Moll Jacob Christian, Bohlken Jens, Kostev Karel
Department of Pediatrics, Clinic Westbrandenburg, 14467 Potsdam, Germany.
Faculty of Medicine, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, 04103 Leipzig, Germany.
Children (Basel). 2025 Mar 11;12(3):348. doi: 10.3390/children12030348.
Blood pressure elevation in children is an important health concern. The extent to which hypertension is diagnosed in German pediatric practices is not yet known. The aim of this study is, therefore, to examine the prevalence of hypertension diagnosis in children and adolescents treated in pediatric practices, as well as the factors associated with hypertension in this population. This retrospective case-control study used electronic medical records from 258 primary care pediatricians in Germany and included children and adolescents aged 0-17 years with an initial documented diagnosis of primary hypertension between January 2005 and December 2023. Hypertension patients were matched 1:5 with non-hypertension patients by age and sex. Conditional multivariable logistic regression models were used to estimate the association of chronic diseases and therapies with a risk of hypertension. After 1:5 matching, the present study included 7482 children and adolescents with hypertension, and 37,410 controls without hypertension. The average prevalence of hypertension was 0.12% and the incidence was 1.24 cases per 1000 person-years, both increasing with age. In the multivariable regression analysis, a significant positive association was observed between hypertension and ten disorders including obesity (odds ratio, OR: 6.91; 95% confidence intervals, CI: 6.28-7.60), type 1 diabetes mellitus (OR: 2.85; 95% CI: 2.13-3.82), dyslipidemia (OR: 1.99; 95% CI: 1.46-2.72), chronic bronchitis (OR: 1.63; 95% CI: 1.39-1.90), hypothyroidism (OR: 1.62; 95% CI: 1.30-2.02), migraine (OR: 1.52; 95% CI: 1.17-1.98), ADHD (OR: 1.45; 95% CI: 1.28-1.65), scoliosis (OR: 1.40; 95% CI: 1.13-1.73), chronic rhinitis (OR: 1.31; 95% CI: 1.14-1.50), and reaction to severe stress and adjustment disorders (OR: 1.31; 95% CI: 1.04-1.65). Furthermore, paracetamol prescription was positively associated with hypertension risk (OR: 1.68; 95% CI: 1.41-2.00). The significant associations between hypertension and chronic disorders, particularly obesity, underscore the need for early prevention strategies. Prospective studies are needed to confirm these associations. Similarly, pathophysiological and mechanistic explanations for the associations identified need to be explored and verified in properly designed studies.
儿童血压升高是一个重要的健康问题。目前尚不清楚德国儿科诊所中高血压的诊断情况。因此，本研究的目的是调查儿科诊所治疗的儿童和青少年中高血压的诊断患病率，以及该人群中与高血压相关的因素。这项回顾性病例对照研究使用了来自德国258名基层儿科医生的电子病历，纳入了2005年1月至2023年12月期间首次记录诊断为原发性高血压的0至17岁儿童和青少年。高血压患者与非高血压患者按年龄和性别进行1:5匹配。使用条件多变量逻辑回归模型来估计慢性病和治疗与高血压风险之间的关联。经过1:5匹配后，本研究纳入了7482名患有高血压的儿童和青少年，以及37410名没有高血压的对照。高血压的平均患病率为0.12%，发病率为每1000人年1.24例，两者均随年龄增长而增加。在多变量回归分析中，观察到高血压与包括肥胖（比值比，OR：6.91；95%置信区间，CI：6.28 - 7.60）、1型糖尿病（OR：2.85；95%CI：2.13 - 3.82）、血脂异常（OR：1.99；95%CI：1.46 - 2.72）、慢性支气管炎（OR：1.63；95%CI：1.39 - 1.90）、甲状腺功能减退（OR：1.62；95%CI：1.30 - 2.02）、偏头痛（OR：1.52；95%CI：1.17 - 1.98）、注意力缺陷多动障碍（ADHD）（OR：1.45；95%CI：1.28 - 1.65）、脊柱侧弯（OR：1.40；95%CI：1.13 - 1.73）、慢性鼻炎（OR：1.31；95%CI：1.14 - 1.50）以及对严重压力和适应障碍的反应（OR：1.31；95%CI：1.04 - 1.65）在内的十种疾病之间存在显著正相关。此外，对乙酰氨基酚处方与高血压风险呈正相关（OR：1.68；95%CI：1.41 - 2.00）。高血压与慢性疾病，尤其是肥胖之间的显著关联强调了早期预防策略的必要性。需要进行前瞻性研究来证实这些关联。同样，对于所确定的关联的病理生理和机制解释需要在设计合理的研究中进行探索和验证。
