From the Cincinnati Children's Hospital Medical Center, OH and University of Cincinnati College of Medicine (G.H., L.J.M., M.M., E.M.U.).
Seattle Children's Hospital, Washington (J.T.F., C.D.H.).
Hypertension. 2018 Oct;72(4):955-961. doi: 10.1161/HYPERTENSIONAHA.118.11530.
Ambulatory blood pressure (BP) monitoring provides a more precise measure of BP status than clinic BP and is currently recommended in the evaluation of high BP in children and adolescents. However, ambulatory BP monitoring may not always be available. Our aim was to determine the clinic BP percentile most likely to predict ambulatory hypertension. We evaluated clinic and ambulatory BP in 247 adolescents (median age, 15.7 years; 63% white; 54% male). Clinic BP percentile (based on the fourth report and the 2017 American Academy of Pediatrics clinical practice guidelines) and ambulatory BP status (normal versus hypertension) were determined by age-, sex-, and height-specific cut points. Sensitivity and specificity of different clinic BP percentiles and cutoffs to predict ambulatory hypertension were calculated. Forty (16%) and 67 (27%) patients had systolic hypertension based on the fourth report and the 2017 guidelines, respectively, whereas 38 (15%) had wake ambulatory systolic hypertension. The prevalence of ambulatory wake systolic hypertension increased across clinic systolic BP percentiles, from 3% when clinic systolic BP was <50th percentile to 41% when ≥95th percentile. The 2017 guidelines' 85th systolic percentile had similar sensitivity (86.8%) and better specificity (57.4% versus 48.1%) than elevated BP (≥90th percentile or ≥120 mm Hg) to diagnose ambulatory hypertension. When evaluating adolescents for hypertension, 2017 guidelines' clinic systolic 85th percentile may be the optimal threshold at which to perform ambulatory BP monitoring.
动态血压监测比诊室血压监测能更精确地测量血压状况，目前被推荐用于评估儿童和青少年的高血压。然而，动态血压监测可能并不总是可用。我们的目的是确定最有可能预测动态高血压的诊室血压百分位数。我们评估了 247 名青少年（中位数年龄 15.7 岁；63%为白人；54%为男性）的诊室血压和动态血压。诊室血压百分位数（基于第四份报告和 2017 年美国儿科学会临床实践指南）和动态血压状态（正常与高血压）是通过年龄、性别和身高特定切点来确定的。计算了不同诊室血压百分位数和切点预测动态高血压的敏感性和特异性。根据第四份报告和 2017 年指南，分别有 40 名（16%）和 67 名（27%）患者存在收缩压高血压，而 38 名（15%）患者存在觉醒时动态收缩压高血压。随着诊室收缩压百分位数的升高，觉醒时动态收缩压高血压的患病率也随之增加，从诊室收缩压<第 50 百分位数时的 3%增加到≥第 95 百分位数时的 41%。2017 年指南的 85 百分位收缩压具有相似的敏感性（86.8%）和更好的特异性（57.4%比 48.1%），高于升高的血压（≥第 90 百分位或≥120mmHg）来诊断动态高血压。在评估青少年高血压时，2017 年指南的诊室收缩压 85 百分位可能是进行动态血压监测的最佳阈值。
