Li Yuge, Yuan Hongtao, Cai Shuya, Li Fusheng, Nan Jing, Yang Yuxiang, Piao Wei, Zhao Liyun, Yu Dongmei
National Institute for Nutrition and Health, China CDC, Beijing 100050, China.
National Institute for Nutrition and Health, China CDC, Beijing 100050, China NHC Key Laboratory of Public Nutrition and Health, Beijing 100050, China.
Wei Sheng Yan Jiu. 2024 Jul;53(4):532-560. doi: 10.19813/j.cnki.weishengyanjiu.2024.04.003.
To describe and analysis the detection rate of high normal blood pressure and high blood pressure among Chinese children and adolescents aged 7-17 years from 2016 to 2017 according to the clinical practice guideline for screening and management of high blood pressure in Children and Adolescents published by the American Academy of Pediatrics(the AAP reference), the international blood pressure references among Children and Adolescents aged 6 to 17 years(the international reference), health industry standard of the People's Republic of China "Reference of screening for elevated blood pressure among children and adolescents aged 7 to 18 years(WS/T 610-2018)"(the industry reference) and updating blood pressure references for Chinese children aged 3 to 17 years(the guideline reference).
Data was from the China Nutrition and Health Surveillance of Children and Lactating Women(2016-2017), in which the multistage stratified whole group random sampling method was used to draw participants from 275 surveillance sites in 31 provinces(autonomous regions and municipalities). In total, 67 231 participants were included according to the inclusion and exclusion criteria. Blood pressure was measured three times by trained staff using a validated oscillometric blood pressure monitor at the same point. The average blood pressure was calculated for the three measurements for SBP and DBP. To match the sampling design methodology, all values were weighted to represent the total population of Chinese children and adolescents 7-17 years of age considering sampling weights for each stratification based on the sixth population census data provided by the National Bureau of Statistics.
The detection rate varied greatly under different references. The detection rate of high normal blood pressure was ranked from high to low according to the AAP reference(20.15%) > the guideline reference(17.29%) > the industry reference(13.14%) > the international reference(12.66%); the detection rate of high blood pressure in descending order is the guideline reference(24.31%) > the international reference(21.34%) > the AAP reference(20.59%) > the industry reference(19.96%).
Although the consistency between the AAP references and international references and our national two references were medium to high, the difference in detection rate obtained by analysis was large. Considering the differences of demographic characteristics in the reference population, caution should be taken when applying foreign references to judge the blood pressure status of children and adolescents in China.
根据美国儿科学会发布的《儿童青少年高血压筛查与管理临床实践指南》（AAP参考标准）、6至17岁儿童青少年国际血压参考标准（国际参考标准）、中华人民共和国卫生行业标准《7至18岁儿童青少年血压偏高筛查参考值（WS/T 610-2018）》（行业参考标准）以及3至17岁中国儿童更新血压参考标准（指南参考标准），描述并分析2016年至2017年中国7至17岁儿童青少年中高正常血压和高血压的检出率。
数据来自中国儿童和哺乳期妇女营养与健康监测（2016 - 2017年），采用多阶段分层整群随机抽样方法从31个省（自治区、直辖市）的275个监测点抽取参与者。根据纳入和排除标准，共纳入67231名参与者。由经过培训的工作人员使用经过验证的示波血压监测仪在同一点测量三次血压。计算收缩压（SBP）和舒张压（DBP）三次测量的平均血压。为匹配抽样设计方法，考虑到基于国家统计局提供的第六次人口普查数据的每个分层的抽样权重，对所有值进行加权以代表中国7至17岁儿童青少年的总人口。
在不同参考标准下，检出率差异很大。高正常血压检出率从高到低依次为：AAP参考标准（20.15%）＞指南参考标准（17.29%）＞行业参考标准（13.14%）＞国际参考标准（12.66%）；高血压检出率从高到低依次为：指南参考标准（24.31%）＞国际参考标准（21.34%）＞AAP参考标准（20.59%）＞行业参考标准（19.96%）。
虽然AAP参考标准与国际参考标准以及我国两个参考标准之间的一致性为中到高，但分析得出的检出率差异较大。考虑到参考人群人口统计学特征的差异，在应用国外参考标准判断中国儿童青少年血压状况时应谨慎。
