Ponad 7000 publikacji medycznych!
Statystyki za 2021 rok:
odsłony: 8 805 378
Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu
© Borgis - Postępy Nauk Medycznych 11/2015, s. 787-793
*Mieczysław Litwin1, Zbigniew Kułaga2
Nadciśnienie tętnicze u dzieci – zarys problemu, wartości referencyjne, wskazania do badań przesiewowych i zasady leczenia
Pediatric hypertension – definition, normative values, epidemiology, screening and treatment
1Department of Nephrology and Arterial Hypertension, The Children’s Memorial Health Institute, Warszawa
2Department of Public Health, The Children’s Memorial Health Institute, Warszawa
Streszczenie
Pomimo jednoznacznej pediatrycznej definicji nadciśnienia tętniczego, istnieje wiele kontrowersji dotyczących stosowania właściwych norm ciśnienia tętniczego, wskazań do prowadzenia badan przesiewowych i leczenia nadciśnienia u dzieci i młodzieży. W artykule przedstawiono historię badań nad nadciśnieniem u dzieci, opracowania norm ciśnienia tętniczego oraz zasady leczenia nadciśnienia tętniczego pierwotnego u dzieci i młodzieży. Przedstawiono również kontrowersje związane z zasadnością prowadzenia badań przesiewowych w kierunku nadciśnienia tętniczego w wieku rozwojowym. Zbyt wczesne wprowadzenie badań przesiewowych prowadzi do błędnego rozpoznania nadciśnienia tętniczego, co jest związane z dużą częstością nadciśnienia białego fartucha i efektu białego fartucha. Z kolei zaniechanie badań przesiewowych może prowadzić do zbyt późnego rozpoznania choroby, co ma szczególne znaczenie w przypadku wtórnych postaci nadciśnienia tętniczego. Decyzje o wprowadzeniu powszechnych badań przesiewowych w kierunku nadciśnienia tętniczego w populacji dziecięcej powinny opierać się zarówno na epidemiologii choroby, jej etiologii, jak i znaczeniu efektu białego fartucha w danej grupie wiekowej. Również, zakres działań diagnostycznych w przypadku już rozpoznanego nadciśnienia tętniczego zależy zarówno od wieku chorego, jak i od ciężkości nadciśnienia. Z kolei leczenie nadciśnienia tętniczego musi uwzględniać jego patogenezę, a w przypadku nadciśnienia tętniczego pierwotnego jego fenotyp pośredni.
Summary
Definition of arterial hypertension in children and adolescents is well known, but there is a lot of controversies regarding use of proper referential values, indications for screening and treatment. In the article we shortly describe history of research on arterial hypertension in children and development of normative blood pressure values. We also discuss the problem of use of referential blood pressure values in childhood, and the prevalence and incidence of arterial hypertension in children. Intermediate phenotype of primary hypertension and the role of life-style in prevention and treatment of primary hypertension in children and adolescents has been discussed. Although there is increasing amount of data indicating that cardiovascular disease starts already in childhood, the population screening of blood pressure in children has been questioned recently. However, it seems that the problem is not “why to measure blood pressure in children” but rather “when to start to measure blood pressure in children”.



