Oh Jin Hee, Hong Young Mi
Department of Pediatrics, St.Vincent's Hospital, The Catholic University of Korea, Seoul, Korea.
Department of Pediatrics, Ewha Womans University Hospital College of Medicine, Seoul, Korea.
Korean Circ J. 2019 Mar;49(3):223-237. doi: 10.4070/kcj.2018.0448.
It has been known for a long time that elevated blood pressure (BP) in the young may persist and progress into adult hypertension (HTN). Multiple studies have revealed the predicted BP trajectory lines starting from childhood and related them to later cardiovascular (CV) risks in adulthood. As a small baby grows into a tall adult, BP will also naturally increase. Among early-life predictors of adult HTN, birth history, such as prematurity, and low birth weight have been popular subjects in research on pediatric HTN, because body size at birth has been reported to be inversely related to the risk of adulthood HTN. The hypothesis of HTN in prematurely born adolescents has been postulated as a physiological predisposition to postnatal excessive weight gain. Current body weight is a well-known independent predictor of HTN in children, and some studies showed that children demonstrating upward crossing of their weight percentiles while growing into adolescents have significantly increased risk for elevated BP later in life. Recently, reports focused on the adverse effect of excessive catch-up growth in this population are gradually drawing attention. Accordingly, children born prematurely or with intrauterine growth restriction who show rapid changes in their weight percentile should be under surveillance with BP monitoring. Prevention of childhood obesity, along with special care for premature infants or infants small for their gestational age, by providing healthy nutritional guidelines should be cardinal strategies for the prevention of adult HTN and CV risks later in life.
长期以来，人们都知道年轻人血压升高可能会持续并发展为成人高血压。多项研究揭示了从儿童期开始的预测血压轨迹线，并将它们与成年后期的心血管风险联系起来。随着一个小婴儿成长为高大的成年人，血压也会自然升高。在成人高血压的早期预测因素中，出生史，如早产和低出生体重，一直是小儿高血压研究中的热门课题，因为据报道出生时的体型与成年期高血压风险呈负相关。早产青少年患高血压的假说被认为是出生后体重过度增加的生理易感性。目前的体重是儿童高血压的一个众所周知的独立预测因素，一些研究表明，在成长为青少年过程中体重百分位数呈上升趋势的儿童，日后患高血压的风险会显著增加。最近，关注该人群过度追赶生长的不良影响的报告逐渐引起了关注。因此，早产或有子宫内生长受限的儿童，若体重百分位数有快速变化，应进行血压监测。通过提供健康的营养指南来预防儿童肥胖，同时对早产儿或小于胎龄儿给予特别护理，应是预防成年期高血压和日后心血管风险的主要策略。
