Sharma Ajaya, Altamirano-Diaz Luis, Grattan Michael, Filler Guido, Sharma Ajay P
Faculty of Medical Sciences, University of Western Ontario, London, Ontario, Canada.
Division of Cardiology, London Health Sciences Centre, London, Ontario, Canada.
Kidney Int Rep. 2020 Jan 30;5(5):611-617. doi: 10.1016/j.ekir.2020.01.017. eCollection 2020 May.
The influence of using 24-hour ambulatory blood pressure (ABP) thresholds recommended by the American Heart Association (AHA) (24-hour mean ABP >95th percentile and ABP load >25%) or the European Society of Hypertension (ESH) (mean 24-hour ABP >95th percentile or >130/80 mm Hg if mean ABP 95th percentile exceeds 130/80 mm Hg) on the diagnosis of pediatric hypertension has been understudied.
In a cross-sectional, retrospective study of 159 children from a tertiary care outpatient clinic, we classified office blood pressure (OBP) as normotension or hypertension based on the OBP thresholds recommended by the American Academy of Pediatrics (AAP) and the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents (herein referred to as the fourth report) by the National High Blood Pressure Educational Program Working Group on High Blood Pressure in Children and Adolescents separately. Thereafter, we evaluated the agreement between the ambulatory AHA and ESH thresholds for diagnosing normotension, white-coat hypertension (WCH), masked hypertension (MH), and hypertension based on the patient's ABP and OBP hypertension pattern.
With office hypertension as per the AAP thresholds, the AHA and ESH thresholds classified 85% of subjects similarly into normotension, WCH, MH, and hypertension (κ = 0.78; 95% CI, 0.67-0.89). The agreement between the AHA and ESH thresholds did not change when OBP was reclassified by the fourth-report OBP thresholds (κ = 0.77; 95% CI, 0.65-0.88). With OBP classified by either AAP or fourth-report thresholds, the ESH thresholds diagnosed 6% to 7% more children as hypertensive, whereas the AHA threshold classified 11% more children as normotensive.
The AHA and ESH thresholds have good agreement in classifying OBP. However, the ESH threshold classifies more OBP as hypertensive and the AHA threshold classifies more OBP as normotensive.
美国心脏协会（AHA）推荐的24小时动态血压（ABP）阈值（24小时平均ABP>第95百分位数且ABP负荷>25%）或欧洲高血压学会（ESH）推荐的阈值（24小时平均ABP>第95百分位数，或若平均ABP第95百分位数超过130/80 mmHg，则>130/80 mmHg）对儿童高血压诊断的影响尚未得到充分研究。
在一项对三级医疗门诊诊所的159名儿童进行的横断面回顾性研究中，我们分别根据美国儿科学会（AAP）推荐的诊室血压（OBP）阈值以及儿童和青少年高血压诊断、评估和治疗第四次报告（以下简称第四次报告），由儿童和青少年高血压国家教育项目工作组将OBP分类为正常血压或高血压。此后，我们根据患者的ABP和OBP高血压模式，评估了动态AHA和ESH阈值在诊断正常血压、白大衣高血压（WCH）、隐匿性高血压（MH）和高血压方面的一致性。
按照AAP阈值诊断为诊室高血压时，AHA和ESH阈值将85%的受试者类似地分类为正常血压、WCH、MH和高血压（κ=0.78；95%CI，0.67-0.89）。当根据第四次报告的OBP阈值重新分类OBP时，AHA和ESH阈值之间的一致性没有变化（κ=0.77；95%CI，0.65-0.88）。无论OBP是根据AAP还是第四次报告的阈值进行分类，ESH阈值诊断为高血压的儿童多6%至7%，而AHA阈值诊断为正常血压的儿童多11%。
AHA和ESH阈值在分类OBP方面具有良好的一致性。然而，ESH阈值将更多的OBP分类为高血压，而AHA阈值将更多的OBP分类为正常血压。
