Bald M, Lettgen B, Wingen A M, Bonzel K E
Department of Pediatric Nephrology, University Children's Hospital, Essen, Germany.
Clin Nephrol. 1996 Jul;46(1):50-3.
24-hour blood pressure monitoring is a valuable method for the diagnosis of arterial hypertension as well as for assessment of the diurnal rhythm of the arterial blood pressure (BP). The nocturnal decrease of blood pressure ("dipping") may be attenuated or abolished in children with advanced renal failure and glomerular diseases. Arterial hypertension is a longlasting problem in children who had recovered from hemolytic uremic syndrome (HUS). We therefore performed BP monitoring in 11 children and adolescents (age 1.3 to 18.8 years, 6 males, 5 females) after HUS using a portable oscillometric device (SpaceLabs 90207). Six of the subjects had a normal renal function (group A). The other 5 patients had impaired renal function with a glomerular filtration rate <60 ml/min/1.73 m2 (group B). Nocturnal dipping was calculated as nocturnal mean blood pressure minus diurnal mean blood pressure given in per cent of diurnal mean blood pressure. Two of the patients in group A had diurnal mean BP above the 95th percentile of the German collaboration study, but none of the group was hypertensive during the night, and nocturnal dipping was 13.6% (9.7-15.5%, median and range) for systolic BP and 23.7% (15.5-29.9%) for diastolic BP which is very similar to healthy children. All of the patients had a normal diurnal BP rhythm. From patients of group B, 4 had elevated diurnal mean BP and also 4 were hypertensive during the night. Nocturnal dipping was 1.4% (0.7-4.1%) for systolic and 6.8% (0-10.7%) for diastolic BP which is clearly attenuated compared to group A. We therefore conclude that arterial hypertension is more common in patients after HUS if they have impaired renal function, and diurnal rhythm of arterial blood pressure is attenuated in these patients. However, nocturnal dipping of blood pressure is not disturbed in children after HUS without renal insufficiency, even if they were hypertensive.
24小时血压监测是诊断动脉高血压以及评估动脉血压（BP）昼夜节律的一种有价值的方法。晚期肾衰竭和肾小球疾病患儿的夜间血压下降（“勺型”）可能会减弱或消失。动脉高血压是溶血尿毒综合征（HUS）康复患儿的一个长期问题。因此，我们使用便携式示波装置（太空实验室90207）对11例HUS后的儿童和青少年（年龄1.3至18.8岁，男6例，女5例）进行了血压监测。其中6名受试者肾功能正常（A组）。另外5例患者肾功能受损，肾小球滤过率<60 ml/min/1.73 m2（B组）。夜间血压下降幅度计算为夜间平均血压减去日间平均血压，以日间平均血压的百分比表示。A组中有2例患者的日间平均血压高于德国合作研究的第95百分位数，但该组夜间均无高血压，收缩压的夜间血压下降幅度为13.6%（9.7 - 15.5%，中位数和范围），舒张压为23.7%（15.5 - 29.9%），这与健康儿童非常相似。所有患者的日间血压节律均正常。B组患者中，4例日间平均血压升高，4例夜间高血压。收缩压的夜间血压下降幅度为1.4%（0.7 - 4.1%），舒张压为6.8%（0 - 10.7%），与A组相比明显减弱。因此，我们得出结论，HUS后肾功能受损的患者动脉高血压更为常见，且这些患者的动脉血压昼夜节律减弱。然而，HUS后无肾功能不全的儿童即使高血压，其夜间血压下降也未受干扰。
