中国儿童青少年血压参照标准的研究制定

目的 研制适合中国儿童青少年生长发育特点的血压参照标准。方法 通过文献检索和推荐方法,汇集中国4个直辖市和7个省、自治区自2000年以来以人群为基础的3~18岁汉族儿童青少年血压测量数据,组成112 227人的参照人群样本,采用“2005年全国学生体质与健康调研”人群身高和BMI指标对本参照人群生长发育和营养状况进行评价;描述血压随年龄的变化趋势;采用LMS方法拟合收缩期Korotkoff第1音（SBP）、舒张期Korotkoff第4音（DBP-K4）、舒张期Korotkoff第5音（DBP-K5）的百分位曲线,采SBP、DBP-K4和DBP-K5的性别、年龄别第50、90、95和99百分位（P50、P90、P95和P99）组成“中国儿童青少年血压参照标准”;将研制产生的中国儿童青少年血压参照标准分别与北京标准、美国标准和WHO标准进行比较。结果 男、女性儿童青少年的SBP、DBP-K4和DBP-K5各百分位曲线均随年龄增长呈逐渐上升趋势。中国儿童青少年血压参照标准的SBP和DBP-K4参照值与美国标准接近,5岁以下和15岁以上的SBP参照值低于美国标准（P<0.05）;除个别年龄组（男、女3岁,男≥16岁,女≥14岁）外,DBP-K4与美国标准吻合度,而DBP-K5显著低于美国标准。无论是SBP还是DBP中国标准均显著低于WHO 标准。结论 中国儿童青少年血压标准包括SBP、DBP-K4和DBP-K5 3个指标的参照值,是以来自中国儿童青少年血压发育特点的流行病学和临床研究数据为基础所产生,符合目前中国大陆儿科临床操作规范,同时兼顾与国际标准的接轨,具有现实可操作性和前瞻性,建议在中国大陆地区推广应用。     

Home blood pressure in children and adolescents: a comparison with office and ambulatory blood pressure measurements

Aim: To compare BP measurements of children and adolescents using different methods office BP (OBP), ambulatory BP monitoring (ABPM) and home BP measurement (HBPM) and to study their correlations. Method: Individuals were evaluated between 5 and 15 years of age who had been referred because of a previous high BP. OBP was measured with the OMRON‐705CP. Three measurements were carried out at 5‐min intervals. HBPM were taken using the same device, two measurements at 5‐min intervals in the morning and in the evening during 7 days. ABPM was performed using the SpaceLabs 90207 monitors. Results: A total of 109 children and adolescents were evaluated (9.82 ± 2.63 years), 52.3% boys, 56.9% non‐white. The office systolic BP (SBP) was lower than in daytime ABPM (p < 0.001) but similar HBPM (p = 0.294), and the office diastolic BP (DBP) was lower than daytime ABPM (p < 0.001) and in HBPM (p = 0.035). The SBP and DBP at HBPM was lower than daytime ABPM (p < 0.001). Daytime ambulatory BP was more closely associated with home readings (SBP r = 0.731 and DBP r = 0.616) than with office’s readings (SBP r = 0.653 and DBP r = 0.394). Conclusion: The BP of children and adolescents varies depending on the place and manner of measurement. ABPM presents better correlation with HBPM than with the office measurements.     

Waist-to-height ratio is not a predictor of systolic blood pressure in 3-year-old children

Waist:height has been proposed as an indicator of cardiovascular risk. We investigated the association of waist:height with systolic BP (sBP) in 3 year old children. Body mass index was a significant predictor of sBP, whereas waist:height was not: suggesting waist:height is not a useful indicator of sBP in this age group.     

Non-invasive oscillometric measurement of systolic,mean and diastolic blood pressure in infants with congenital heart defects after operation. A comparison with direct blood pressure measurements

The accuracy of indirect oscillometric blood pressure measurements has been evaluated in 32 infants up to 11 months of age undergoing heart surgery. In a number of 1029 simultaneous measurements the indirect blood pressure was compared with the direct value obtained from a radial artery catheter. Cuffs of different sizes were applied. The main results were as follows: (1) Regarding the ratio of cuff width to arm circumference, the best correlation between oscillometric and direct blood pressure measurements was obtained with a ratio of 0.38–0.41. (2) The value of indirect blood pressure measurements depends on the absolute height of the blood pressure. In low blood pressure there is a tendency to underestimate and in high blood pressure there is a tendency to overestimate by the oscillometric blood pressure measurement.By applying an appropriate cuff size and by using our diagrams it should be possible to derive a direct value for the blood pressure on the basis of indirect oscillometric blood pressure measurements.Abbreviations BP blood pressure - BPM blood pressure measurements - CW/ArmC cuff width to arm circumference ratio - DAP diastolic arterial pressure - MAP mean arterial pressure - SAP systolic arterial pressure - ME mean error - SD standard deviation Research fellow supported by the A. v. Humboldt Stiftung     

Circadian rhythm of blood pressure in children with reference to normal and diseased children

