Improving blood pressure in children is protective over the long term.
Improving blood pressure in children is protective over the long term.
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从长远来看，改善儿童血压具有保护作用。
DOI：
10.1161/circulationaha.113.003954
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发表时间：
2013
期刊：
影响因子：
37.8
通讯作者：
Zachariah,JustinP
中科院分区：
文献类型：
--
作者：
Zachariah,JustinP
Zachariah改善儿童血压199项研究表明，直觉上满意的心脏干预措施可能是错误的，甚至是危险的，科学界正在认识到，正确的答案有时是不合理的。11、12因此，真理来自严格的随机、盲目、对照试验(RCT)，只有在这些裁决之后才应采取临床行动。毫无疑问，区域合作研究发挥着强大的作用，但当它不能发挥作用时该怎么办？例如，哪些RCT针对儿童食用蔬菜以预防成人心血管疾病？这样的研究会出现吗？在没有RCT数据相反的情况下，孩子们有没有免费吃蛋糕的许可证？在这个荒谬的例子中，用其他干预措施取代蔬菜说明了测试原始和主要心血管疾病预防策略的困难。在一个近1/20的儿童血压升高、近1/5的儿童胆固醇升高、两个亚群中都有近50%体重正常的人群中，单纯关注肥胖缺乏可信度。13儿童心血管疾病的危险因素也值得关注，因为新出现的数据支持这样一个合理的猜测，即终身降低心血管疾病风险可能优于药物降低心血管疾病风险。14因此，在缺乏一项随机对照试验的情况下，本研究为改善儿童血压的效用提供了具体证据。这项研究中改善的生理学可能与肥胖有关，因为消解组的平均体重指数显著下降。其他解释可能包括白大褂高血压，这在儿童中特别有问题，并使结果的流行病学评估复杂化。尽管Juhola和他的同事提供的数据令人信服，但我们不能从这些数据中推断出药物降压的效果作为改善机制，在20年以上的框架内，发育中机构的副作用概况可能不同，现在的儿童可能与20年前的i3C队列相似，也可能不相似。目前的数据确实将降血压的动脉粥样硬化益处扩展到了儿科年龄组。我们可以希望，关于长期结果和生物机制的更多数据即将公布。
Zachariah Improving Blood Pressure in Children 199 studies demonstrating how intuitively satisfying cardiac interventions can be wrong or even dangerous, the scientific community is realizing that the right answer is sometimes irrational. 11, 12 Therefore, truth is derived from rigorous randomized, blinded, controlled trials (RCTs), and clinical action should only transpire following these verdicts. No doubt, there is a strong role for the RCT, but what to do when it is not forthcoming? For example, which RCT addresses children eating vegetables to prevent adult CVD? Will such a study ever transpire? Do children have free license to eat cake at will in the absence of RCT data to the contrary? Substituting vegetables in this absurd example with other interventions illustrates the difficulties in testing primordial and primary CVD prevention strategies. Simply focusing on obesity lacks credibility in a population where nearly 1 in 20 children have elevated BP, nearly 1 in 5 have elevated cholesterol, and close to 50% of both subsets have normal weight. 13 CVD risk factors in children deserve attention too, because emerging data support the rational conjecture that lifelong CVD risk reduction may be superior to pharmacological CVD risk reduction. 14 So, in the absence of an RCT testing BP-lowering interventions over a 25-year frame, the present study offers specific evidence for the utility of improving BP in children. The physiology of the improvement in this study may relate to obesity, because the mean body mass index decreased significantly in the resolution group. Other explanations may include white-coat hypertension, which is particularly problematic in children and complicates the epidemiological assessment of outcomes. Although the data presented by Juhola and colleagues are compelling, we must not infer the effect of pharmacological BP lowering from these data as mechanisms of improvement, sideeffect profiles in developing bodies over a 20+ year frame likely differ, and current children may or may not be similar to the i3C cohort who were children 20 years ago. The present data do extend the atherosclerotic benefits of BP lowering down to the pediatric age group. We can hope that more data on long-term outcomes and biological mechanisms are forthcoming.
影响因子：
24
作者：
Gray, Linsay;Lee, I-Min;Sesso, Howard D.;Batty, G. David
通讯作者：
Batty, G. David