肥胖儿童和青少年血压分类的百分位表与基于算法的计算器比较：一项临床试验的二次分析。

Comparison of percentile tables and algorithm-based calculators for classification of blood pressures in children and adolescents with obesity: A secondary analysis of a clinical trial.

机构信息

Liggins Institute, University of Auckland, Auckland, New Zealand.

School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

出版信息

J Paediatr Child Health. 2023 Feb;59(2):242-246. doi: 10.1111/jpc.16270. Epub 2022 Nov 20.

DOI:10.1111/jpc.16270

PMID:36404725

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10100042/

Abstract

AIM

Obesity as a major risk factor for childhood hypertension necessitates careful blood pressure (BP) monitoring of those affected. This study aimed to compare BP classification in a cohort of children affected by obesity using tables versus digital calculations in two sets of guidelines.

METHODS

This study was a secondary analysis of data collected from a randomised clinical trial of a multidisciplinary life-style assessment and intervention program. Baseline data from 237 children with a body mass index >99th percentile or >91st percentile with weight-related comorbidities and available BP measurements were analysed. We assessed agreement between tables and algorithms in classification of elevated BP/pre-hypertension and hypertension based on the American Academy of Paediatrics (AAP) clinical practice guidelines (CPG) and the older Fourth Report using Cohen's weighted kappa. The prevalence of hypertensive diagnoses was also compared between the two guidelines.

RESULTS

Agreement between BP tables and algorithmic calculation of percentiles was discordant, though improved in the AAP CPG compared to the Fourth Report (Cohen's kappa = 0.70 vs. 0.57, respectively). None (0%) were missed diagnoses, and 59 (24.9%) were false positives for the Fourth Report, and 0 (0%) were missed diagnoses, and 49 (20.9%) were false positives for the AAP CPG. Under the recent guidelines, there was an increase in prevalence of 6.0% (95% confidence interval (CI) 2.5-9.4%; P = 0.0001) for BP ≥90th percentile, and of 3.0% (95% CI 0.4-5.6%; p = 0.016) for hypertension (BP ≥ 95th percentile) in the cohort (18.0% and 6.8%, respectively, increased from 12.0% and 3.8%).

CONCLUSIONS

Digital calculators over tables in clinical practice are recommended where possible to improve the accuracy of paediatric BP classification. Substantial rates of elevated BP/Hypertension were found in this cohort of children and adolescents with overweight and obesity.

摘要

目的

肥胖是儿童高血压的一个主要危险因素，因此需要对受影响的人群进行仔细的血压（BP）监测。本研究旨在比较两种指南中使用表格和数字计算对肥胖儿童的 BP 分类。

方法

这是一项多学科生活方式评估和干预计划随机临床试验数据的二次分析。对 237 名体重指数（BMI）>第 99 百分位数或>第 91 百分位数且伴有与体重相关的合并症且有可用 BP 测量值的儿童的基线数据进行了分析。我们根据美国儿科学会（AAP）临床实践指南（CPG）和旧的第四报告，评估了表格和算法在根据美国儿科学会（AAP）临床实践指南（CPG）和旧的第四报告，评估了表格和算法在根据美国儿科学会（AAP）临床实践指南（CPG）和旧的第四报告，评估了表格和算法在分类升高的 BP/前期高血压和高血压方面的一致性，采用 Cohen 加权 Kappa 进行评估。还比较了两种指南之间高血压诊断的患病率。

结果

BP 表格和算法计算百分位数之间的一致性不一致，但与第四报告相比，AAP CPG 有所改善（Cohen Kappa 分别为 0.70 和 0.57）。第四报告没有漏诊病例（0%），59 例（24.9%）为假阳性，AAP CPG 无漏诊病例（0%），49 例（20.9%）为假阳性。根据最近的指南，BP≥第 90 百分位数的患病率增加了 6.0%（95%可信区间（CI）为 2.5-9.4%；P=0.0001），BP≥第 95 百分位数的高血压（BP≥第 95 百分位数）的患病率增加了 3.0%（95%CI 为 0.4-5.6%；p=0.016），队列中分别为 18.0%和 6.8%（分别从 12.0%和 3.8%增加）。