Kim Jeong Yeon, Cho Heeyeon, Kim Jae Hyun
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.
Front Med (Lausanne). 2022 Feb 24;9:793771. doi: 10.3389/fmed.2022.793771. eCollection 2022.
The prevalence of pediatric hypertension and obesity has increased over the past decades. Pediatric hypertension and obesity are associated with adult hypertension, metabolic syndrome, and cardiovascular disease. There are two main pediatric blood pressure (BP) classification guidelines, the "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents" (AAP 2017) and "2016 European Society of Hypertension guidelines for the management of high BP in children and adolescents" (ESH 2016). No study has classified Korean youths with cardiometabolic risk. This study analyzed the prevalence of high BP according to AAP 2017 (elevated BP and hypertension) and ESH 2016 (prehypertension and hypertension) in Korean children. Additionally, the cardiometabolic risk factors (CMRFs) were compared between children who were hypertensive in AAP 2017 but normotensive in ESH 2016 (upward reclassified) to those who were normotensive in both AAP 2017 and ESH 2016. Data were extracted from the Korea National Health and Nutrition Examination Survey, 2016-2018. A total of 1,858 children aged 10-17 years were included in the analysis. The prevalence of elevated BP/prehypertension and hypertension was 4.1 and 6.5% by ESH 2016, and 8.9 and 9.4% by AAP 2017 in Korean youth, respectively. The AAP 2017 reclassified 11.9% of youth in the upper BP class. When those upward reclassified youth were compared to those who were normotensive in both AAP 2017 and ESH 2016, reclassified youth were male predominant (77.1 vs. 49.6%, < 0.001), older (14.6 vs. 13.8, < 0.001) and showed higher body mass index (BMI) z-score (0.77 vs. 0.15, < 0.001) and more overweight/obesity (14.0/30.6 vs. 13.3/6.4%, < 0.001) and severe CMRFs (triglyceride 83.2 vs. 72.9 mg/dL, = 0.011; high-density lipoprotein cholesterol 47.3 vs. 51.1 mg/dL, < 0.001; alanine transaminase 21.7 IU/L vs. 14.7 IU/L, = 0.001, uric acid 5.89 vs. 5.22 mg/dL, < 0.001; metabolic syndrome 13.2 vs. 1%, < 0.001). In conclusion, AAP 2017 showed a higher prevalence of abnormal BP in Korean youth, and those upward reclassified by AAP 2017 were more obese and had severe CMRFs than normotensive Korean children. The AAP 2017 could allow the early detection of Korean youth with more CMRFs.
在过去几十年中，儿童高血压和肥胖的患病率有所上升。儿童高血压和肥胖与成人高血压、代谢综合征及心血管疾病相关。有两个主要的儿童血压（BP）分类指南，即《儿童和青少年高血压筛查与管理临床实践指南》（美国儿科学会，2017年）和《2016年欧洲高血压学会儿童和青少年高血压管理指南》（ESH，2016年）。尚无研究对具有心脏代谢风险的韩国青少年进行分类。本研究根据美国儿科学会2017年指南（血压升高和高血压）和ESH 2016年指南（高血压前期和高血压）分析了韩国儿童高血压的患病率。此外，还比较了在AAP 2017中为高血压但在ESH 2016中为血压正常（向上重新分类）的儿童与在AAP 2017和ESH 2016中均为血压正常的儿童之间的心脏代谢危险因素（CMRFs）。数据来自2016 - 2018年韩国国家健康与营养检查调查。共有1858名10 - 17岁的儿童纳入分析。按照ESH 2016年指南，韩国青少年中血压升高/高血压前期和高血压的患病率分别为4.1%和6.5%；按照AAP 2017年指南，分别为8.9%和9.4%。AAP 2017年将11.9%的青少年重新分类到更高血压类别。当将那些向上重新分类的青少年与在AAP 2017和ESH 2016中均为血压正常的青少年进行比较时，重新分类的青少年以男性为主（77.1%对49.6%，P<0.001），年龄更大（14.6岁对13.8岁，P<0.001），体重指数（BMI）z评分更高（0.77对0.15，P<0.001），超重/肥胖更多（14.0%/30.6%对13.3%/6.4%，P<0.001），严重CMRFs更多（甘油三酯83.2对72.9mg/dL，P = 0.011；高密度脂蛋白胆固醇47.3对51.1mg/dL，P<0.001；谷丙转氨酶21.7对14.7IU/L，P = 0.001，尿酸5.89对5.22mg/dL，P<0.001；代谢综合征13.2%对1%，P<0.001）。总之，AAP 2017显示韩国青少年中血压异常的患病率更高，且AAP 2017向上重新分类的青少年比血压正常的韩国儿童更肥胖且有严重的CMRFs。AAP 2017能够使更多具有CMRFs的韩国青少年得以早期发现。