For decades, arterial hypertension was regarded as a typical disease of adulthood, strictly related with aging and associated with clinically evident other diseases such as diabetes, ischemic heart disease and/or chronic kidney disease. However, the first measurements of blood pressure in hospitalized children started already 100 years ago when Cook and Briggs from John Hopkins Hospital reported that hospitalized children aged up to 2 years had systolic blood pressure in range from 75 to 90 mmHg and preschool children had systolic blood pressure in the range from 90-110 mmHg. In next decades when strict relations between blood pressure values and cardiovascular risk was documented, blood pressure measurements became routine clinical practice in adults. It is important to note that this analysis was ordered by insurance company Kaiser Permanente and was published in 1925 (1). In Poland, Aleksander Januszkiewicz from Vilnius University stated already in 1922 that “sphygmomanometric measurement of blood pressure” should be routine clinical practice. He also published results of first population study of blood pressure measurements in young adults and adolescents in Poland made in 1920s in Vilnius by Zajączkowski and Łobza (2, 3). They measured blood pressure in 2700 army recruits and 303 male, “non-army” adolescents in age 16-20 years. Blood pressure was measured several times using Korotkov sphygmomanometer, in lying position, at least 1-2 hours after physical exercise. According to Januszkiewicz report, normal systolic blood pressure was in the range of 101-130 mmHg. Systolic blood pressure above 140 mmHg was noted in 10.5% of recruits and in 6.6% of non-army adolescents.
In the same time i.e. in years 1928-1932, normative values of blood pressure in adolescents and adults were published in United States. It was found that systolic blood pressure values rise with age and until age of 30 years are higher in males than in females. In 1924 Stocks published normative values of blood pressure including children below 10 years of age. He reported blood pressure values in age strata from 5 to 39 years in two-year intervals (4). Interestingly, these values are similar to normative values used nowadays. Stocks made few interesting observations and noted that systolic blood pressure rises from adolescence until 39th year of age and that diastolic blood pressure is relatively stable. Thus, it leads to increase of pulse pressure. In Poland, the first pediatric report on blood pressure is from 1925 when Matylda Biehler in her handbook “Principles of diagnosis of pediatric diseases” cited results of the study by dr Nobècourt, who measured blood pressure in children with Riva-Rocci method (5). In the same handbook she also noted that in children in age below 4 years “blood pressure is difficult to estimate, is elevated during crying and lowered during sleep”. Biehler proposed also an algorithm to calculate blood pressure in relations to age: blood pressure = 80 + (2 x X); where X is the age in years.
The next step in understanding character of blood pressure distribution in pediatric population is from reports published in 1952 by Hamilton et al. They published referential values of blood pressure based on measurements done in patients, including children from 10 years of age, who were referred to departments of dermatology, orthopedics and because of venous atheroembolic disease (6). Although blood pressure measured in hospitalized patients cannot be regarded as source data for construction of normative referential values, this study gave few important results. First, they found that in every age strata, including children, blood pressure values have normal distribution and there is no strictly defined threshold dividing normal and abnormal blood pressure values. Second, it indicates that those subjects who have highest blood pressure will suffer in future from hypertensive disease. However, those who have normal blood pressure will have normal blood pressure in future or risk of increase of blood pressure will be lower. Third, Hamilton et al. made in 180 subjects second blood pressure measurements after 3 weeks to 4 months. They found that mean blood pressure values were significantly lower than those obtained during first measurement and the difference was higher the higher was first blood pressure measurement. These historical reports which evidence normal distribution of blood pressure in population gave arguments for advocates of polygenic etiology of arterial hypertension in discussion with advocates of monogenic origin of arterial hypertension.
In the next decade first reports of normative blood pressure values expressed as percentile charts were published. In 1966 Londe published normative values of blood pressure based on measurements done in 1473 healthy children and adolescents in age range 4-15 years and presented values of 80th and 90th percentile for systolic and diastolic blood pressure (7). In the same time, in Poland Mira Pyżuk and Napoleon Wolański published percentile charts of systolic and diastolic blood pressure for children and adolescents in age from 3 to 18 years (8, 9). However, the percentile charts were combined both for girls and boys because, as authors claimed “the differences between blood pressure values in boys and girls were statistically negligible”.
The important step in description of the pediatric hypertension was done in 1970s when the first report of the US Task Force for Blood Pressure in Children and Adolescents was published. In this publication known as “The First Report”, pediatric blood pressure normative values based on data obtained in population studies were published and definition of arterial hypertension in childhood based on percentile distribution and cut-off of 95th percentile was proposed. Because of white coat effect, it was proposed to define arterial hypertension when elevated blood pressure was found on three independent measurements. Since then, the next Task Force Reports were published in 10 years intervals. The last, the 4th Task Report was published in 2004 (10). Task Force Reports include both normative blood pressure values and guidelines for the diagnosis and management of blood pressure in children and adolescents. The normative values of blood pressure presented in the Task Force Reports are based on results obtained in NHANES studies. The next, 5th Task Report is prepared to be published in 2016.
Normative values of blood pressure based on sphygmomanometric auscultatory measurements published in the Task Force Reports became the most often used referential data. In 2009 European Society of Hypertension published pediatric guidelines of diagnosis and management of hypertension in children and adolescents and now new, updated European guidelines are prepared to be published in 2016 (11).
Blood pressure measurements in children and adolescents: auscultatory or automatic – the role of normative, referential values

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
  • Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
  • Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
  • Aby kupić kod proszę skorzystać z jednej z poniższych opcji.