Circadian rhythms of blood pressure in children were investigated using ambulatory blood pressure monitoring (ABPM). The subjects were 58 normal children (26 boys and 32 girls), 10 children with orthostatic dysregulation (OD) consisting of (three boys and seven girls) and 13 children taking prednisolone (nine boys and four girls). Systolic pressure in the normal group increased from early morning, peaked in the afternoon and gradually dropped thereafter. Blood pressure in the 22:00–05:30 h time range was significantly lower than in other time ranges. Blood pressure in the OD group was generally lower than in the normal group, while that in the steroid group tended to be higher. Systolic mid-line estimating statistic of rhythm (MESOR) was significantly higher in boys than girls in both 10–12 year olds and 13–15 year olds according to Cosinor analysis. However, no increase in MESOR was observed in either boys or girls between the 10–12 year and 13–15 year age groups. The OD group showed lower diastolic MESOR than the normal group and the steroid group showed higher systolic MESOR. Seventy-two per cent of those in the normal group manifested significant circadian rhythm. Only 50% of 10 12 year olds manifested circadian rhythm, whereas the figure for 13–15 year olds increased to 80–90%, suggesting that a pacemaker regulating circadian rhythm comes into effect at puberty. The percentage of those who manifested circadian rhythm in the OD group and steroid group was about 60%, lower than in the normal group.     

宁夏银川市城区儿童青少年不同肥胖表型与血压异常的关系

目的:了解银川市城区儿童青少年不同肥胖表型与血压异常的关系,为肥胖儿童青少年提供适宜的治疗及干预措施。方法:采用现况研究设计,以方便整群抽样的方法于2017年9月至2018年9月共抽取银川市1 047名12～18岁儿童青少年为研究对象,其中男530名、女517名,年龄(13.93±1.24)岁,并对其进行问卷调查、体格...     

Left atrial diameters in overweight children with normal blood pressure

OBJECTIVE: To measure left atrial (LA) diameter in normotensive, overweight children and to determine the variables that independently influence LA diameters. STUDY DESIGN: A cross-sectional study on 22 overweight children (age, 13.40 +/- 1.22 years) and 18 control children (age, 13.40 +/- 2.19 years) was performed. LA diameter, left ventricular (LV) geometry, and LV systolic/diastolic function were measured through echocardiography. Data were compared between the two groups. Multiple regression analysis, with LA diameter as dependent variable, was conducted. RESULTS: In the overweight group, LV diastolic dimension, LV mass index, peak S, S/D ratio, Am, maximal LA diameter (34.1 mm vs 25.4 mm), middle LA diameter (26.9 mm vs 18.1 mm), and minimal LA diameter (22.5 mm vs 16.1 mm) were increased and Em/Am ratio was decreased. In multiple regression analysis, body mass index (R(2) = 0.7040, 0.7085, 0.7406 in respective maximal, middle, and minimal LA diameter) and systolic blood pressure (R(2) = 0.0540, 0.0477, 0.030 in respective maximal, middle, and minimal LA diameter) were significant independent correlates of all three measures of LA diameter. CONCLUSIONS: LA diameter in normotensive overweight children is increased. Body mass index and systolic blood pressure were significant correlates of LA diameter.     

Circadian blood pressure changes in untreated children with kidney disease and conserved renal function

Abstract Ambulatory blood pressure monitoring over 24 h was applied in 31 children with kidney disease, aged 3–19 (median 11) years, in the absence of renal insufficiency and without antihypertensive therapy. Median creatinine clearance was 112ml/min/1.73m². Ambulatory blood pressure monitoring revealed that eight patients (26%) were hypertensive during the daytime, compared to 62% through casual recordings obtained in the office and 38% when blood pressure was taken at home. Nocturnal hypertension was detected by ambulatory monitoring in six patients, two of whom had normal blood pressure in the daytime. Median nocturnal dipping was 13% for systolic and 21% for diastolic blood pressure, i.e. similar to healthy children. Rhythm analysis recognized a distorted circadian pattern for systolic and/or diastolic blood pressure in eight patients. In conclusion, ambulatory blood pressure monitoring allows the evaluation of hypertension more reliably than casual recordings in the office. Nocturnal hypertension, as a major risk factor for renal deterioration, is detected in a similar proportion as daytime hypertension in almost 20% of untreated children with kidney disease and normal renal function.     

Aortic vessel wall characteristics and blood pressure in children with intrauterine growth retardation and abnormal foetal aortic blood flow

Blood pressure and pulsatile diameter changes of the abdominal aorta were measured in 68 children (mean age 9 years), with varying degrees of intrauterine growth retardation who were previously examined in their intrauterine life with Doppler velocimetry of the thoracic descending aorta. Diastolic blood pressure was lower ( p < 0.05) and pulse pressure was increased ( p < 0.01) in children with a birthweight small for gestational age as compared to those with a birthweight appropriate for gestational age. Systolic blood pressure was positively associated with relative increase in weight from birth up to the time of examination ( p < 0.01), but not to early catch-up growth. Aortic vessel wall diameters were smaller in children born small for gestational age, both before and after correction for current body surface area ( p < 0.01). Blood pressure and aortic vessel wall characteristics exhibited no relationship to the foetal aortic Doppler wave-form. Changes in foetal haemodynamics associated with intrauterine growth retardation do not appear to contribute to a later increase in blood pressure. Within a group of foetuses with suspected growth retardation, increasing foetal weight deviation and a birthweight small for gestational age is associated with lower diastolic blood pressure at 9 years of age.