PAS2013：超重儿将早面临高血压风险

　　华盛顿——在美国儿科学术团体(PAS)2013年会上，明尼苏达州布卢明顿HealthPartners教育研究所的Emily D. Parker博士报告称，在生长发育过程中出现超重或肥胖的儿童，早在3~5岁时就有可能罹患高血压。

　　这项研究分析了59,638名年龄介于3~17岁的儿童的体重和血压变化趋势。这些儿童数据来自加利福利亚洲、科罗拉多州和明尼苏达州的3个大型保险数据库2007~2010年的纪录。在这个时间段内，所有儿童至少前往当地医疗保健机构4次，并且第一次访视时血压正常。

　　大约一半(45%)的儿童为白种人，黑人占11%，亚洲人占8%，西班牙人占7%；该队列的其余儿童则为其他种族。年龄范围为3~5岁(27%)、6~8 岁 (17%)、9~11岁 (21%)、12~14岁 (22%)和15~17岁(13%)。

　　在这项研究中，体重正常定义为体重指数(BMI)介于第5~85百分位，而超重定义为BMI介于第85~95百分位，肥胖定义为BMI≥第95百分位。基线时，平均BMI位于第64个百分位。平均基线收缩压位于第39百分位，平均舒张压位于第50个百分位。

　　在所分析的时间段内，65%的儿童维持正常体重，8%仍然超重，10%仍然肥胖。共有9%的儿童体重增加(从健康体重变为超重，或者从超重变为肥胖)，8%的儿童体重下降(从超重变为正常体重，或者从肥胖变为超重)。

　　在此期间共出现了16,102例新发高血压前期病例(27%)和597例新发高血压病例(1%)。校正基线年龄、种族、地区和收缩压的多因素分析模型显示，与维持健康体重的儿童相比，变为超重或肥胖的儿童出现高血压前期的几率增加57%。继续维持超重状态的儿童出现高血压前期的几率增加49%，继续维持肥胖状态的儿童出现高血压前期的几率增加1.3倍。上述所有差异都有统计学意义。

　　从某个体重类别上升到更高类别的儿童出现高血压的几率增加87%。维持超重和维持肥胖的儿童，高血压风险分别增加28%和2.6倍。同样，所有差异都有统计学意义。

　　Parker博士报告称，分析还显示，在从高血压前期进展为高血压的风险方面也存在显著的差异。体重类别上升的儿童进展为高血压的几率增加27%，维持肥胖的儿童风险增加86%。但维持超重的儿童从高血压前期进展为高血压的风险无显著增加。

　　Parker博士总结道，在整个2.5年的时间段内一直处于肥胖状态的儿童情况最糟。这部分儿童出现新发高血压前期的风险增加1倍以上，出现新发高血压的风险则增加了将近3倍。

与高血压相关的拓展阅读：

• JAMA：高血压加重遗传易感AD患者的脑内淀粉样蛋白沉积
• Lancet：利尿剂并不是对肥胖高血压患者合理的治疗方案
• JAMA：常用高血压药物能造福更多心衰患者
• Circulation：未控制高血压仍为急性主动脉夹层最显著危险因素 更多信息请点击：有关高血压更多资讯

High blood pressure begins early in overweight children
WASHINGTON – Children as young as 3-5 years old appear to be at risk for developing hypertension if they become overweight or obese as they grow.
Prehypertension was 57% more likely to develop in children who went from being of normal weight to being overweight, and hypertension was almost twice as likely to develop, compared with children who maintained a normal weight, *Dr. Elyse Kharbanda, reported at the annual meeting of the Pediatric Academic Societies.
The picture was even grimmer for the 10% of children who remained obese during the entire 2.5-year study, said *Dr. Kharbanda of HealthPartners Institute for Education and Research, Bloomington, Minn. Those children were more than twice as likely to develop incident prehypertension and nearly four times as likely to develop incident hypertension.
Her study examined trends in weight and blood pressure among 59,638 children aged 3-17 years. The children were drawn from three large insurance data sets in northern California, Colorado, and Minnesota from the time period of 2007-2010. All of the children had visited a health care facility in their group at least four times during the study period, and all had normal blood pressure at the first visit.
About half (45%) of the children were white, 11% were black, 8% Asian, and 7% Hispanic; other ethnicities made up the remainder of the cohort. Age ranges were 3-5 years (27%), 6-8 years (17%), 9-11 years (21%), 12-14 years (22%), and 15-17 years (13%).
For the study, normal weight was defined as a body mass index in the 5th to less than 85th percentile, while overweight was defined as BMI in the 85th to less than 95th percentile. Obesity was defined as a BMI in the 95th percentile or greater.
At baseline, mean BMI was in the 64th percentile. The children’s mean baseline blood pressure was in the 39th percentile for systolic and 50th for diastolic.
Over the study period, 65% of the children maintained a normal weight, 8% remained overweight, and 10% remained obese. Nine percent of the group increased in weight, either from a healthy weight to overweight, or from overweight to obese. Eight percent of the children lost weight, going from overweight to normal weight or from obese to overweight.
During the study period, there were 16,102 new cases of prehypertension (27%) and 597 cases of incident hypertension (1%).
A multivariate analysis controlled for age, race, study site, and systolic blood pressure at baseline. In the fully adjusted model, compared with children who maintained a healthy weight, those who became overweight or obese were 57% more likely to develop prehypertension. Children who stayed overweight were 49% more likely to develop prehypertension, and those who remained obese were 2.3 times more likely to develop prehypertension. All of the differences were statistically significant.
Children who increased from one weight category to the next were 87% more likely to develop hypertension. The increased risk was 28% for those who stayed overweight and 3.6% for those who remained obese. Again, the changes were statistically significant {nextpage}
The analysis also found significant differences in progression from prehypertension to hypertension. Children whose weight category increased were 27% more likely to progress, and those who stayed obese, 86% more likely. Children who stayed overweight were not significantly more likely to progress from prehypertension to hypertension, Dr. Kharbanda said.