Alsaeed Habeeb, Metzger Daniel L, Blydt-Hansen Tom D, Rodd Celia, Sharma Atul
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
Division of Endocrinology and Diabetes, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
Pediatr Res. 2021 Oct;90(4):903-909. doi: 10.1038/s41390-021-01369-x. Epub 2021 Jan 27.
Screening studies have shown that 0.7-4.5% of generally healthy children have isolated diastolic high BP. We therefore studied the characteristics of children with diastolic BP in the elevated and hypertensive ranges according to current guidelines in US children from the National Health and Nutrition Examination Survey (NHANES, 1999-2016).
We studied 17,362 children (8-18 years) with BP measured by sphygmomanometry. High BP was categorized as isolated systolic (iSH), isolated diastolic (iDH), or Mixed.
Overall, 86.0% (95% CI = 85.0-87.0) of the population had normal BP, 8.7% (8.0-9.3) elevated BP, 4.9% (4.4-5.5) Stage 1, and 0.4% (0.4-0.6) Stage 2. Moreover, 11.1% (10.3-12.0) had iSH, 1.9% (1.5-2.2) iDH, and 1.0% (0.8-1.2) Mixed. Children with iDH were more likely to be female, younger, white, and leaner than those with iSH, with lower rates of overweight/obesity. iDH was generally between normals and iSH. Resting heart rate was significantly higher in iDH even after adjustment for known covariates.
Children with iDH may have a distinct clinical picture. A leaner habitus and higher resting heart rate may reflect differences in underlying pathophysiology. Longitudinal follow-up studies are needed to better define the pathogenesis, progression, and long-term prognosis in iDH.
Using gold-standard auscultation and 2017 guidelines, isolated diastolic high BP (iDH) is found in 1.9% (95% CI 1.5-2.2) of American children; these children are younger, leaner, more female, and have fewer cardiometabolic risks. Resting heart rate is significantly higher in iDH compared to both normals and iSH even after adjustments for known covariates. Autonomic hyperactivity in iDH may speak to both etiology and therapeutic approaches. iDH appears to be a distinct clinical phenotype characterized by differences in anthropometric measures, sex, age, and resting heart rate. Follow-up studies are clearly needed to clarify its pathogenesis, progression, and prognosis.
筛查研究表明，0.7%-4.5%的一般健康儿童存在单纯舒张期高血压。因此，我们根据美国国家健康与营养检查调查（NHANES，1999-2016）中美国儿童的现行指南，研究了舒张血压处于升高和高血压范围的儿童的特征。
我们研究了17362名8至18岁通过血压计测量血压的儿童。高血压被分类为单纯收缩期（iSH）、单纯舒张期（iDH）或混合型。
总体而言，86.0%（95%CI=85.0-87.0）的人群血压正常，8.7%（8.0-9.3）血压升高，4.9%（4.4-5.5）为1期，0.4%（0.4-0.6）为2期。此外，11.1%（10.3-12.0）有单纯收缩期高血压，1.9%（1.5-2.2）有单纯舒张期高血压，1.0%（0.8-1.2）为混合型。与单纯收缩期高血压儿童相比，单纯舒张期高血压儿童更可能为女性、年龄更小、为白人且更瘦，超重/肥胖率更低。单纯舒张期高血压一般介于正常血压和单纯收缩期高血压之间。即使在对已知协变量进行调整后，单纯舒张期高血压儿童的静息心率仍显著更高。
单纯舒张期高血压儿童可能有独特的临床表现。更瘦的体型和更高的静息心率可能反映了潜在病理生理学的差异。需要进行纵向随访研究以更好地确定单纯舒张期高血压的发病机制、进展和长期预后。
采用金标准听诊法和2017年指南，在美国儿童中发现1.9%（95%CI 1.5-2.2）存在单纯舒张期高血压；这些儿童更年轻、更瘦、女性更多，且心血管代谢风险更低。即使在对已知协变量进行调整后，单纯舒张期高血压儿童的静息心率与正常血压儿童和单纯收缩期高血压儿童相比仍显著更高。单纯舒张期高血压中的自主神经功能亢进可能与病因和治疗方法有关。单纯舒张期高血压似乎是一种独特的临床表型，其特征在于人体测量指标、性别、年龄和静息心率的差异。显然需要进行随访研究以阐明其发病机制、进展和预后。
