Lingens N, Soergel M, Loirat C, Busch C, Lemmer B, Schärer K
Division of Paediatric Nephrology, University Children's Hospital, Heidelberg, Germany.
Pediatr Nephrol. 1995 Apr;9(2):167-72. doi: 10.1007/BF00860734.
Ambulatory blood pressure monitoring (ABPM) has been shown to be more representative of blood pressure (BP) levels than casual BP measurements in adult patients treated by haemodialysis (HD). In this study we compared ABPM using the oscillometric SpaceLabs 90207 monitor with casual BP measurements in 35 paediatric patients [17 treated by peritoneal dialysis (PD) and 18 by HD]. Heart rate and plasma concentrations of atrial natriuretic peptide were also measured. No correlations were found between ABPM and causal BP measurements, except for systolic day-time BP in PD patients (r = 0.63). Seventy percent of PD and 33% of HD patients were regarded as hypertensive when evaluated by ABPM, while casual BP measurements demonstrated hypertension in 47% (P < 0.05) of PD patients and in 44% (NS) of HD patients. One-third of patients were reclassified by ABPM either from normotensive to hypertensive (7/19) or from hypertensive to normotensive (5/16). BP assessed by ABPM was higher in PD than in HD patients. The physiological decline of BP at night was significant and more pronounced in PD than in HD patients. In HD patients day-time BP did not differ between the 1st and the 2nd interdialytic day, but increased in the night hours before the following dialysis session. A positive correlation was found between day-time BP and pre-dialysis plasma atrial natriuretic peptide in both treatment groups. In conclusion this study demonstrates that casual BP recordings are not representative of average BP in dialysed paediatric patients. ABPM is useful in the diagnosis and treatment of hypertension in children with end-stage renal disease.
动态血压监测（ABPM）已被证明，对于接受血液透析（HD）治疗的成年患者，它比偶然的血压测量更能代表血压（BP）水平。在本研究中，我们使用示波法SpaceLabs 90207监测仪对35例儿科患者（17例接受腹膜透析（PD）治疗，18例接受HD治疗）进行了ABPM，并与偶然的血压测量结果进行了比较。还测量了心率和血浆心房利钠肽浓度。除了PD患者的日间收缩压（r = 0.63）外，ABPM与偶然血压测量之间未发现相关性。通过ABPM评估时，70%的PD患者和33%的HD患者被视为高血压，而偶然血压测量显示47%（P < 0.05）的PD患者和44%（无显著性差异）的HD患者患有高血压。三分之一的患者通过ABPM重新分类，要么从血压正常变为高血压（7/19），要么从高血压变为血压正常（5/16）。ABPM评估的血压在PD患者中高于HD患者。夜间血压的生理性下降很显著，且在PD患者中比HD患者更明显。在HD患者中，第1次和第2次透析间期的日间血压没有差异，但在下一次透析前的夜间血压升高。在两个治疗组中，日间血压与透析前血浆心房利钠肽之间均发现正相关。总之，本研究表明，偶然的血压记录不能代表透析儿科患者的平均血压。ABPM对终末期肾病儿童高血压的诊断和治疗有用。