Opcja #1

24

Wybieram
  • dostęp do tego artykułu
  • dostęp na 7 dni

uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony

Opcja #2

59

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 30 dni
  • najpopularniejsza opcja

Opcja #3

119

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 90 dni
  • oszczędzasz 28 zł
Piśmiennictwo
1. Kułaga Z, Litwin M: Wartości referencyjne ciśnienia tętniczego dzieci i młodzieży – historia, stan aktualny, perspektywy. [W:] Litwin M, Januszewicz A, Prejbisz A: Nadciśnienie tętnicze u młodzieży i młodych dorosłych. Medycyna Praktyczna, Kraków 2011.
2. Januszkiewicz A: Podstawowe metody badania w diagnostyce. Pol Gaz Lek 1922; 16: 305-307.
3. Januszkiewicz A: Nadciśnienie tętnicze. Pol Arch Med 1929; 7: 487-573.
4. Stocks P: Blood pressure in early life. Draper’s Company. Nature 1925; 115: 301-302.
5. Biehler M: Podstawy diagnostyki chorób dzieci. Gebethner i Wolff, Warszawa 1925.
6. Hamilton M, Pickering GW, Roberts JAF, Sowry GSC: The aetiology of essential hypertension. 1. The arterial pressure in the general population. Clin Sci (Lond) 1954; 13: 11-35.
7. Londe S: Blood pressure in children as determined under office conditions. Clin Pediatr 1966; 5: 71.
8. Wolański N: Podobieństwo tętniczego ciśnienia krwi między rodzicami i ich dziećmi w różnej fazie rozwoju osobniczego. Przegl Antropol 1971; 37: 57-70.
9. Wolański N: Metody kontroli i normy rozwoju dzieci i młodzieży. PZWL, Warszawa 1975.
10. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555-576.
11. Lurbe E, Cifkova R, Cruikshank JK et al.: Management of high blood pressure in children and adolescents: Recommendations of the European Society of Hypertension. J Hypertens 2009; 27: 1719-1742.
12. Park MK: Blood Pressure Tables. Pediatrics 2005: 115; 826-827.
13. Rosner B, Prineas R, Daniels SR, Loggie J: Blood pressure differences between blacks and whites in relation to body size among US children and adolescents. Am J Epidemiol 2000; 151: 1007-1019.
14. Rosner B, Cook N, Portman R et al.: Determination of Blood Pressure Percentiles in Normal-Weight Children: Some Methodological Issues. Am J Epidemiol 2008; 167: 653-666.
15. Neuhauser HK, Thamm M, Ellert U et al.: Blood pressure percentiles by age and height from nonoverweight children and adolescents in Germany. Pediatrics 2011; 127(4): e978-988.
16. Kułaga Z, Litwin M, Grajda A et al.; OLAF Study Group: Oscillometric blood pressure percentiles for Polish normal-weight school-aged children and adolescents. J Hypertens 2012; 30: 1942-1954.
17. Barba G, Buck C, Bammann K et al.; IDEFICS consortium: Blood pressure reference values for European non-overweight school children: the IDEFICS study. Int J Obes (Lond) 2014; 38 (suppl. 2): S48-56.
18. McNiece KL, Poffenbarger TS, Turner JL et al.: Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007; 150: 640-644.
19. Symonides B, Jędrusik P, Artyszuk L et al.: Different diagnostic criteria significantly affect the rates of hypertension in 18-year-old high school students. Arch Med Sci 2010; 6: 689-694.
20. Dereziński T, Kułaga Z, Litwin M: Prevalence of arterial hypertension and anthropometrical predictors of elevated blood pressure in 14 years old adolescents. European Society of Hypertension Meeting 2015, Milan, abstract.
21. Daley MF, Sinaiko AR, Reifler LM et al.: Patterns of Care and Persistence After Incident Elevated Blood Pressure. Pediatrics 2013; 132: e349-e355.
22. Redwine KM, Acosta AA, Poffenbarger T et al.: Development of Hypertension in Adolescents with Pre-Hypertension. J Pediatr 2012; 160: 98-103.
