Right Analysis-wrong conclusion: Obese youth with higher BP are at risk for target organ damage.
Right Analysis-wrong conclusion: Obese youth with higher BP are at risk for target organ damage.
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正确的分析-错误的结论：血压较高的肥胖青少年存在靶器官损伤的风险。
DOI：
10.1093/ajh/hpv009
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发表时间：
2015
影响因子：
3.2
通讯作者：
Falkner,Bonita
中科院分区：
文献类型：
--
作者：
Urbina,ElaineM;Falkner,Bonita
血压计由Karl Ritter于19世纪80年代发明，后来被用作体检中的常规生命体征，因为发现极高或极低的血压（BP）水平表明存在疾病。在历史回顾中，Kotchen 2追踪了保险业在认识BP和死亡率之间关系方面的作用。在20世纪初，血压测量成为人寿保险检查的一部分，从那个时代开发的精算数据显示血压升高对预期寿命的影响。然而，直到20世纪50年代，来自心脏研究的数据才表明，血压的适度升高可预测未来的不良心血管（CV）事件。3该研究证实，高血压是心血管疾病的危险因素，并预测随后的发病率。后来的许多研究重复了这些发现，并证明随着血压升高，CV风险呈线性增加，没有阈值效应（即，较低血压水平是“安全”的明确临界点）。4这些历史观察结果值得记住，因为不是血压水平本身导致发病率和死亡率，而是血压升高对重要身体器官造成的伤害导致CV事件。事实上，BP相关的靶器官损伤，如左心室质量（LVM）升高、颈动脉内膜中层厚度（cIMT）增加和脉搏波速度（PWV）是成人硬CV事件的预测因子，即使在调整其他CV风险因素后也是如此。5-7升高儿童未来不良事件风险的确切BP水平尚不清楚。随着无症状健康儿童的标准BP数据的发展，人们认识到儿童和青少年的BP水平大大低于成人;并且BP水平逐渐升高，与儿童生长和发育相对应。在成人中，有长期结局数据将BP水平（例如，140/90 mm Hg）与后续事件（如卒中、心力衰竭、肾衰竭或死亡）的高风险联系起来，从而提供了预测高风险的数值BP水平。然而，没有这样的结果数据，链接的BP水平与高风险是在儿童时期。此外，健康儿童的血压数据表明，根据年龄，性别和身高，标准血压分布曲线发生了变化。由于这些原因，自20世纪70年代末以来，儿童高血压在统计学上被定义为与正态分布的极端部分相匹配的BP水平。因此，儿童期高血压定义为血压水平≥年龄、性别和身高调整后血压分布的第95百分位数。[8]因此，儿童高血压的定义是统计学上的，与成人高血压不同，它不是基于结果的。儿童期高血压的定义是否准确估计了以后CV事件或潜在CV损伤的风险尚未得到证实。肥胖与高血压的关系在成人和儿童中都已经得到了很好的证实。一些流行病学和临床报告描述了超重和肥胖与儿童期高血压和高血压患病率的密切关系。9-11当将超重和肥胖儿童从第四次报告中使用的儿童血压数据中删除时，12第95百分位数的血压水平较低。13在Schwandt等人的报告中。14在本期杂志中，作者清楚地证明了正常体重与超重与肥胖儿童的年龄，身高和性别调整后的BP分布的差异。肥胖儿童的血压分布明显较高。例如，身高中位数15岁的第95百分位数...
See ARTICLE page 672 The sphygmomanometer was invented by Karl Ritter in the 1880s 1 and was later adopted as a routine vital sign in physical examination since extremely high or low blood pressure (BP) levels were found to indicate presence of disease. In an historical review, Kotchen 2 tracked the role of the insurance industry in recognizing a relationship between BP and mortality. In the early 1900s, BP measurement became part of life insurance examinations, and actuarial data developed from that era showed an effect of elevated BP on life expectancy. However, it was not until the 1950s that data from the Framingham Heart Study demonstrated that modest elevations of BP were predictive of future adverse cardiovascular (CV) events. 3 The study confirmed that high BP is a risk factor for CV disease and predicts subsequent morbidity. Many later studies replicated these findings and demonstrated that as BP increases there is a linear increase in CV risk, without a threshold effect (ie, a clear cut-point at which lower levels of BP are “safe”). 4 These historical observations are important to remember because it is not the BP level itself, which confers morbidity and mortality, but it is the harm the BP elevation is causing to important body organs that leads to CV events. In fact, BP-related target organ damage such as elevated left ventricular mass (LVM), increased carotid intima-media thickness (cIMT), and pulse wave velocity (PWV) are predictors of hard CV events in adults, even after adjusting for other CV risk factors. 5–7 The precise level of BP that elevates risk for future adverse events in children is less clear. With development of normative BP data on asymptomatic healthy children, it was recognized that BP levels in children and adolescents are considerably lower than in adults; and there is a progressive increase in BP level that corresponds to childhood growth and development. In adults, there are long-term outcome data that link a BP level (eg, 140/90 mm Hg) with high risk for subsequent events such as stroke, heart failure, kidney failure, or death, thus providing a numerical BP level to predict heightened risk. However, no such outcome data that link a BP level with heightened risks are available in childhood. Moreover, BP data in healthy children demonstrate a shift in the normative BP distribution curve according to age, sex, and height. For these reasons, since the late 1970s, hypertension in childhood has been defined statistically as a BP level that matches the extreme portion of the normal distribution. Therefore, hypertension in childhood is defined as BP level that is≥ 95th percentile of the age, sex, and heightadjusted BP distribution. 8 Thus, hypertension in children is defined statistically and, unlike adult hypertension, is not based on outcomes. Whether this childhood definition of hypertension accurately estimates risk for later CV events or for underlying CV injury has never been confirmed. The association of obesity with higher BP has been has well established in both adults and children. Several epidemiologic and clinical reports describe the strong association of overweight and obesity with high BP and prevalence of hypertension in childhood. 9–11 When overweight and obese children were removed from the child BP data used in the Fourth Report, 12 the BP levels at the 95th percentile were lower. 13 In the report by Schwandt et al. 14 in this issue of the journal, the authors clearly demonstrate divergence in age, height, and sex-adjusted BP distribution in normal weight vs. overweight vs. obese children. The BP distributions are considerably higher in obese children. For example, the 95th percentile for a median height 15-year …
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影响因子：
4.9
作者：
B. Falkner
通讯作者：
B. Falkner
影响因子：
3.2
作者：
Schwandt, Peter;Scholze, Juergen E.;Haas, Gerda M.
通讯作者：
Haas, Gerda M.
DOI：
--
发表时间：
1957-04
期刊：
American journal of public health and the nation's health
影响因子：
--
作者：
T. Dawber;F. E. Moore;G. Mann
通讯作者：
T. Dawber;F. E. Moore;G. Mann
影响因子：
5
作者：
Rosner, B.;Cook, N.;Falkner, B.
通讯作者：
Falkner, B.
DOI：
10.2105/ajph.47.4_pt_2.4
发表时间：
1957-01-01
期刊：
AMER JOUR PUBL HEALTH
影响因子：
--
作者：
DAWBER, T. R.;MOORE, F. E.;MANN, G. V.
通讯作者：
MANN, G. V.