儿童和青少年高血压(英文).ppt

Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Childhood and Adolescent Hypertension,James H.Moller,M.D.,Professor and former Head of Pediatrics,University 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 prevention,Primordial-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 Studies,Risk 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,Evaluation of Children and Adolescents,History 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 Adolescents,Careful and repeated measurement of blood pressure,Measure height and weight-compare to growth charts,Measure abdominal circumference,Calculate body mass index(BMI),BMI=weight(kg)/height(M)squared,Childhood and Adolescent Hypertension,Definition of Hypertension,systolic or diastole pressure above 95%for gender,age and height on at least 3 occasions.,Childhood and Adolescent Hypertension,Management of Normal BP,BP 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 Hypertension,BP 95%-99%,Measure BP in 2 weeks,Management-food choices and physical activity,Medication if persistent high BP,symptomatic,diabetes or secondary,Childhood and Adolescent Hypertension,Clustering of Cardiovascular Risk Factors,Measure fasting lipid pro 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.Medication,Indication-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.,Medication,Diuretics 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,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/m,2,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,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 Association,Circulation 2006:106:143-160,