儿童和青少年高血压.ppt
Childhood and Adolescent Hypertension,James H.Moller,M.D.Professor and former Head of PediatricsUniversity of Minnesota Minneapolis Minnesota,55455,Childhood and Adolescent Hypertension,Cardiovascular Disease Prevention,Childhood and Adolescent Hypertension,Trends during past 50 years-1958-mostly“secondary”Primary considered rare.2008-mostly“primary”,Secondary to obesity and lack of physical activity,Childhood and Adolescent Hypertension,Types of Cardiovascular preventionPrimordial-Prevention of development of cardiovascular risk factors.Primary-Control cardiovascular risk factors once they are present.Secondary-Reduction of risk factors once a cardiovascular event has occurred.,Childhood and Adolescent Hypertension,PDAY and Bogalusa StudiesFatty streaks in coronary arteries and aorta occur early in life.More advanced fibrous plaques in adolescents and young adults.,Childhood and Adolescent Hypertension,PDAY and Bogalusa StudiesRisk factors of high body mass index,high blood pressure,dyslipidemia strongly associated with extent of arterial lesions.Presence of multiple risk factors associated with higher risk of atherosclerotic lesions.,Childhood and Adolescent Hypertension,Long-term study of children first seen from 1922 to1935.Of adolescents with BMI greater than 75%relative risk of death from coronary heart disease is 2.3.Also higher morbidity from coronary artery disease.,Childhood and Adolescent Hypertension,Clustering of Cardiovascular Risk FactorsStroke associated with obesity and hypertensionObese children often have some degree of insulin resistanceInsulin resistance syndrome occurs in children with truncal obesity,high triglycerides,low LDL-C,hyperinsulinemia,Childhood and Adolescent Hypertension,Evaluation of Children and AdolescentsHistory about physical activity,food choices,smoking,sleep disorders.Family history of early(under 55 years)of cardiovascular events or disease.,Childhood and Adolescent Hypertension,Evaluation of Children and AdolescentsCareful and repeated measurement of blood pressureMeasure height and weight-compare to growth chartsMeasure abdominal circumferenceCalculate body mass index(BMI)BMI=weight(kg)/height(M)squared,Childhood and Adolescent Hypertension,Blood Pressure MeasurementAll children over 3 years old in medical setting should have blood pressure measured.Auscultation preferred measurement method.Use appropriate sized blood pressure cuff.Elevated blood pressure measurement must be confirmed by repeat readings,Childhood and Adolescent Hypertension,Definition of Pre-hypertensionSystolic or diastolic blood pressure between 90%and 95%for gender,age and height on at least 3 occasions.Blood pressure above 120/80 on at least 3 occasions.,Childhood and Adolescent Hypertension,Definition of Hypertensionsystolic or diastole pressure above 95%for gender,age and height on at least 3 occasions.,Childhood and Adolescent Hypertension,Management of Normal BPBP less than 90%.Measure BP on next regular medical visit.Encourage healthy food choices and physical activity.Medication-none.,Childhood and Adolescent Hypertension,Management of Pre-hypertensionBP-90%-95%or greater than 120/80Measure BP again in 6 months.Weight management if obese.Counsel on food choices and physical activityMedications-none,Childhood and Adolescent Hypertension,Management of HypertensionBP 95%-99%Measure BP in 2 weeksManagement-food choices and physical activityMedication if persistent high BP,symptomatic,diabetes or secondary,Childhood and Adolescent Hypertension,Clustering of Cardiovascular Risk FactorsMeasure fasting lipid profile and blood glucose and A1C level in pre-hypertensive obese children,all children over 95%blood pressure,Childhood and Adolescent Hypertension,Management of Elevated Blood Pressure.MedicationIndication-secondary hypertension,insufficient response to life style modification.Medication-initially a single drug.Goal-reduction of blood pressure below 90%.,Childhood and Adolescent Hypertension,Management of Elevated Blood Pressure in Children.Most patients with high BP-treatment is life-long.Long-term consequences of untreated hypertension in children-unknown.Long-term consequences of medication effects in children-unknown.Therefore,definitive indication is needed before beginning medication.,Childhood and Adolescent Hypertension,Management of Elevated Blood Pressure in Children.MedicationDiuretics and beta-blockers in children have a long history of safety and efficacy.Remain appropriate for use in children and adolescents.,Childhood and Adolescent Hypertension,Adult blood pressure correlates with:childhood blood pressure,body size,Change in ponderosity between childhood and adulthood.,Childhood and Adolescent Hypertension,In childhood,the magnitude of change in blood pressure related to amount of ponderosity gain or loss and does not depend on initial blood pressure.Thus,for obese children weight loss may be effective method for reducing blood pressure.,Changes in BMI and Systolic BP in Minneapolis School Children Between 1986&1996,1986,1996,18.5,19,19.5,20,20.5,21,21.5,Male,Female,kg/m2,BMI,P.0001,P.0001,102,104,106,108,Male,Female,mm Hg,Systolic BP,P.0001,P=.0002,Childhood and Adolescent Hypertension,Chinas division of KFC,Pizza Hut,and Taco Bell profits increased 33%last year.KFC-2,500 restaurants in 450 cities.KFC projects 14,000 restaurants in China-more than number of McDonalds restaurants in the US.,Childhood and Adolescent Hypertension,5-2-1-0 Principle5 fresh fruits or vegetables/day2 hour limit of screen time/day1 hour physical activity/day0 sweetened drinks(sodas)/day,Childhood and Adolescent Hypertension,The Fourth Report on the Diagnosis,Evaluation,and Treatment of High Blood Pressure in children and Adolescents.Pediatrics 2004;114;555-576,Childhood and Adolescent Hypertension,American Heart Association Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood.Circulation 2003:107:1562-1566,Childhood and adolescent Hypertension,Cardiovascular Health in Children.A Statement for Health Professionals from Committee on atherosclerosis,Hypertension and Obesity in the Young.American Heart AssociationCirculation 2006:106:143-160,
