Basaran Cemaliye, Kasap Demir Belde, Tekindal Mustafa Agah, Erfidan Gokcen, Simsek Ozgur Ozdemir, Arslansoyu Camlar Secil, Alparslan Caner, Alaygut Demet, Mutlubas Fatma, Elmali Ferhan
Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, İzmir, Turkey.
Faculty of Medicine, Department of Pediatrics, Division of Nephrology & Rheumatology, Izmir Katip Celebi University, İzmir, Turkey.
Hypertens Res. 2022 Jun;45(6):1047-1057. doi: 10.1038/s41440-022-00896-2. Epub 2022 Apr 1.
We aimed to evaluate the agreements between the guidelines used for both office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM). Our secondary aim was to define the best threshold to assess children at risk of left ventricular hypertrophy (LVH). Thresholds proposed by the Fourth Report (FR), European Society of Hypertension (ESH), and American Academy of Pediatrics (AAP) for OBP and the Wühl, ESH, and American Heart Association (AHA) for ABPM were used, and nine different BP phenotype combinations were created. The agreements between the thresholds, the sensitivity of the thresholds, and the BP phenotypes used to predict LVH were determined in 949 patients with different ages and body mass indices (BMIs). The agreements between the guidelines for OBP and ABPM were "good" and "very good" (κ = 0.639; 95% CI, 0.638-0.640, κ = 0.986; 95% CI, 0.985-0.988), respectively. To classify OBP and ABPM into BP phenotypes, we obtained nine different combinations, which had "very good" agreement (κ = 0.880; 95% CI, 0.879-0.880). The sensitivity of AAP for detecting LVH was the highest in <12-year-old obese children (S = 75.8, 95% CI, 56.4-89.7). The sensitivity of ABPM in detecting LVH was similar among different age and BMI groups. The sensitivity of different BP phenotypes tended to be higher in the groups where OBP was evaluated according to AAP. The highest sensitivity was detected in the 13- to 15-year-old normal weight group.(S: 88.8, 95% CI, 51.7-99.7). The AAP guideline is more sensitive and decisive for BP phenotypes to detect LVH, especially in normal-weight children ≤ 15 years, while ABPM thresholds for children have limited effect.
我们旨在评估用于诊室血压（OBP）和动态血压监测（ABPM）的指南之间的一致性。我们的次要目标是确定评估有左心室肥厚（LVH）风险儿童的最佳阈值。使用了第四次报告（FR）、欧洲高血压学会（ESH）和美国儿科学会（AAP）提出的OBP阈值，以及Wühl、ESH和美国心脏协会（AHA）提出的ABPM阈值，并创建了九种不同的血压表型组合。在949名不同年龄和体重指数（BMI）的患者中，确定了阈值之间的一致性、阈值的敏感性以及用于预测LVH的血压表型。OBP和ABPM指南之间的一致性分别为“良好”和“非常好”（κ = 0.639；95% CI，0.638 - 0.640，κ = 0.986；95% CI，0.985 - 0.988）。为了将OBP和ABPM分类为血压表型，我们获得了九种不同的组合，其一致性为“非常好”（κ = 0.880；95% CI，0.879 - 0.880）。AAP在检测12岁以下肥胖儿童LVH方面的敏感性最高（S = 75.8，95% CI，56.4 - 89.7）。ABPM在检测LVH方面的敏感性在不同年龄和BMI组中相似。在根据AAP评估OBP的组中，不同血压表型的敏感性往往更高。在13至15岁正常体重组中检测到最高敏感性（S：88.8，95% CI，51.7 - 99.7）。AAP指南在检测LVH的血压表型方面更敏感且更具决定性，尤其是在15岁及以下的正常体重儿童中，而儿童ABPM阈值的作用有限。
