The increasing burden of pediatric hypertension.
The increasing burden of pediatric hypertension.
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小儿高血压的负担日益加重。
DOI：
10.1161/hypertensionaha.112.197624
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Samuels,Joshua
中科院分区：
文献类型：
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作者：
Samuels,Joshua
在本期《高血压》杂志中，Tran等人报道了住院儿童高血压带来的经济和医疗负担的增加。利用儿科医院出院的医疗成本和利用项目数据库，作者首次看到了高血压对儿童的经济影响日益增长。这项重要的研究有助于消除关于儿童高血压的一些剩余的神话，其中许多正在迅速让位于诸如这些新数据的证据(表)。当然，最大的误区是，高血压是一种成人疾病，与儿童没有真正的相关性。为什么要担心儿童高血压？首先，现在很明显，高血压儿童确实会成长为高血压成年人。2008年的一项荟萃分析发现了50项研究，证明了从青春期到成年期的血压跟踪。然而，这两种疾病并不是同义词。儿童对高血压的诊断与成人有很大不同。当儿童在整个儿科年龄范围内成长为成年人时，他们的血压通常会逐渐上升。因此，儿童血压是根据年龄、身高和性别的阈值进行分类，而不是像全国高血压预防、检测、评估和治疗联合委员会第七次报告中所述的“一刀切”的定义。国家高血压教育项目儿童和青少年高血压工作组的第四份报告将重复测量血压在前5%的儿童定义为高血压。3这一统计定义缺乏成人指南中基于结果的发现，并同样保证一定比例的儿童将患有高血压。尽管根据定义，前5%的人被归类为高血压，但反复血压升高的要求导致更常见的发现，样本人群中有3%至4%的人患有持续性高血压。这些数字虽然远低于患有高血压的成年人的30%，但并不比其他常见的儿童疾病，如注意力缺陷多动障碍或哮喘(9%)低多少，而比一些得到更多关注的疾病(如自闭症或癫痫(1%))高得多。第二个误区是，儿童的血压问题几乎总是归因于次要原因。二次超-
In this issue of Hypertension, Tran et al1 report on the increasing economic and medical burden of hypertension in hospitalized pediatric patients. Using the Healthcare Cost and Utilization Project database of pediatric hospital discharges, the authors have provided the first glimpse of the growing economic impact that hypertension is playing in children. This important study helps dispel some of the remaining myths about pediatric high blood pressure, many of which are rapidly giving way to evidence such as these new data (Table). The biggest myth, of course, is that hypertension is an adult disease with no real relevance to children.Why be concerned about pediatric hypertension? For one, it is now clear that hypertensive children do grow into hypertensive adults. A 2008 meta-analysis found 50 studies demonstrating the tracking of blood pressure from adolescence into adulthood. 2 The diseases are not, however, synonymous. Children differ greatly from adults in the diagnosis of hypertension. As children grow into adult size across the pediatric age range, their blood pressure normally exhibits a gradual rise. Rather than a “onesize-fits-all” definition as in the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, children’s blood pressure is, therefore, categorized from thresholds based on age, height, and sex. The fourth report from the National High Blood Pressure Education Program’s Working Group on High Blood Pressure in Children and Adolescents defines children whose blood pressure is in the top 5% on repeated measurements as hypertensive. 3 This statistical definition lacks the outcomes-based findings found in adult guidelines and similarly guarantees that a set proportion of children will have hypertension. Although by definition the top 5% are classified as hypertensive, the requirement of repeatedly elevated blood pressure leads to the more common finding of 3% to 4% of sampled populations having sustained hypertension. 4, 5 These numbers, although much lower than the 30% of adults who have hypertension, are not much lower in prevalence than other common childhood illnesses, such as attention deficit hyperactivity disorder or asthma (9% each) and much higher than some disorders that get far more attention, such as autism or epilepsy (1% each). A second myth is that pediatric blood pressure problems are almost always attributed to secondary causes. Secondary hyper-