Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy.
Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy.
Nutr Metab Cardiovasc Dis. 2023 Apr;33(4):892-899. doi: 10.1016/j.numecd.2022.12.026. Epub 2023 Jan 5.
Recently, the European Society of Cardiology task force released a Consensus document (ESC-CD) on pediatric hypertension (HTN) supporting the use of normative tables (age range 6-16 years) for the diagnosis of HTN, while the Hypertension Canada Guidelines (HTN-CGs) proposed static cutoffs. We aimed to assess the prevalence of HTN by ESC-CD or HTN-CGs and their association with glomerular function and left ventricular (LV) geometry in youths with overweight/obesity (OW/OB).
Data of 3446 youths were analyzed. HTN by was defined using normative tables (ESC-CD) or static cutoffs of BP ≥ 120/80 in children (age <12 years) and ≥130/85 mmHg in adolescents (age ≥12 years) (HTN-CGs). Mildly reduced glomerular filtration rate was defined by GFR <90 ≥ 60 mL/min/1.73 m. Concentric LV hypertrophy (cLVH) was assessed in 500 youths and defined by LVH and high relative wall thickness as proposed by ESC-CD. Prevalence of HTN was 27.9% by ESC-CD and 22.7% by HTN-CGs. The association with mildly reduced glomerular filtration rate was significant only in hypertensive adolescents classified by HTN-CGs [Odds Ratio (OR), 95%Cl] 2.16 (1.44-3.24), whereas the association with cLVH was significant using both criteria: children OR 2.18 (1.29-3.67) by ESC-CD and 2.27 (1.32-3.89) by HTN-CGs; adolescents OR 2.62 (1.17-5.84) by ESC-CD and 2.83 (1.14-7.02) by HTN-CGs.
Although static cutoffs may represent a simplification for HTN identification, tables by ESC-CD detect a higher number of hypertensive youths before a clear appearance of glomerular impairment, which offers advantages in terms of primary cardiovascular prevention.
最近，欧洲心脏病学会工作组发布了一份关于儿科高血压（HTN）的共识文件（ESC-CD），支持使用年龄范围为 6-16 岁的正常标准表来诊断 HTN，而加拿大高血压指南（HTN-CGs）则提出了静态切点。我们旨在评估超重/肥胖（OW/OB）青少年中 ESC-CD 或 HTN-CGs 诊断的 HTN 患病率及其与肾小球功能和左心室（LV）几何结构的关系。
分析了 3446 名青少年的数据。HTN 是通过使用正常标准表（ESC-CD）或 BP 定义的，即儿童年龄<12 岁时 BP≥120/80mmHg，青少年（年龄≥12 岁）时 BP≥130/85mmHg（HTN-CGs）。肾小球滤过率轻度降低定义为 GFR<90≥60mL/min/1.73m。500 名青少年进行了同心性 LV 肥厚（cLVH）评估，并按照 ESC-CD 提出的 LVH 和高相对壁厚度标准进行了定义。ESC-CD 诊断的 HTN 患病率为 27.9%，HTN-CGs 诊断的 HTN 患病率为 22.7%。仅在 HTN-CGs 诊断为高血压的青少年中，与肾小球滤过率轻度降低相关的关联具有统计学意义[优势比（OR），95%置信区间]2.16（1.44-3.24），而与 cLVH 的关联使用两个标准均具有统计学意义：ESC-CD 诊断的儿童 OR 2.18（1.29-3.67）和 HTN-CGs 诊断的儿童 OR 2.27（1.32-3.89）；ESC-CD 诊断的青少年 OR 2.62（1.17-5.84）和 HTN-CGs 诊断的青少年 OR 2.83（1.14-7.02）。
虽然静态切点可能代表了 HTN 识别的简化，但 ESC-CD 的表格在肾小球损害明显出现之前，能检测到更多的高血压青少年，这在心血管一级预防方面具有优势。
