Department of Pediatrics, University Hospital Jena, Jena, Germany
Pediatric Endocrinology and Diabetology, Haunersche Kinderklinik, Munich, Germany.
Diabetes Care. 2020 Jun;43(6):1311-1318. doi: 10.2337/dc19-2022. Epub 2020 Mar 30.
In 2017, the American Academy of Pediatrics introduced a new guideline (2017 Clinical Practice Guideline of the American Academy of Pediatrics [AAP 2017]) to diagnose arterial hypertension (HTN) in children that included revised, lower normative blood pressure (BP) values and cut points for diagnosing high BP in adolescents. We studied the impact of the new AAP 2017 on prevalence of HTN in children with type 1 diabetes mellitus (T1DM).
Up to September 2018, 1.4 million office BP measurements in 79,849 children and adolescents (aged 5-20 years) with T1DM were documented in the DPV (Diabetes Prospective Follow-up) registry. BP values of the most recent year were aggregated, and BP values of 74,677 patients without antihypertensive medication were analyzed (median age 16 years and diabetes duration 5.3 years, 52.8% boys). BP values were classified according to AAP 2017 and the references of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) (2011) and the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (fourth report) (2004).
Of the patients, 44.1%, 29.5%, and 26.5% were hypertensive according to AAP 2017, KiGGS, and fourth report, respectively. Differences in prevalence of HTN were strongly age dependent: <10 years, AAP 2017 31.4%, KiGGS 30.7%, fourth report 19.6%; 10 to <15 years, AAP 2017 30.9%, KiGGS 31.2%, fourth report 22.4%; and ≥15 years, AAP 2017 53.2%, KiGGS 28.4%, fourth report 30.0%. Among teenagers ≥15 years, 59.1% of boys and only 46.3% of girls were classified as hypertensive by AAP 2017 but only 21.1%/26% of boys and 36.7%/34.4% of girls by KiGGS/fourth report, respectively.
Classification of BP as hypertension depends strongly on the normative data used. Use of AAP 2017 results in a significant increase in HTN in teenagers ≥15 years with T1DM, particularly in boys. AAP 2017 enhances the awareness of elevated BP in children, particularly in patients with increased risk for cardiovascular disease.
2017 年，美国儿科学会（AAP）发布了一项新的临床实践指南（AAP 2017），用于诊断儿童的动脉高血压（HTN），其中包括修订后的、更低的血压正常值和青少年高血压诊断的切点。我们研究了新的 AAP 2017 对 1 型糖尿病（T1DM）儿童 HTN 患病率的影响。
截至 2018 年 9 月，在 DPV（糖尿病前瞻性随访）登记处记录了 79849 名 5-20 岁 T1DM 儿童和青少年的多达 140 万次门诊血压测量值。汇总了最近一年的血压值，并分析了 74677 名未服用抗高血压药物患者的血压值（中位年龄 16 岁，糖尿病病程 5.3 年，52.8%为男性）。根据 AAP 2017 以及德国儿童和青少年健康访谈和检查调查（KiGGS）（2011 年）和第四次儿童和青少年高血压诊断、评估和治疗报告（第四次报告）（2004 年）的参考标准对血压值进行分类。
根据 AAP 2017、KiGGS 和第四次报告，患者中分别有 44.1%、29.5%和 26.5%患有高血压。高血压患病率的差异与年龄密切相关：<10 岁时，AAP 2017 为 31.4%，KiGGS 为 30.7%，第四次报告为 19.6%；10-<15 岁时，AAP 2017 为 30.9%，KiGGS 为 31.2%，第四次报告为 22.4%；≥15 岁时，AAP 2017 为 53.2%，KiGGS 为 28.4%，第四次报告为 30.0%。在≥15 岁的青少年中，AAP 2017 诊断为高血压的男孩为 59.1%，而女孩仅为 46.3%，而 KiGGS/第四次报告中，男孩分别为 21.1%/26%，女孩为 36.7%/34.4%。
高血压的血压分类很大程度上取决于使用的正常参考值。使用 AAP 2017 会导致患有 T1DM 的≥15 岁青少年的 HTN 显著增加，尤其是男孩。AAP 2017 提高了对儿童血压升高的认识，特别是对心血管疾病风险增加的患者。
