Robinson Suzanne K, Rodd Celia J, Metzger Daniel L, Sharma Atul K
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba.
Department of Pediatrics and Child Health, Section of Pediatric Endocrinology, University of Manitoba, Winnipeg, Manitoba.
Paediatr Child Health. 2020 Mar 30;26(3):e158-e165. doi: 10.1093/pch/pxaa026. eCollection 2021 Jun.
We assess the impact of the 2017 American Academy of Pediatrics (AAP) guidelines on the prevalence of high blood pressure (BP) in generally healthy Canadian children and identify risk factors associated with high BP (elevated, stage 1, or stage 2 at a single visit).
A cohort of 7,387 children aged 6 to 18 years in the Canadian Health Measures Survey (CHMS, 2007 to 2015) had BPTru oscillometry with centiles and stages assigned using both the 2017 AAP guidelines and the 2004 Fourth Report from the National Institute of Health/National Heart Lung and Blood Institute (NIH/NHLBI).
Although both shifted upwards significantly, mean population systolic BP and diastolic BP percentiles are now 24.2 (95% confidence interval: 23.3 to 25.2) and 46.4 (45.3 to 47.6). As a result, the population prevalence of high BP increased from 4.5% (3.9 to 5.2, NIH/NHLBI) to 5.8% (5.0 to 6.6, AAP), less than in US children measured by auscultation (14.2%, 13.4 to 15.0). Children with high BP were more likely to be overweight/obese, to be exposed to prenatal/household smoking, and to have hypertriglyceridemia, without differences in dietary salt, infant breastfeeding, neonatal hospitalizations, or exercise frequency.
The 2017 AAP guidelines increase the prevalence of high BP in Canadian children; Canadian prevalence appears lower than in the USA. This may reflect differences in measurement methods or in the prevalence of childhood overweight/obesity between countries, that is, 31.1% (28.9 to 33.3) versus 40.6% (39.5 to 42.0), respectively. Those with high BP were more likely to have other cardiac risk factors, including overweight/obesity, prenatal/household smoking exposure, and hypertriglyceridemia.
我们评估了2017年美国儿科学会（AAP）指南对一般健康的加拿大儿童高血压患病率的影响，并确定与高血压（单次就诊时血压升高、1期或2期）相关的风险因素。
加拿大健康测量调查（CHMS，2007年至2015年）中的7387名6至18岁儿童队列接受了BPTru示波测量，并使用2017年AAP指南和美国国立卫生研究院/国立心肺血液研究所（NIH/NHLBI）的2004年第四次报告来确定百分位数和分期。
尽管两者均显著上移，但现在总体人群收缩压和舒张压百分位数分别为24.2（95%置信区间：23.3至25.2）和46.4（45.3至47.6）。结果，高血压的总体患病率从4.5%（3.9至5.2，NIH/NHLBI）增至5.8%（5.0至6.6，AAP），低于通过听诊测量的美国儿童（14.2%，13.4至15.0）。高血压儿童更有可能超重/肥胖、暴露于产前/家庭吸烟环境以及患有高甘油三酯血症，在饮食盐、婴儿母乳喂养、新生儿住院或运动频率方面无差异。
2017年AAP指南增加了加拿大儿童高血压的患病率；加拿大的患病率似乎低于美国。这可能反映了测量方法的差异或各国儿童超重/肥胖患病率的差异，即分别为31.1%（28.9至33.3）和40.6%（39.5至42.0）。高血压患者更有可能有其他心脏危险因素，包括超重/肥胖、产前/家庭吸烟暴露和高甘油三酯血症。
