Department of Pediatrics, Vittore Buzzi Children's Hospital, University of Milan, 20154 Milan, Italy.
Centro Cardiologico Monzino IRCCS, Milan, Italy.
Nutr Metab Cardiovasc Dis. 2023 Apr;33(4):900-912. doi: 10.1016/j.numecd.2023.01.001. Epub 2023 Jan 13.
Hypertension (HTN) is common among obese children and adolescents and increases their cardiovascular risk later in adulthood. The aim of the study was to evaluate the prevalence of HTN identified by office blood pressure (BP) measurement and ambulatory BP monitoring (ABPM) in a cohort of obese children and adolescents and its association with anthropometric and glycometabolic indices.
Seventy consecutive obese Caucasian children and adolescents aged 7-16 years were enrolled. Patients underwent ABPM, echocardiogram and carotid ultrasonography. Sex- and age-adjusted logistic multivariable analysis models were used to assess the association between HOMA-IR, HOMA-β, QUICKI with HTN at ABPM. Receiver Operation Curve (ROC) analysis with Youden J statistics was used to identify the optimal HOMA-IR, HOMA-β and QUICKI cut-off to predict HTN at ABPM. Hypertensive office BP was found in 25.7% of obese patients. ABPM diagnosed HTN in 34.9% of patients: 20.6% of obese patients had masked HTN (MHTN), and 12.7% had white coat HTN (WCH). Hypertensive obese patients (according to ABPM) had higher HOMA-IR and HOMA-β, and a lower QUICKI than normotensive subjects. HOMA-IR, HOMA-β and QUICKI predicted HTN at ABPM in obese patients in age- and sex-adjusted logistic multivariable models. Optimal cut-offs to predict HTN at ABPM in obese patients were: HOMA-IR ≥ 3.30, HOMA-β ≥ 226.7 and QUICKI <0.33, with high sensitivity.
A sequential testing strategy applying office BP and glycometabolic indices can identify hypertensive obese pediatric patients with high diagnostic accuracy and potentially reducing costs. This strategy needs validation in an external and larger cohort.
高血压（HTN）在肥胖儿童和青少年中很常见，会增加他们成年后患心血管疾病的风险。本研究的目的是评估通过诊室血压（BP）测量和动态血压监测（ABPM）在肥胖儿童和青少年队列中识别 HTN 的患病率，并评估其与人体测量学和糖代谢指标的关系。
共纳入 70 例连续的肥胖白种人儿童和青少年，年龄 7-16 岁。患者接受 ABPM、超声心动图和颈动脉超声检查。使用性别和年龄调整的逻辑多元变量分析模型评估 HOMA-IR、HOMA-β、QUICKI 与 ABPM 中 HTN 的相关性。使用 Youden J 统计量的Receiver Operation Curve (ROC) 分析确定 HOMA-IR、HOMA-β 和 QUICKI 的最佳截断值，以预测 ABPM 中的 HTN。肥胖患者中发现 25.7%存在诊室高血压。ABPM 诊断出 34.9%的患者存在高血压：20.6%的肥胖患者存在隐匿性高血压（MHTN），12.7%的患者存在白大衣高血压（WCH）。与正常血压患者相比，高血压肥胖患者（根据 ABPM 诊断）的 HOMA-IR 和 HOMA-β 更高，QUICKI 更低。在年龄和性别调整的逻辑多元变量模型中，HOMA-IR、HOMA-β 和 QUICKI 预测肥胖患者的 ABPM 高血压。预测肥胖患者 ABPM 高血压的最佳截断值为：HOMA-IR≥3.30、HOMA-β≥226.7 和 QUICKI<0.33，具有较高的敏感性。
应用诊室血压和糖代谢指标的序贯检测策略可以识别出具有高诊断准确性的高血压肥胖儿科患者，并可能降低成本。该策略需要在外部更大的队列中进行验证。
