Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.
Division of Nephrology, University of Western Ontario, London, Ontario, Canada.
Am J Hypertens. 2021 Mar 11;34(2):198-206. doi: 10.1093/ajh/hpaa161.
The impact of diagnosing pediatric hypertension based on all three-24-hour, day and night ambulatory blood pressure (ABP) thresholds (combined ABP threshold) vs. conventionally used 24-hour ABP threshold is not known.
In this cross-sectional, retrospective study from a tertiary care outpatient clinic, we evaluated the diagnosis of hypertension based on the 24-hour European Society of Hypertension (ESH) and combined ESH ABP thresholds in untreated children with essential hypertension. The American Academy of Pediatrics (AAP) and Fourth Report thresholds were used to classify office blood pressure (OBP).
In 159 children, aged 5-18 years, the 24-hour ESH and combined ESH thresholds classified 82% (95th confidence interval (CI) 0.68, 0.97) ABP similarly with the area under the curve (AUC) of 0.86 (95th CI 0.80, 0.91). However, the AUC of the 2 ABP thresholds was significantly higher in the participants with office hypertension than office normotension, with OBP classified by the AAP (AUC 0.93, 95th CI 0.84, 0.98 vs. 0.80, 95th CI 0.71, 0.88) or Fourth Report (AUC 0.93, 95th CI 0.83, 0.98 vs. 0.81, 95th CI 0.73, 0.88) threshold. With OBP classified by the either OBP threshold, the combined ESH threshold diagnosed significantly more masked hypertension (MH) (difference 15%, 95th CI 4.9, 24.7; P = 0.00); however, the diagnosis of white coat hypertension (WCH) by the 2 ABP thresholds did not differ significantly (difference 4%, 95th CI 1.8, 10; P = 0.16).
In children with essential hypertension, the 24-hour and combined ESH thresholds have a stronger agreement for diagnosing WCH than MH.
基于所有 24 小时、白天和夜间动态血压（ABP）阈值（联合 ABP 阈值）与传统使用的 24 小时 ABP 阈值诊断儿科高血压的影响尚不清楚。
在这项来自三级保健门诊的横断面、回顾性研究中，我们评估了未治疗的原发性高血压儿童基于欧洲高血压学会（ESH）24 小时和联合 ESH ABP 阈值的高血压诊断。美国儿科学会（AAP）和第四次报告阈值用于分类诊室血压（OBP）。
在 159 名年龄为 5-18 岁的儿童中，24 小时 ESH 和联合 ESH 阈值以 0.86（95%置信区间（CI）0.80,0.91）的曲线下面积（AUC）类似地分类 82%（95%CI0.68,0.97）ABP。然而，在有诊室高血压的参与者中，这两个 ABP 阈值的 AUC 显著高于诊室血压正常的参与者，使用 AAP（AUC0.93，95%CI0.84,0.98 与 0.80，95%CI0.71,0.88）或第四次报告（AUC0.93，95%CI0.83,0.98 与 0.81，95%CI0.73,0.88）阈值分类的 OBP。使用任何 OBP 阈值分类的 OBP，联合 ESH 阈值诊断出更多的隐匿性高血压（MH）（差异 15%，95%CI4.9,24.7；P=0.00）；然而，使用这两个 ABP 阈值诊断的白大衣高血压（WCH）并没有显著差异（差异 4%，95%CI1.8,10；P=0.16）。
在原发性高血压儿童中，24 小时和联合 ESH 阈值在诊断 WCH 方面比 MH 具有更强的一致性。
