Section of Pediatric Endocrinology, Child Health Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Pediatr. 2018 Jun 1;172(6):557-565. doi: 10.1001/jamapediatrics.2018.0223.
Based on the new 2017 blood pressure guidelines, the prevalence of high blood pressure (BP) among adults has increased from 32% to 46%. Based on new norms and diagnostic thresholds that better align with adult definitions, new clinical practice guidelines were also published for children. The American Academy of Pediatrics clinical practice guidelines for the management of elevated BP in children replace the 2004 fourth report from the National Heart, Lung, and Blood Institute.
To assess the consequences of the American Academy of Pediatrics clinical practice guidelines for the management of elevated BP in children on the prevalence and severity of elevated BP among children and to characterize risk factors for children with new-onset hypertension or a worsening in clinical stage ("reclassified upward").
DESIGN, SETTING, AND PARTICIPANTS: This study applied both sets of guidelines to classify BP in 15 647 generally healthy, low-risk children aged 5 to 18 years from National Health and Nutrition Examination Surveys (from January 1, 1999, to December 31, 2014). In the case-control portion of the study, children whose BP was reclassified upward (cases) were matched for sex, age, and height with controls with normal BP. Anthropometric and laboratory risk factors were compared, and age- and sex-specific z scores for weight, waist circumference, and body mass index were calculated. Blood pressure was measured by auscultation by trained personnel. After the child rested quietly for 5 minutes, 3 to 4 consecutive BP readings were recorded.
Blood pressure percentiles and clinical classification based on either the 2017 American Academy of Pediatrics guidelines or the 2004 National Heart, Lung, and Blood Institute report.
Among the 15 647 children in the study (7799 girls and 7848 boys; mean [SD] age, 13.4 [2.8] years), based on the American Academy of Pediatrics guidelines, the estimated (weighted) population prevalence of elevated BP increased from 11.8% (95% CI, 11.1%-13.0%) to 14.2% (95% CI, 13.4%-15.0%). Overall, 905 of 15 584 children (5.8%) had newly diagnosed hypertension (n = 381) or a worsening in clinical stage (n = 524), which represents a substantial increase in disease burden for the health care system. Children whose BP was reclassified upward were more likely to be overweight or obese, with higher z scores for weight, waist circumference, and body mass index. The prevalence of abnormal laboratory test results was also increased, with adverse lipid profiles and increased hemoglobin A1c levels (prediabetes).
Clustering of cardiovascular risk factors in otherwise healthy US children suggests that those whose BP was reclassified represent a high-risk population whose cardiovascular risk may previously have been underestimated.
根据 2017 年新的血压指南，成年人高血压（BP）的患病率从 32%上升到 46%。基于与成人定义更好匹配的新规范和诊断阈值，也为儿童发布了新的临床实践指南。美国儿科学会（AAP）治疗儿童血压升高的临床实践指南取代了 2004 年美国国家心肺血液研究所（National Heart, Lung, and Blood Institute）的第四份报告。
评估美国儿科学会（AAP）治疗儿童血压升高的临床实践指南对儿童血压升高的患病率和严重程度的影响，并描述新诊断为高血压或临床分期恶化（“重新分类为更高阶段”）的儿童的危险因素。
设计、地点和参与者：本研究应用两套指南对来自全国健康和营养检查调查（National Health and Nutrition Examination Surveys，NHANES）的 15647 名年龄在 5 至 18 岁的一般健康、低危儿童的血压进行分类（从 1999 年 1 月 1 日至 2014 年 12 月 31 日）。在该研究的病例对照部分，血压重新分类为升高的儿童（病例）按性别、年龄和身高与血压正常的对照匹配。比较了体格测量和实验室危险因素，并计算了体重、腰围和体重指数的年龄和性别特异性 z 分数。血压由经过培训的人员通过听诊测量。在儿童安静休息 5 分钟后，记录 3 到 4 次连续血压读数。
基于 2017 年美国儿科学会指南或 2004 年美国国家心肺血液研究所报告的血压百分位数和临床分类。
在这项研究的 15647 名儿童（7799 名女孩和 7848 名男孩；平均[标准差]年龄，13.4[2.8]岁）中，根据美国儿科学会指南，血压升高的估计（加权）人群患病率从 11.8%（95%CI，11.1%-13.0%）增加到 14.2%（95%CI，13.4%-15.0%）。总体而言，15584 名儿童中有 905 名（5.8%）新诊断为高血压（n=381）或临床分期恶化（n=524），这代表医疗系统的疾病负担大幅增加。血压重新分类为升高的儿童更有可能超重或肥胖，体重、腰围和体重指数的 z 分数更高。异常实验室检查结果的发生率也有所增加，表现为血脂异常和糖化血红蛋白水平升高（糖尿病前期）。
美国健康儿童心血管危险因素的聚集表明，那些血压重新分类为升高的儿童代表了一个高风险人群，其心血管风险可能以前被低估了。
