LVMI) value for obese adolescents to diagnose left ventricular hypertrophy (LVH).
This study included 130 children (57 obese hypertensive, 36 obese normotensive, 14 normal weight hypertensive and 23 normal weight normotensive). Adolescents whose BP was measured during clinical examination, after 24-h BP was detected using ABPM, were examined with echocardiography for calculation of LVMI to determine cardiac risk factors for LVH.
There was a significant difference between the LVMI of obese-normotensive and obese-hypertensive adolescents, which showed the effect of obesity on LVMI independent of HT. Twenty (35.7%) of 56 obese adolescents with HT detected with ABPM had normal BP measurements during clinical examination. Dipper and nondipper features of obese adolescents were significantly higher in ABPM than those with normal body mass index. When the cutoff LVMI value for LVH was set at ≥38 g/m2.7, 38.9% of obese-normotensive and 50.9% of obese-hypertensive subjects had LVH; however, when the cutoff value was set at ≥51 g/m2.7, the rates were 2.8% and 19.3%, respectively.
Obesity is a risk factor for LVH independent of HT. To identify masked HT, 24-h ABPM and cardiac examination should be routinely performed in obese adolescents. Using a limit of LVMI ≥38 g/m2.7 in evaluating LVH secondary to HT in obese individuals may lead to an overestimated diagnosis rate of LVH.
肥胖和高血压是众所周知的心脏危险因素。我们的目标是表明，即使肥胖青少年在临床检查期间动脉血压（BP）测量正常，动态血压监测（ABPM）结果也可能偏高，可能存在心脏受累情况，并且还能检测肥胖青少年的左心室质量指数（LVMI）值以诊断左心室肥厚（LVH）。
本研究纳入了130名儿童（57名肥胖高血压、36名肥胖血压正常、14名正常体重高血压和23名正常体重血压正常）。在临床检查时测量血压的青少年，在通过ABPM检测24小时血压后，接受超声心动图检查以计算LVMI，从而确定LVH的心脏危险因素。
肥胖血压正常和肥胖高血压青少年的LVMI之间存在显著差异，这表明肥胖对LVMI有影响，且独立于高血压。通过ABPM检测出患有高血压的56名肥胖青少年中，有20名（35.7%）在临床检查期间血压测量正常。肥胖青少年在ABPM中的勺型和非勺型特征显著高于体重指数正常者。当LVH的LVMI临界值设定为≥38 g/m².⁷时，38.9%的肥胖血压正常者和50.9%的肥胖高血压者患有LVH；然而，当临界值设定为≥51 g/m².⁷时，这一比例分别为2.8%和19.3%。
肥胖是独立于高血压的LVH危险因素。为了识别隐匿性高血压，应常规对肥胖青少年进行24小时ABPM和心脏检查。在评估肥胖个体因高血压继发的LVH时，使用LVMI≥38 g/m².⁷的限值可能会导致LVH诊断率被高估。
