Falkner Bonita
Sydney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, United States.
Front Cardiovasc Med. 2022 Nov 4;9:1033628. doi: 10.3389/fcvm.2022.1033628. eCollection 2022.
Beginning in the 1970s, hypertension in children and adolescents has been defined as systolic and/or diastolic blood pressure (BP) that is equal to or greater than the 95th percentile of the normal BP distribution in healthy children. The definition of hypertension in adults is based on longitudinal data that links a BP level with an increased risk for subsequent adverse outcomes related to hypertension including heart failure, kidney failure, stroke, or death. The statistical definition of hypertension continues to be used in childhood because there have been no data that link a BP level in childhood with a heightened risk for adverse outcomes in adulthood. Findings from clinical and epidemiologic research have advanced understanding of high BP in childhood. While hypertension in some children can be secondary to underlying kidney, cardiovascular, or endocrine disorder, it is now known that primary (essential) hypertension can be present in childhood. The prevalence of hypertension in childhood is approximately 2-5% and another 13-18% of children and adolescents have elevated BP and are at heightened risk for developing hypertension. The leading cause of childhood hypertension is primary hypertension, especially in adolescents. For children and adolescents with secondary hypertension, the treatment can focus on managing the underlying cause of hypertension. Less is known about managing primary hypertension in childhood, including diagnosis, evaluation, treatment, and possibilities for prevention. The phenotype of primary hypertension in childhood and recent findings will be discussed.
从20世纪70年代开始，儿童和青少年高血压被定义为收缩压和/或舒张压等于或高于健康儿童正常血压分布的第95百分位数。成人高血压的定义基于纵向数据，这些数据将血压水平与随后发生的与高血压相关的不良后果（包括心力衰竭、肾衰竭、中风或死亡）风险增加联系起来。高血压的统计学定义在儿童期仍在使用，因为尚无数据表明儿童期的血压水平与成年期不良后果风险增加有关。临床和流行病学研究结果加深了对儿童高血压的认识。虽然一些儿童的高血压可能继发于潜在的肾脏、心血管或内分泌疾病，但现在已知原发性（特发性）高血压也可在儿童期出现。儿童高血压的患病率约为2%至5%，另有13%至18%的儿童和青少年血压升高，患高血压的风险增加。儿童高血压的主要原因是原发性高血压，尤其是在青少年中。对于继发性高血压的儿童和青少年，治疗可侧重于控制高血压的潜在病因。关于儿童原发性高血压的管理，包括诊断、评估、治疗和预防可能性，了解较少。本文将讨论儿童原发性高血压的表型及最新研究结果。
