University of Western Ontario, London, Ontario, Canada.
Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada.
J Clin Hypertens (Greenwich). 2021 Nov;23(11):1947-1956. doi: 10.1111/jch.14368. Epub 2021 Oct 20.
The agreement between the traditionally-used ambulatory blood pressure (ABP)-load thresholds in children and recently-recommended pediatric American Heart Association (AHA)/European Society of Hypertension (ESH) ABP thresholds for diagnosing ambulatory hypertension (AH), white coat hypertension (WCH), and masked hypertension (MH) has not been evaluated. In this cross-sectional study on 450 outpatient participants, the authors evaluated the agreement between previously used ABP-load 25%, 30%, 40%, 50% thresholds and the AHA/ESH thresholds for diagnosing AH, WCH, and MH. The American Academy of Pediatrics thresholds were used to diagnose office hypertension. The AHA threshold diagnosed ambulatory normotension/hypertension closest to ABP load 50% in 88% (95% CI 0.79, 0.96) participants (k 0.67, 95% CI 0.59, 0.75) and the ESH threshold diagnosed ambulatory normotension/hypertension closest to ABP load 40% in 86% (95% CI 0.77, 0.94) participants (k 0.66, 95% CI 0.59, 0.74). In contrast, the AHA/ESH thresholds had a relatively weaker agreement with ABP load 25%/30%. Therefore, the diagnosis of AH was closest between the AHA threshold and ABP load 50% (difference 3%, 95% CI -2.6%, 8.6%, p = .29) and between the ESH threshold and ABP load 40% (difference 4%, 95% CI -2.1%, 10.1%, p = .19) than between the AHA/ESH and ABP load 25%/30% thresholds. A similar agreement pattern persisted between the AHA/ESH and various ABP load thresholds for diagnosing WCH and MH. The AHA and ESH thresholds diagnosed AH, WCH, and MH closest to ABP load 40%/50% than ABP load 25%/30%. Future outcome-based studies are needed to guide the optimal use of these ABP thresholds in clinical practice.
传统使用的动态血压（ABP）负荷阈值与最近推荐的儿科美国心脏协会（AHA）/欧洲高血压学会（ESH）ABP 阈值用于诊断动态高血压（AH）、白大衣高血压（WCH）和隐匿性高血压（MH）之间的一致性尚未得到评估。在这项针对 450 名门诊参与者的横断面研究中，作者评估了先前使用的 ABP 负荷 25%、30%、40%、50%阈值与 AHA/ESH 阈值诊断 AH、WCH 和 MH 的一致性。儿科学会的阈值用于诊断办公室高血压。AHA 阈值在 88%（95%CI 0.79，0.96）参与者中最接近 ABP 负荷 50%诊断为动态正常血压/高血压（Kappa 值为 0.67，95%CI 0.59，0.75），ESH 阈值在 86%（95%CI 0.77，0.94）参与者中最接近 ABP 负荷 40%诊断为动态正常血压/高血压（Kappa 值为 0.66，95%CI 0.59，0.74）。相比之下，AHA/ESH 阈值与 ABP 负荷 25%/30%的一致性相对较弱。因此，AH 的诊断在 AHA 阈值与 ABP 负荷 50%之间最接近（差异为 3%，95%CI-2.6%，8.6%，p=0.29），在 ESH 阈值与 ABP 负荷 40%之间最接近（差异为 4%，95%CI-2.1%，10.1%，p=0.19），而不是在 AHA/ESH 与 ABP 负荷 25%/30%之间。在诊断 WCH 和 MH 时，AHA/ESH 与各种 ABP 负荷阈值之间也存在类似的一致性模式。AHA 和 ESH 阈值最接近 ABP 负荷 40%/50%诊断 AH、WCH 和 MH，而不是 ABP 负荷 25%/30%。需要进一步进行基于结局的研究来指导这些 ABP 阈值在临床实践中的最佳使用。
