原发性和继发性高血压患儿动态血压监测特点

目的 探讨儿童原发性高血压与继发性高血压的血压特点,提高对儿童高血压的病因识别.方法 选择2003年11月-2011年3月在首都医科大学附属北京安贞医院高血压科住院的高血压患儿为研究对象,按其病因分为原发性高血压和继发性高血压2组.患儿均常规测定身高、体质量、空腹血糖、血Cr、血尿酸、血脂及肾素、血管紧张素Ⅱ和醛固酮水平,并计算体质量指数(BMI).行手测血压、24 h动态血压监测,分析2组间日间、夜间收缩压(SBP)及舒张压(DBP)水平、日间、夜间SBP及DBP血压负荷等指标.结果 高血压患儿中男19例,女6例；年龄(12.4±2.5)岁.原发组患儿体质量和BMI均高于继发组患儿[(70.94±31.46)kg vs (45.93±14.62)kg; (24.98±6.96) kg·m-2 vs (19.13±4.89) kg·m-2],2组间差异均有统计学意义(P =0.013,0.031).与原发组患儿比较,继发组患儿的日间平均DBP水平[(91.14±10.67) mmHg vs (79.06±10.42) mmHg(1 mmHg=0.133kPa)]、夜间平均DBP水平明显升高[(81.43±12.71)mmHg vs (66.83±12.49) mmHg],日间SBP负荷[(79.46±18.17)％ vs(46.88±33.29)％],夜间SBP负荷[(89.02±15.74)％vs54.22 ±27.91)％],日间DBP血压负荷[(62.87±31.33)％ vs(30.94±27.36)％],差异均有统计学意义(Pa＜0.05).结论 原发性高血压患儿多伴有肥胖.继发性高血压患儿动态血压监测中日间和夜间DBP水平增高、日间和夜间SBP负荷、日间DBP负荷高.在儿童中动态监测血压水平,可帮助鉴别病因.

Features of Ambulatory Blood Pressure Monitoring in Children with Primary Hypertension and Secondary Hypertension

Objective To investigate the blood pressure characteristics of children with primary hypertension and secondary hypertension to improve the identification of hypertension in children.Methods The subjects were the children with high blood pressure in Beijing Anzhen Hospital from Nov.2003 to Mar.2011.They were divided into 2 groups:primary group and secondary group.Height,weight,fasting blood glucose,serum creatinine,uric acid,blood lipid level,renin-angiotensin-aldosterone concentration were all routinely tested.The body mass index(BMI) were calculated.Office blood pressure and 24 hour ambulatory blood pressure were measured.The levels of daytime and nighttime systolic blood pressure(SBP) and diastolic blood pressure(DBP),the daytime and nighttime SBP load and DBP load were analyzed.Results There were 19 boys and 6 girls in the patients with hypertension.Their average age was(12.4±2.5) years.The weight and BMI of children in primary group were higher than those in the secondary group[(70.94±31.46) kg vs(45.93±14.62) kg,(24.98±6.96) kg·m-2 vs(19.13±4.89) kg·m-2],the differences between the 2 groups were statistically significant(P=0.013,0.031).The levels of daytime and nighttime DBP were significantly increased in the secondary group as compared with the primary group [(91.14±10.67) mmHg vs(79.06±10.42) mmHg(1 mmHg=0.133 kPa),(81.43±12.71) mmHg vs(66.83±12.49) mmHg,P<0.05].The daytime and nighttime SBP load and daytime DBP load of the children in secondary group were higher than those in primary group[(79.46±18.17)% vs(46.88±33.29)%,(89.02±15.74)% vs(54.22±27.91)%,(62.87±31.33)% vs(30.94±27.36)%,Pa<0.05].Conclusions Primary hypertension is associated with obesity in children.The levels of daytime and nighttime SBP load,daytime DBP load increase in secondary hypertension children.Recommended that ambulatory blood pressure monitoring is employed to understand children′s blood pressure levels and help identify the cause.