儿童和青少年高血压ppt课件

ChildhoodandAdolescentHypertensionJamesH.Moller,M.D.ProfessorandformerHeadofPediatricsUniversityofMinnesotaMinneapolisMinnesota,55455molle002umn.edu儿童和青少年高血压ChildhoodandAdolescentHyper1ChildhoodandAdolescentHypertensionCardiovascularDiseasePrevention儿童和青少年高血压ChildhoodandAdolescentHyper2ChildhoodandAdolescentHypertensionTrendsduringpast50years-1958-mostly“secondary”Primaryconsideredrare.2008-mostly“primary”,Secondarytoobesityandlackofphysicalactivity儿童和青少年高血压ChildhoodandAdolescentHyper3ChildhoodandAdolescentHypertensionTypesofCardiovascularpreventionPrimordial-Preventionofdevelopmentofcardiovascularriskfactors.Primary-Controlcardiovascularriskfactorsoncetheyarepresent.Secondary-Reductionofriskfactorsonceacardiovasculareventhasoccurred.儿童和青少年高血压ChildhoodandAdolescentHyper4ChildhoodandAdolescentHypertensionPDAYandBogalusaStudiesFattystreaksincoronaryarteriesandaortaoccurearlyinlife.Moreadvancedfibrousplaquesinadolescentsandyoungadults.儿童和青少年高血压ChildhoodandAdolescentHyper5ChildhoodandAdolescentHypertensionPDAYandBogalusaStudiesRiskfactorsofhighbodymassindex,highbloodpressure,dyslipidemiastronglyassociatedwithextentofarteriallesions.Presenceofmultipleriskfactorsassociatedwithhigherriskofatheroscleroticlesions.儿童和青少年高血压ChildhoodandAdolescentHyper6ChildhoodandAdolescentHypertensionLong-termstudyofchildrenfirstseenfrom1922to1935.OfadolescentswithBMIgreaterthan75%relativeriskofdeathfromcoronaryheartdiseaseis2.3.Alsohighermorbidityfromcoronaryarterydisease.儿童和青少年高血压ChildhoodandAdolescentHyper7儿童和青少年高血压儿童和青少年高血压8ChildhoodandAdolescentHypertensionClusteringofCardiovascularRiskFactorsStrokeassociatedwithobesityandhypertensionObesechildrenoftenhavesomedegreeofinsulinresistanceInsulinresistancesyndromeoccursinchildrenwithtruncalobesity,hightriglycerides,lowLDL-C,hyperinsulinemia儿童和青少年高血压ChildhoodandAdolescentHyper9ChildhoodandAdolescentHypertensionEvaluationofChildrenandAdolescentsHistoryaboutphysicalactivity,foodchoices,smoking,sleepdisorders.Familyhistoryofearly(under55years)ofcardiovasculareventsordisease.儿童和青少年高血压ChildhoodandAdolescentHyper10ChildhoodandAdolescentHypertensionEvaluationofChildrenandAdolescentsCarefulandrepeatedmeasurementofbloodpressureMeasureheightandweight-comparetogrowthchartsMeasureabdominalcircumferenceCalculatebodymassindex(BMI)BMI=weight(kg)/height(M)squared儿童和青少年高血压ChildhoodandAdolescentHyper11ChildhoodandAdolescentHypertensionBloodPressureMeasurementAllchildrenover3yearsoldinmedicalsettingshouldhavebloodpressuremeasured.Auscultationpreferredmeasurementmethod.Useappropriatesizedbloodpressurecuff.Elevatedbloodpressuremeasurementmustbeconfirmedbyrepeatreadings儿童和青少年高血压ChildhoodandAdolescentHyper12儿童和青少年高血压儿童和青少年高血压13ChildhoodandAdolescentHypertensionDefinitionofPre-hypertensionSystolicordiastolicbloodpressurebetween90%and95%forgender,ageandheightonatleast3occasions.Bloodpressureabove120/80onatleast3occasions.儿童和青少年高血压ChildhoodandAdolescentHyper14ChildhoodandAdolescentHypertensionDefinitionofHypertensionsystolicordiastolepressureabove95%forgender,ageandheightonatleast3occasions.