23. de Moraes AC, Carvalho HB, Siani A et al.; IDEFICS consortium: Incidence of high blood pressure in children – effects of physical activity and sedentary behaviors: the IDEFICS study: High blood pressure, lifestyle and children. Int J Cardiol 2015 Feb 1; 180: 165-701.
24. Today Study Group: Rapid rise in hypertension and nephropathy in youth with type 2 diabetes. Diabetes Care 2013; 36: 1735-1741.
25. Bocelli A, Favilli S, Pollini I et al.: Prevalence and long-term predictors of left ventricular hypertrophy, late hypertension, and hypertensive response to exercise after successful aortic coarctation repair. Pediatr Cardiol 2013; 34: 620-629.
26. Gupta-Malhotra M, Banker A, Shete S et al.: Essential hypertension vs. secondary hypertension among children. Am J Hypertens 2015; 28: 73-80.
27. Litwin M, Śladowska J, Antoniewicz J et al.: Metabolic abnormalities, insulin resistance, and metabolic syndrome in children with primary hypertension. Am J Hypertens 2007; 20: 875-882.
28. Mathieu P, Poirier P, Pibarot P et al.: Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension 2009; 53: 577-584.
29. Despres JP: Intra-abdominal obesity: an untreated risk factor for type 2 diabetes and cardiovascular disease. J Endocrinol Invest 2006; 29 (3 suppl.): 77-82.
30. Pausova Z, Abrahamowicz M, Mahboubi A et al.: Functional variation in the androgen-receptor gene is associated with visceral adiposity and blood pressure in male adolescents. Hypertension 2010; 55: 706-714.
31. Zhang YX, Wang SR: The relationship of waist circumference distribution to blood pressure levels among children and adolescents in Shandong, China. Int J Cardiol 2013; 168: 1516-1520.
32. Kulaga Z, Litwin M, Tkaczyk M et al.: The height-, weight-, and BMI-for-age of Polish school-aged children and adolescents relative to international and local growth references. BMC Public Health 2010; 10: 109.
33. Dong B, Wang Z, Wang HJ, Ma J: Associations between adiposity indicators and elevated blood pressure among Chinese children and adolescents. J Hum Hypertens 2015; 29: 236-240.
34. Kromeyer-Hauschild K, Neuhauser H, Schaffrath Rosario A, Schienkiewitz A: Abdominal obesity in German adolescents defined by waist-to-height ratio and its association to elevated blood pressure: the KiGGS study. Obes Facts 2013; 6: 165-175.
35. Kuba VM, Leone C, Damiani D: Is waist-to-height ratio a useful indicator of cardio-metabolic risk in 6-10-year-old children? BMC Pediatr 2013; 13: 91.
36. Beck CC, Lopes Ada S, Pitanga FJ: Anthropometric indicators as predictors of high blood pressure in adolescents. Arq Bras Cardiol 2011; 96: 126-133.
37. Pausova Z, Mahboubi A, Abrahamowicz M et al.: Sex differences in the contributions of visceral and total body fat to blood pressure in adolescence. Hypertension 2012; 59: 572-579.
38. Chobanian AV, Bakris GL, Black HR et al.: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206-1252.
39. Mancia G, Fagard R, Narkiewicz K et al; Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281-1357.
40. Tykarski A, Narkiewicz K, Gaciong Z et al.: 2015 guidelines for the management of hypertension. Recommendations of the Polish Society of Hypertension – short version. Kardiol Pol 2015; 73: 676-700.
41. Blair SN, Goodyear NN, Gibbons LW et al.: Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA 1984; 252: 487-490.
42. Kenney MJ, Seals DR: Postexercise hypotension. Key features, mechanisms, and clinical significance. Hypertension 1993; 22: 653-664.
43. American College of Sports Medicine. Position stand: Physical activity, physical fitness, and hypertension. Med Sci Sports Exerc 1993; 25: i-x.
