Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Nephrology, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
Pediatr Nephrol. 2024 Feb;39(2):513-519. doi: 10.1007/s00467-023-06101-x. Epub 2023 Jul 29.
Current recommendations regarding the utility of diagnostic investigations for pediatric hypertension are based on limited evidence, leading to wide practice variation. The objective of this study was to characterize the cohort of children that may benefit from secondary hypertension workup, and determine the diagnostic yield of investigations.
This was a single-center, retrospective cohort study of 169 children aged 1-18 years referred between 2000 and 2015, to a tertiary pediatric nephrology center in Canada, for evaluation of hypertension. The number of investigations completed, abnormal findings, and diagnostic findings that helped establish hypertension etiology was determined.
56 children were diagnosed with primary and 72 children with secondary hypertension in the outpatient setting. Secondary hypertension was predominant at all ages except for obese adolescents ≥ 12 years. Half of children with traditional risk factors for primary hypertension, including obesity, were diagnosed with secondary hypertension. Kidney ultrasound had the highest yield of diagnostic results (19.8%), with no difference in yield between age groups (P = 0.19). Lipid profile had a high yield of abnormal results (25.4%) as part of cardiovascular risk assessment but was only abnormal in overweight/obese children. Echocardiogram had a high yield for identification of target-organ effects in hypertensive children (33.3%).
A simplified secondary hypertension workup should be considered for all hypertensive children and adolescents. High yield investigations include a kidney ultrasound, lipid profile for overweight/obese children, and echocardiograms for assessment of target-organ damage. Further testing could be considered based on results of initial investigations for the most cost-effective management. A higher resolution version of the Graphical abstract is available as Supplementary information.
目前关于儿科高血压诊断性检查的应用建议主要基于有限的证据，导致实践中存在广泛的差异。本研究的目的是描述可能从继发性高血压检查中获益的儿童人群特征，并确定检查的诊断收益。
这是一项单中心、回顾性队列研究，纳入了 2000 年至 2015 年间在加拿大一家三级儿科肾病中心因高血压就诊的 169 名 1-18 岁儿童。确定完成的检查数量、异常发现以及有助于确定高血压病因的诊断发现。
56 名儿童被诊断为原发性高血压，72 名儿童被诊断为继发性高血压。继发性高血压在所有年龄段均占主导地位，除肥胖青少年（≥12 岁）外。一半有肥胖等原发性高血压传统危险因素的儿童被诊断为继发性高血压。肾脏超声检查的诊断结果阳性率最高（19.8%），不同年龄组之间阳性率无差异（P=0.19）。血脂谱作为心血管风险评估的一部分，其异常结果阳性率较高（25.4%），但仅在超重/肥胖儿童中异常。超声心动图对高血压儿童靶器官损害的识别阳性率较高（33.3%）。
应考虑对所有高血压儿童和青少年进行简化的继发性高血压检查。阳性率较高的检查包括肾脏超声、超重/肥胖儿童的血脂谱以及评估靶器官损伤的超声心动图。根据初始检查结果，可以考虑进一步检查，以实现最具成本效益的管理。一份更清晰的图表摘要可在补充信息中获取。
