Bhatt Girish C, Pakhare Abhijit P, Gogia Priya, Jain Shikha, Gupta Nayan, Goel Sudhir K, Malik Rajesh
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS) Bhopal, Bhopal, India.
Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS) Bhopal, Bhopal, India.
Front Pediatr. 2020 May 19;8:232. doi: 10.3389/fped.2020.00232. eCollection 2020.
The epidemic of obesity, along with hypertension (HT) and cardiovascular disease, is a growing contributor to global disease burden. It is postulated that obese children are predisposed to hypertension and subsequent cardiovascular disease in adulthood. Early detection and management of hypertension in these children can significantly modify the course of the disease. However, there is a paucity of studies for the characterization of blood pressure in obese children through ambulatory blood pressure monitoring (ABPM), especially in the developing world. This study aims to characterize ambulatory blood pressure in obese children and to explore feasibility of using office BP that will predict ambulatory hypertension. In the present study, 55 children with a body mass index (BMI) in the ≥95th percentile for age and sex were enrolled in a tertiary care hospital and underwent 24 h of ABPM and detailed biochemical investigations. Ambulatory hypertension was recorded in 14/55 (25.5%; white coat hypertension in 17/29 (58.6%) and masked hypertension in 2/26 (7.69%). For office SBP percentile the area under curve (AUC) was 0.773 (95% CI: 0.619-0.926, = 0.005) and for office DBP percentile the AUC was 0.802 (95% CI: 0.638-0.966, = 0.002). The estimated cut offs (Youden's index) for office blood pressure which predicts ambulatory hypertension in obese children were the 93rd percentile for systolic BP (sensitivity-67% and specificity-78%) and the 88th percentile for diastolic BP (sensitivity-83% and specificity-62%). Ambulatory blood pressure abnormalities are highly prevalent among children with obesity. Office blood pressure did not accurately predict ambulatory hypertension. More than half of the children labeled as "hypertension" on office blood pressure measurement in the study were diagnosed to have white coat hypertension (WCH), thus emphasizing the role of ABPM for evaluation of WCH before the child is subjected to detailed investigations or started on pharmacotherapy.
肥胖症的流行，连同高血压（HT）和心血管疾病一起，对全球疾病负担的影响日益增大。据推测，肥胖儿童成年后易患高血压及随后的心血管疾病。对这些儿童的高血压进行早期检测和管理可显著改变疾病进程。然而，通过动态血压监测（ABPM）来描述肥胖儿童血压特征的研究很少，尤其是在发展中世界。本研究旨在描述肥胖儿童的动态血压特征，并探索使用诊室血压来预测动态高血压的可行性。在本研究中，55名年龄和性别体重指数（BMI）处于≥第95百分位数的儿童被纳入一家三级护理医院，接受了24小时的ABPM及详细的生化检查。14/55（25.5%）记录为动态高血压；17/29（58.6%）为白大衣高血压，2/26（7.69%）为隐匿性高血压。诊室收缩压百分位数的曲线下面积（AUC）为0.773（95%CI：0.619 - 0.926，P = 0.005），诊室舒张压百分位数的AUC为0.802（95%CI：0.638 - 0.966，P = 0.002）。预测肥胖儿童动态高血压的诊室血压估计切点（约登指数）为收缩压第93百分位数（敏感性 - 67%，特异性 - 78%）和舒张压第88百分位数（敏感性 - 83%，特异性 - 62%）。动态血压异常在肥胖儿童中非常普遍。诊室血压不能准确预测动态高血压。在本研究中，超过一半在诊室血压测量中被标记为“高血压”的儿童被诊断为白大衣高血压（WCH），因此强调了在儿童接受详细检查或开始药物治疗之前，ABPM对评估WCH的作用。
