Berenson G S, Cresanta J L, Webber L S
Annu Rev Med. 1984;35:535-60. doi: 10.1146/annurev.me.35.020184.002535.
Essential hypertension begins in early childhood. Current evidence suggests that those children persisting at high levels over time may be considered to have essential hypertension. The evaluation of high levels is best judged from blood pressure percentile grids representing population measurements, as long as the methods used to measure blood pressure and to generate the grids are similar. Resting, basal blood pressure measurements are more reproducible and are better for following the time course of blood pressure levels in children. Measurements should be made in an unhurried, relaxed atmosphere by trained observers using adequately lighted instruments placed at eye level and a cuff size appropriate for the child's arm length and circumference. Repeated observations and serial blood pressure measurements of growing children are necessary for judgments of abnormal levels. There is a progressive rise of approximately 1.5 mm Hg systolic and 1 mm Hg diastolic pressure per year of age, but blood pressure levels in the growing child are more closely related to height. In most instances elevated blood pressure levels in children cannot be attributed to secondary causes. Various hemodynamic and biochemical mechanisms have been identified in the early stages of hypertension, and mechanisms contributing to the development of hypertension may be of different magnitudes in black children and white children. Studies following young adults over many years have shown the predictive value of baseline blood pressure levels for subsequent hypertension. Children tracking at the high percentiles can be identified and are candidates for early intervention. The key to early prevention of essential hypertension is to influence children and adolescents to adopt lifestyles that promote good health and prevent development of cardiovascular risk factors.
原发性高血压始于儿童早期。目前的证据表明，那些血压长期维持在高水平的儿童可被视为患有原发性高血压。只要测量血压和生成百分位数网格所使用的方法相似，通过代表人群测量值的血压百分位数网格来评估高血压水平是最佳方式。静息时的基础血压测量值更具可重复性，并且更有利于追踪儿童血压水平随时间的变化。测量应由经过培训的观察者在不匆忙、放松的环境中进行，使用放置在眼睛水平高度且光线充足的仪器，并使用适合儿童手臂长度和周长的袖带。对于成长中的儿童，需要进行多次观察和连续血压测量，以判断血压水平是否异常。收缩压每年大约升高1.5毫米汞柱，舒张压每年大约升高1毫米汞柱，但成长中儿童的血压水平与身高的关系更为密切。在大多数情况下，儿童血压升高不能归因于继发性原因。在高血压早期已发现各种血流动力学和生化机制，并且导致高血压发展的机制在黑人儿童和白人儿童中可能具有不同程度的影响。对年轻人进行多年跟踪研究表明，基线血压水平对后续高血压具有预测价值。可以识别出处于高百分位数的儿童，他们是早期干预的候选对象。早期预防原发性高血压的关键在于影响儿童和青少年采用促进健康并预防心血管危险因素发展的生活方式。
