Chien Shao-Ju, Li Lung-Chih, Kuo Hsiao-Ching, Tain You-Lin, Hsu Chien-Ning
Division of Pediatric Cardiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
J Clin Med. 2023 Jun 28;12(13):4367. doi: 10.3390/jcm12134367.
BACKGROUND/AIMS: Childhood-onset hypertension is associated with cardiovascular morbidity and adult mortality. This study aimed to assess guideline-adherent hypertension among Taiwanese youth and the agreement on hypertension between the 2017 American Academy of Pediatrics guidelines and the 2004 Fourth Report.
In this cross-sectional study, we collected outpatient blood pressure (OBP) measurements obtained during routine care visits from a large healthcare delivery system between 2009 and 2018 to evaluate the rate of guideline-adherent hypertension and assess patient-related factors of pediatric hypertension.
In total, 12,469 children and adolescents who underwent three separate ≥3 OBP measurements over 33,369 person-years with a total of 95,608 BP measurements in an outpatient setting were analyzed. According to the 2017 American Academy of Pediatrics (AAP) guidelines, the rate of pediatric hypertension in the study setting, which included participants aged 1 to 17 years, ranged from 0.78 to 5.95 per 1000 persons. Although there was perfect agreement between the thresholds of the two guidelines for defining hypertension in the age groups of 1-7, 8-12, and 13-17 years (all κ statistic ≥ 0.85), the use of the AAP threshold classified more adolescents as having hypertension. Children and adolescents with hypertension often had complex chronic diseases and required substantial healthcare services in outpatient, emergency, and inpatient settings.
The present study provides evidence of guideline-adherent pediatric hypertension and highlights the importance of regularly monitoring blood pressure to identify and manage hypertension in children and adolescents. Further research is required to determine the impact of new thresholds on the detection of target organ damage at a pediatric age.
背景/目的：儿童期高血压与心血管疾病发病率及成人死亡率相关。本研究旨在评估台湾青少年中遵循指南的高血压情况，以及2017年美国儿科学会指南与2004年《第四次报告》之间关于高血压的一致性。
在这项横断面研究中，我们收集了2009年至2018年期间从一个大型医疗服务系统的常规护理就诊中获得的门诊血压（OBP）测量值，以评估遵循指南的高血压发生率，并评估儿童高血压的患者相关因素。
总共分析了12469名儿童和青少年，他们在门诊环境中经过33369人年的三次独立的≥3次OBP测量，共有95608次血压测量。根据2017年美国儿科学会（AAP）指南，该研究环境中1至17岁参与者的儿童高血压发生率为每1000人0.78至5.95例。虽然在1 - 7岁、8 - 12岁和13 - 17岁年龄组中，两种指南定义高血压的阈值之间存在完全一致性（所有κ统计量≥0.85），但使用AAP阈值将更多青少年归类为患有高血压。患有高血压的儿童和青少年通常患有复杂的慢性病，并且在门诊、急诊和住院环境中需要大量的医疗服务。
本研究提供了遵循指南的儿童高血压的证据，并强调了定期监测血压以识别和管理儿童及青少年高血压的重要性。需要进一步研究以确定新阈值对儿童期靶器官损害检测的影响。