44. Paffenbarger RS Jr, Jung DL, Leung RW et al.: Physical activity and hypertension: an epidemiological view. Ann Med 1991; 23: 319-327.
45. Cornelissen VA, Smart NA: Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc 2013; 2: e004473.
46. Janssen I: Physical activity, fitness and cardiac, vascular and pulmonary morbidities. [In:] Bouchard C, Blair SN, Haskell WL (eds.): Physical Activity and Health. Human Kinetics 2012: 190.
47. Fares A: Winter Hypertension: Potential mechanisms. Int J Health Sci 2013; 7: 210-219.
48. Sherman DL: Exercise and endothelial function. Coron Artery Dis 2000; 11: 117-122.
49. Cesa CC, Sbruzzi G, Ribeiro RA et al.: Physical activity and cardiovascular risk factors in children: meta-analysis of randomized clinical trials. Prev Med 2014 Dec; 69: 54-62.
50. Kelley GA, Kelley KS, Tran ZV: The effects of exercise on resting blood pressure in children and adolescents: a meta-analysis of randomized controlled trials. Prev Cardiol 2003; 6: 8-16.
51. Tsioufis C, Kyvelou S, Tsiachris D et al.: Relation between physical activity and blood pressure levels in young Greek adolescents: the Leontio Lyceum Study. Eur J Public Health 2011; 21: 63-68.
52. de Moraes AC, Carvalho HB, Siani A et al.: Incidence of high blood pressure in children – effects of physical activity and sedentary behaviors: the IDEFICS study: High blood pressure, lifestyle and children. Int J Cardiol 2015; 180: 165-170.
53. Farpour-Lambert NJ, Aggoun Y, Marchand LM et al.: Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in prepubertal obese children. J Am Coll Cardiol 2009; 54: 2396-2406.
54. Litwin M, Niemirska A, Sladowska-Kozlowska J et al.: Regression of target organ damage and metabolic abnormalities in children and adolescents with primary hypertension – prospective study. Pediatr Nephrol 2010; 25: 2489-2499.
55. Śladowska-Kozłowska J, Litwin M, Niemirska A et al.: Association of the eNOS G894T gene polymorphism with target organ damage in children with newly diagnosed primary hypertension. Pediatr Nephrol 2015; 30: 2189-2197.
56. Grontved A, Andersen L, Franks P et al.: NOS3 variants, physical activity, and blood pressure in the European Youth Heart Study. Am J Hypertens 2011; 24: 444-450.
57. Litwin M, Michałkiewicz J, Trojanek J et al.: Altered genes profile of renin-angiotensin system, immune system, and adipokines receptors in leukocytes of children with primary hypertension. Hypertension 2013 Feb; 61(2): 431-436.
58. Moyer VA; U.S. Preventive Services Task Force: Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Pediatrics 2013; 132(5): 907-914.
59. Litwin M: Nadciśnienie tętnicze u dzieci – problemy diagnostyczne i kontrowersje terapeutyczne. Terapia 2015; XXIII: 66-73.
60. Kishi S, Teixido-Tura G, Ning H et al.: Cumulative Blood Pressure in Early Adulthood and Cardiac Dysfunction in Middle Age: The CARDIA Study. J Am Coll Cardiol 2015 Jun 30; 65(25): 2679-2687.
61. Juhola J, Magnussen CG, Berenson GS et al.: Combined effects of child and adult elevated blood pressure on subclinical atherosclerosis: the International Childhood Cardiovascular Cohort Consortium. Circulation 2013 Jul 16; 128(3): 217-224.
otrzymano: 2015-09-08
zaakceptowano do druku: 2015-09-30

Adres do korespondencji:
*Mieczysław Litwin
Department of Nephrology and Arterial Hypertension The Children’s Memorial Health Institute
Aleja Dzieci Polskich 20, 04-730 Warszawa
tel. +48 (22) 815-15-40
fax +48 (22) 815-15-39
m.litwin@ipczd.pl

Postępy Nauk Medycznych 11/2015
Strona internetowa czasopisma Postępy Nauk Medycznych