Çocuklarda ofis kan basıncı parametreleri ile ayaktan kan basıncı monitörizasyonu (AKBM) sonuçlarının karşılaştırılması: Güncellenmiş AKBM raporuna göre olguların değerlendirilmesi
Öz
Amaç: Günümüzde çocukluk çağında obezitenin yaygınlaşmasıyla birlikte hipertansiyon görülme sıklığı artmaktadır. Ayaktan (ambulatuvar) kan basıncı (KB) monitörizasyonu (AKBM) hedef organ hasarı riskini ofis ölçümünden daha iyi öngörmektedir. Bu çalışmada KB yüksekliği nedeni ile izlenen olguların ofis KB parametreleri ile AKBM sonuçlarının karşılaştırılması ve Amerikan Kalp Birliği’nin 2014 yılında güncellediği çocuklarda AKBM raporuna göre olguların değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Ofis KB değerleri yüksek bulunan (>90 persentil) ve AKBM uygulanan olguların kayıtları retrospektif olarak incelendi. İkincil hipertansiyonu olan veya AKBM sırasında antihipertansif ilaç kullanmakta olan hastalar çalışma dışında tutuldu. Olguların ofis KB ve AKBM sonuçları Amerikan Kalp Birliği’nin 2014’de güncellediği çocuklarda AKBM raporuna göre evrelendirildi. Olguların demografik bilgileri, vücut kitle indeksi (VKİ), VKİ-standart deviasyon skoru (SDS) ve AKBM sonuçları istatistiksel olarak karşılaştırıldı.
Bulgular: Çalışmaya 31 erkek, 26 kız olgu alınmış olup, olguların yaş ortalaması 14.42±2.14 yıldı. Ofis KB ve AKBM sonuçlarına göre, olguların %63’ünde (n=36) beyaz önlük hipertansiyonu, %15.7’inde (n=9) ambulatuvar hipertansiyon, % 12.2’sinde (n=7) ciddi ambulatuvar hipertansiyon, %5.3’ünde (n=3) prehipertansiyon ve %3,5’inde (n=2) maskelenmiş hipertansiyon saptandı. Prehipertansiyonu olan olguların 2’sinde (n=2/3, %66.7) ve ambulatuvar hipertansiyonu olan olguların 10’unda (n=10/18, %55) obezite mevcuttu. Yirmi dört saatlik ortalama sistolik ve diyastolik KB arasında pozitif korelasyon belirlendi. Olgularda VKİ ile 24 saatlik ortalama sistolik KB, gece sistolik KB ve 24 saatlik ortalama arter basıncı değerleri arasında da pozitif korelasyon saptandı.
Sonuç: Ofis KB yüksek olan ve hipertansiyon için risk faktörü taşıyan çocukların izleminde AKBM uygulaması önerilir.
Anahtar Kelimeler
Ofis kan basıncı ayaktan kan basıncı monitörizasyonu hipertansiyon obezite çocuk.
Kaynakça
- Flynn JT. The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol 2013;28(7):1059-66.
- Flynn JT, Daniels SR, Hayman LL, et al. Update: ambulatory blood pressure monitoring in children and adolescents: A scientific statement from the American Heart Association. Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Hypertension 2014;63(5):1116-35.
- Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008;117(25):3171-80.
- 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(2 Suppl 4th report):555-76.
- Urbina E, Alpert B, Flynn J, et al. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: A scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research. Hypertension 2008;52(3):433-51.
- Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital Health Stat 2002;(246):1-190
- Wühl E, Witte K, Soergel M, Mehls O, Schaefer F; German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: Normalized reference values and role of body dimensions. J Hypertens 2002;20(10):1995-2007.
- Cole TJ, Green PJ. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992;11(10):1305-19.
- Becton LJ, Shatat IF, Flynn JT. Hypertension and obesity: Epidemiology, mechanisms and clinical approach. Indian J Pediatr 2012;79(8):1056-61.
- Saner C, Simonetti GD, Wühl E, Mullis PE, Janner M. Increased ambulatory arterial stiffness index in obese children. Atherosclerosis 2015;238(2):185-9.
- Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 2012;307(5):483-90.
- Davis ML, Ferguson MA, Zachariah JP. Clinical Predictors and Impact of Ambulatory Blood Pressure Monitoring in Pediatric Hypertension Referral. J Am Soc Hypertens 2014;8(9):660-7.
