PDF(Pubmed)
Abstract：
The updated clinical practice guideline (CPG) published by the American Academy of Pediatrics in 2017 introduced significant changes to the diagnostic and evaluative approach towards children with elevated blood pressure. The goals of this review were to summarize the current evidence regarding the impact of the new CPG on the identification and risk stratification of children at increased cardiovascular disease risk. Universally, the new CPG definitions of abnormal blood pressure led to more children classified as having a hypertensive blood pressure when compared with alternative definitions. Youth who moved to a higher blood pressure stage with the CPG typically had worse cardiometabolic profiles and more comorbidites. The association of CPG-defined hypertension and concurrent intermediate cardiovascular disease outcomes such as left ventricular hypertrophy and increased pulse wave velocity remains unclear; however, longitudinal data suggests an improved identification of those at greatest risk for adult cardiovascular disease with the CPG definitions. The majority of studies reviewed used blood pressure from one encounter, not replicate blood pressures from multiple visits, to define an abnormal or hypertensive blood pressure. Therefore, future studies investigating the prevalence of confirmed hypertension and the association between confirmed hypertension and outcomes are needed to optimally characterize the performance of the new CPG on identifying children at cardiovascular disease risk.
摘要：
2017年美国儿科学会发布的最新临床实践指南（CPG）对高血压儿童的诊断和评估方法进行了重大改变。这篇综述的目的是总结目前关于新的CPG对心血管疾病风险增加的儿童的识别和风险分层的影响的证据。普遍而言,与其他定义相比,CPG对异常血压的新定义导致更多儿童患有高血压.患有CPG的年轻人进入较高的血压阶段通常具有更差的心脏代谢特征和更多的合并症。CPG定义的高血压与并发的中间心血管疾病结局如左心室肥厚和脉搏波速度增加之间的关系尚不清楚；然而，纵向数据提示CPG定义对成人心血管疾病高危人群的识别效果更好.审查的大多数研究都使用了一次遭遇的血压，不能复制多次就诊的血压，定义异常或高血压血压。因此,需要进一步研究确诊高血压的患病率以及确诊高血压与结局之间的关联,以最佳地表征新CPG在确定心血管疾病风险儿童方面的表现.
