Kaplinski Michelle, Griffis Heather, Liu Fang, Tinker Craig, Laney Nina C, Mendoza Melodee, Cohen Meryl S, Meyers Kevin, Natarajan Shobha S
Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.
Clin Pediatr (Phila). 2020 Mar;59(3):228-235. doi: 10.1177/0009922819898180. Epub 2020 Jan 1.
Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.
小儿系统性高血压（HTN）的诊断不足且治疗不充分。我们机构的心脏病学和肾脏病学部门制定了一项全面的门诊HTN计划，以（1）筛查有HTN风险的儿童，（2）评估心血管健康，以及（3）优化药物治疗。我们报告了2011年12月至2018年9月期间所有初次就诊（n = 304）的结果。在该队列中，38%为肥胖儿童，36%表示几乎不运动或不运动。超过一半的11岁及以上患者未进行推荐的血脂筛查。在评估动态血压监测结果时，诊所血压不能准确诊断有无HTN的患者，许多服用抗高血压药物的患者治疗不充分。就诊建议包括35%的患者增加或更换抗高血压药物。一个致力于小儿HTN的多学科计划有助于筛查有风险的患者。动态血压监测可识别诊所血压正常的患者以及服用抗高血压药物的患者中的HTN。