- Halbach SM, Hamman R, Yonekawa K, Hanevold C. Utility of ambulatory blood pressure monitoring in the evaluation of elevated clinic blood pressures in children. J Am Soc Hypertens 2016;10(5):406-12.
- Cuspidi C, Meani S, Salerno M, et al. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure. J Hypertens 2004;22(2):273-80.
- Sturrock N, George E, Pound N, Stevenson J, Peck G, Sowter H. Nondipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus. Diabetic Med 2000;17(5):360-4.
- Macumber IR, Weiss NS, Halbach SM, Hanevold CD, Flynn JT. The association of pediatric obesity with nocturnal non-dipping on 24-hour ambulatory blood pressure monitoring. Am J Hypertens 2016;29(5):647-52.
Comparison between office blood pressure and ambulatory blood pressure monitoring (ABPM) parameters in children: Evaluation of the cases using the updated ABPM guideline
Öz
Aim: Prevalence of hypertension in youths is rising due to childhood obesity epidemic. Ambulatory blood pressure monitoring (ABPM) has superiority over office blood pressure (BP) measurement for distinguishing patients at higher risk for target-organ damage. We aim to compare the office BP levels with ambulatory levels in patients with prediagnosis of primary hypertension and interpret the data according to the recommendations of American Heart Society on the use of ABPM in the pediatric population reported in 2014.
Results: The study included 31 boys and 26 girls. Mean age was 14.42±2.14 years. BP was categorized based on office and ABPM results into pre- (5.3%, n=3), white-coat (63%, n=36), masked (3.2%, n=2), ambulatory (15.7%, n=9) and severe ambulatory (12.2%, n=7) hypertension. Two of 3 patients with prehypertension and 10 of 18 patients with ambulatory/severe ambulatory hypertension were obese. Positive correlation was found between 24-hour mean systolic and diastolic BP. BMI positively correlated with 24-hour mean systolic BP, night systolic BP, 24 hour mean arterial BP, respectively.
Conclusion: We suggest that children with high office BP measurements and risk for hypertension should be evaluated with ABPM.
Anahtar Kelimeler
Office blood pressure ambulatory blood pressure monitoring hypertension obesity child.
Kaynakça
- Flynn JT. The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol 2013;28(7):1059-66.
- Flynn JT, Daniels SR, Hayman LL, et al. Update: ambulatory blood pressure monitoring in children and adolescents: A scientific statement from the American Heart Association. Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Hypertension 2014;63(5):1116-35.
- Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 2008;117(25):3171-80.
- 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(2 Suppl 4th report):555-76.
- Urbina E, Alpert B, Flynn J, et al. Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: A scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research. Hypertension 2008;52(3):433-51.
- Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital Health Stat 2002;(246):1-190
- Wühl E, Witte K, Soergel M, Mehls O, Schaefer F; German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: Normalized reference values and role of body dimensions. J Hypertens 2002;20(10):1995-2007.
- Cole TJ, Green PJ. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992;11(10):1305-19.
- Becton LJ, Shatat IF, Flynn JT. Hypertension and obesity: Epidemiology, mechanisms and clinical approach. Indian J Pediatr 2012;79(8):1056-61.
- Saner C, Simonetti GD, Wühl E, Mullis PE, Janner M. Increased ambulatory arterial stiffness index in obese children. Atherosclerosis 2015;238(2):185-9.
- Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 2012;307(5):483-90.
- Davis ML, Ferguson MA, Zachariah JP. Clinical Predictors and Impact of Ambulatory Blood Pressure Monitoring in Pediatric Hypertension Referral. J Am Soc Hypertens 2014;8(9):660-7.
- Halbach SM, Hamman R, Yonekawa K, Hanevold C. Utility of ambulatory blood pressure monitoring in the evaluation of elevated clinic blood pressures in children. J Am Soc Hypertens 2016;10(5):406-12.
- Cuspidi C, Meani S, Salerno M, et al. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure. J Hypertens 2004;22(2):273-80.
- Sturrock N, George E, Pound N, Stevenson J, Peck G, Sowter H. Nondipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus. Diabetic Med 2000;17(5):360-4.
- Macumber IR, Weiss NS, Halbach SM, Hanevold CD, Flynn JT. The association of pediatric obesity with nocturnal non-dipping on 24-hour ambulatory blood pressure monitoring. Am J Hypertens 2016;29(5):647-52.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2018 |
| Gönderilme Tarihi | 5 Ocak 2017 |
| Yayımlandığı Sayı | Yıl 2018 |
Kaynak Göster