兒童和青少年高血壓課件

1、Childhood and Adolescent HypertensionJames H. Moller, M.D.Professor and former Head of PediatricsUniversity of Minnesota Minneapolis Minnesota, 55455兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionCardiovascular Disease Prevention兒童和青少年高血壓Childhood and Adol

2、escent HyperChildhood and Adolescent HypertensionTrends during past 50 years-1958-mostly “secondary”Primary considered rare.2008-mostly “primary”,Secondary to obesity and lack of physical activity兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionTypes of Cardiovascular prev

3、entionPrimordial-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.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionPDAY an

4、d Bogalusa StudiesFatty streaks in coronary arteries and aorta occur early in life.More advanced fibrous plaques in adolescents and young adults.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionPDAY and Bogalusa StudiesRisk factors of high body mass index, high blood press

5、ure, dyslipidemia strongly associated with extent of arterial lesions.Presence of multiple risk factors associated with higher risk of atherosclerotic lesions.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionLong-term study of children first seen from 1922 to1935.Of adoles

6、cents with BMI greater than 75% relative risk of death from coronary heart disease is 2.3.Also higher morbidity from coronary artery disease. 兒童和青少年高血壓Childhood and Adolescent Hyper兒童和青少年高血壓兒童和青少年高血壓Childhood and Adolescent HypertensionClustering of Cardiovascular Risk FactorsStroke associated with

7、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兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionEvaluation of Children an

8、d AdolescentsHistory about physical activity, food choices, smoking, sleep disorders.Family history of early (under 55 years) of cardiovascular events or disease.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionEvaluation of Children and AdolescentsCareful and repeated mea

9、surement of blood pressureMeasure height and weight-compare to growth chartsMeasure abdominal circumferenceCalculate body mass index (BMI)BMI=weight (kg)/height(M)squared兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionBlood Pressure MeasurementAll children over 3 years ol

10、d 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兒童和青少年高血壓Childhood and Adolescent Hyper兒童和青少年高血壓兒童和青少年高血壓Childhood and Adolescent Hyper

11、tensionDefinition 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.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionDefinition of Hypertensions

12、ystolic or diastole pressure above 95% for gender, age and height on at least 3 occasions.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionManagement of Normal BPBP less than 90%.Measure BP on next regular medical visit.Encourage healthy food choices and physical activity.

13、Medication-none.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionManagement 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兒童和青少年高血壓Childhood and Adole

14、scent HyperChildhood and Adolescent HypertensionManagement of HypertensionBP 95%-99%Measure BP in 2 weeksManagement-food choices and physical activityMedication if persistent high BP, symptomatic, diabetes or secondary 兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionClust

15、ering of Cardiovascular Risk FactorsMeasure fasting lipid profile and blood glucose and A1C level in pre-hypertensive obese children, all children over 95% blood pressure兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionManagement of Elevated Blood Pressure. MedicationIndic

16、ation-secondary hypertension, insufficient response to life style modification.Medication-initially a single drug.Goal-reduction of blood pressure below 90%.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionManagement of Elevated Blood Pressure in Children.Most patients wit

17、h 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.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescen

18、t HypertensionManagement 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.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionAdult blood

19、pressure correlates with:childhood blood pressure, body size, Change in ponderosity between childhood and adulthood.兒童和青少年高血壓Childhood and Adolescent HyperChildhood and Adolescent HypertensionIn childhood, the magnitude of change in blood pressure related to amount of ponderosity gain or loss and do

20、es not depend on initial blood pressure.Thus, for obese children weight loss may be effective method for reducing blood pressure.兒童和青少年高血壓Childhood and Adolescent HyperChanges in BMI and Systolic BP in Minneapolis School Children Between 1986 & 19961986199618.51919.52020.52121.5Male Femalekg/m2BMIP.

21、0001P.0001102104106108MaleFemalemm HgSystolic BPP.0001P=.0002兒童和青少年高血壓Changes in BMI and Systolic BP兒童和青少年高血壓兒童和青少年高血壓兒童和青少年高血壓兒童和青少年高血壓Childhood and Adolescent HypertensionChinas division of KFC, Pizza Hut, and Taco Bell profits increased 33% last year.KFC-2,500 restaurants in 450 cities.KFC projec

22、ts 14,000 restaurants in China-more than number of McDonalds restaurants in the US.兒童和青少年高血壓Childhood and Adolescent Hyper兒童和青少年高血壓兒童和青少年高血壓Childhood and Adolescent Hypertension5-2-1-0 Principle5 fresh fruits or vegetables/day2 hour limit of screen time/day1 hour physical activity/ day0 sweetened drinks (sodas)/day兒童和青少年高血壓Childhood and Adolescent HyperChil