From the Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China (D.T.).
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.T., F.C., B.R., C.W., B.L.).
Hypertension. 2019 Jun;73(6):1217-1223. doi: 10.1161/HYPERTENSIONAHA.118.12469.
We aimed to evaluate the consequences of the 2017 pediatric hypertension definitions, compared with the 2004 pediatric hypertension definitions on the prevalence of hypertension and to assess the performance of these 2 sets of guidelines in predicting adult hypertension, metabolic syndrome, and left ventricular hypertrophy (LVH). This longitudinal study consisted of 3940 children (47% male; ages 3-18 years) who came from the Bogalusa Heart Study with 36-year follow-up since childhood. Hypertension was identified in 7% and 11% as defined in the 2004 and 2017 guidelines, respectively. The 2004 and 2017 guidelines demonstrated similar associations with adulthood hypertension, metabolic syndrome, and LVH. However, the proportion of children identified as having hypertension who developed adult LVH increased from 12% when defined by the 2004 guidelines to 19% when defined by the 2017 guidelines. Overall, the 329 (8%) children who were reclassified to higher blood pressure categories by the 2017 guidelines were more likely than their propensity score-matched normotensive counterparts to develop hypertension, metabolic syndrome, and LVH in later life, whereas 38 (1%) children who were reclassified to lower blood pressure categories by the 2017 guidelines had similar cardiometabolic outcomes to their propensity score-matched normotensive counterparts. Hence, children who were reclassified to higher blood pressure categories based on 2017 guidelines were at increased risk of developing hypertension, metabolic syndrome, and LVH in later life. The 2017 guidelines identified a group of children with adverse metabolic profile and cardiometabolic outcomes, whose cardiovascular risk seemed to be underestimated using the 2004 guidelines.
我们旨在评估 2017 年儿科高血压定义与 2004 年儿科高血压定义相比对高血压患病率的影响，并评估这两套指南在预测成人高血压、代谢综合征和左心室肥厚（LVH）方面的表现。这项纵向研究包括 3940 名儿童（47%为男性；年龄 3-18 岁），他们来自博加卢萨心脏研究，自儿童时期以来已经随访了 36 年。按照 2004 年和 2017 年指南的定义，分别有 7%和 11%的儿童被诊断为高血压。2004 年和 2017 年的指南与成年期高血压、代谢综合征和 LVH 均具有相似的相关性。然而，按照 2004 年指南定义为高血压的儿童中，有 12%发展为成年 LVH，而按照 2017 年指南定义为高血压的儿童中，这一比例上升至 19%。总的来说，按照 2017 年指南重新分类为更高血压类别（血压类别升高）的 329 名（8%）儿童比其倾向性评分匹配的正常血压对照者更有可能在以后的生活中患上高血压、代谢综合征和 LVH，而按照 2017 年指南重新分类为更低血压类别（血压类别降低）的 38 名（1%）儿童与他们的倾向性评分匹配的正常血压对照者具有相似的心血管代谢结局。因此，基于 2017 年指南重新分类为更高血压类别的儿童在以后的生活中患高血压、代谢综合征和 LVH 的风险增加。2017 年指南确定了一组代谢不良和心血管代谢结局不良的儿童，使用 2004 年指南似乎低估了他们的心血管风险。
