Grisaru Silviu, Yue Melissa, Samuel Susan M, Chaput Kathleen H, Hamiwka Lorraine A
Department of Pediatrics, Cumming Section of Medicine, University of Calgary, Calgary, Alberta.
Werklund School of Education, University of Calgary, Calgary, Alberta.
Paediatr Child Health. 2018 Sep;23(6):e102-e108. doi: 10.1093/pch/pxx207. Epub 2018 Mar 5.
Children with attention deficit/hyperactivity disorder (ADHD) are frequently treated with psycho-stimulant agents causing a modest but significant increase in blood pressure and heart rate. The objective of this study was to define blood pressure characteristics in children with ADHD treated with a variety of medications in a community setup.
Children registered at a large paediatric clinic in Calgary, AB with documented histories of ADHD were randomly contacted. Consenting participants had standardized office BP measurements, ambulatory blood pressure monitoring (ABPM) studies and were asked to complete the sleep disturbance scale for children (SDSC) questionnaire. Findings were compared with data from the Canadian Health Measures Survey (CMHS).
Fifty-five children (47 males) aged 7 to 17 years (average 11.6 ± 2.5 years) with an average BMI z-score of -0.37 ± 1.22 completed the study. All children were medicated, the majority (82%), with various types of stimulant agents. Elevated office BP values were more prevalent than in the CMHS; >90th percentile in 5 (9.1%) and >95th percentile in 3 (5.5%). ABPM confirmed 'white coat hypertension' in 3 (5.5%), masked hypertension in 2 (3.6%) and nondipping in 28 (51%). The SDSC score suggested that 43 (78%) children had disturbed sleep. Logistic regression modelling indicated that nondipping correlated with disturbed sleep.
The 'white coat' phenomenon may be responsible for increased prevalence of elevated rest/office BP values in children with ADHD. Prevalent sleep 'non-dipping' in this population is associated with sleep disturbances but clinical significance of this finding requires further investigation.
患有注意力缺陷多动障碍（ADHD）的儿童经常接受精神兴奋剂治疗，这会导致血压和心率适度但显著升高。本研究的目的是确定在社区环境中接受多种药物治疗的ADHD儿童的血压特征。
随机联系在加拿大阿尔伯塔省卡尔加里一家大型儿科诊所登记且有ADHD病史记录的儿童。同意参与的受试者进行了标准化的诊室血压测量、动态血压监测（ABPM）研究，并被要求完成儿童睡眠障碍量表（SDSC）问卷。研究结果与加拿大健康测量调查（CMHS）的数据进行了比较。
55名年龄在7至17岁（平均11.6±2.5岁）的儿童（47名男性）完成了研究，平均BMI z评分-0.37±1.22。所有儿童均接受药物治疗，大多数（82%）使用了各种类型的兴奋剂。诊室血压值升高比CMHS中更为普遍；5名儿童（9.1%）超过第90百分位数，3名儿童（5.5%）超过第95百分位数。ABPM证实3名儿童（5.5%）有“白大衣高血压”，2名儿童（3.6%）有隐匿性高血压，28名儿童（51%）有血压非勺型变化。SDSC评分显示43名儿童（78%）睡眠受到干扰。逻辑回归模型表明，血压非勺型变化与睡眠干扰相关。
“白大衣”现象可能是导致ADHD儿童静息/诊室血压值升高患病率增加的原因。该人群中普遍存在的睡眠“非勺型”变化与睡眠干扰有关，但这一发现的临床意义需要进一步研究。