儿童和青少年高血压ChildhoodandAdolescentHyper15ChildhoodandAdolescentHypertensionManagementofNormalBPBPlessthan90%.MeasureBPonnextregularmedicalvisit.Encouragehealthyfoodchoicesandphysicalactivity.Medication-none.儿童和青少年高血压ChildhoodandAdolescentHyper16ChildhoodandAdolescentHypertensionManagementofPre-hypertensionBP-90%-95%orgreaterthan120/80MeasureBPagainin6months.Weightmanagementifobese.CounselonfoodchoicesandphysicalactivityMedications-none儿童和青少年高血压ChildhoodandAdolescentHyper17ChildhoodandAdolescentHypertensionManagementofHypertensionBP95%-99%MeasureBPin2weeksManagement-foodchoicesandphysicalactivityMedicationifpersistenthighBP,symptomatic,diabetesorsecondary儿童和青少年高血压ChildhoodandAdolescentHyper18ChildhoodandAdolescentHypertensionClusteringofCardiovascularRiskFactorsMeasurefastinglipidprofileandbloodglucoseandA1Clevelinpre-hypertensiveobesechildren,allchildrenover95%bloodpressure儿童和青少年高血压ChildhoodandAdolescentHyper19ChildhoodandAdolescentHypertensionManagementofElevatedBloodPressure.MedicationIndication-secondaryhypertension,insufficientresponsetolifestylemodification.Medication-initiallyasingledrug.Goal-reductionofbloodpressurebelow90%.儿童和青少年高血压ChildhoodandAdolescentHyper20ChildhoodandAdolescentHypertensionManagementofElevatedBloodPressureinChildren.MostpatientswithhighBP-treatmentislife-long.Long-termconsequencesofuntreatedhypertensioninchildren-unknown.Long-termconsequencesofmedicationeffectsinchildren-unknown.Therefore,definitiveindicationisneededbeforebeginningmedication.儿童和青少年高血压ChildhoodandAdolescentHyper21ChildhoodandAdolescentHypertensionManagementofElevatedBloodPressureinChildren.MedicationDiureticsandbeta-blockersinchildrenhavealonghistoryofsafetyandefficacy.Remainappropriateforuseinchildrenandadolescents.儿童和青少年高血压ChildhoodandAdolescentHyper22ChildhoodandAdolescentHypertensionAdultbloodpressurecorrelateswith:childhoodbloodpressure,bodysize,Changeinponderositybetweenchildhoodandadulthood.儿童和青少年高血压ChildhoodandAdolescentHyper23ChildhoodandAdolescentHypertensionInchildhood,themagnitudeofchangeinbloodpressurerelatedtoamountofponderositygainorlossanddoesnotdependoninitialbloodpressure.Thus,forobesechildrenweightlossmaybeeffectivemethodforreducingbloodpressure.儿童和青少年高血压ChildhoodandAdolescentHyper24ChangesinBMIandSystolicBPinMinneapolisSchoolChildrenBetween1986&19961986199618.51919.52020.52121.5Male Femalekg/m2BMIP.0001P.0001102104106108MaleFemalemm HgSystolic BPP.0001P=.0002儿童和青少年高血压ChangesinBMIandSystolicBP25儿童和青少年高血压儿童和青少年高血压26儿童和青少年高血压儿童和青少年高血压27ChildhoodandAdolescentHypertensionChinasdivisionofKFC,PizzaHut,andTacoBellprofitsincreased33%lastyear.KFC-2,500restaurantsin450cities.KFCprojects14,000restaurantsinChina-morethannumberofMcDonaldsrestaurantsintheUS.儿童和青少年高血压ChildhoodandAdolescentHyper28儿童和青少年高血压儿童和青少年高血压29ChildhoodandAdolescentHypertension5-2-1-0Principle5freshfruitsorvegetables/day2hourlimitofscreentime/day1hourphysicalactivity/day0sweeteneddrinks(sodas)/day儿童和青少年高血压ChildhoodandAdolescentHyper30ChildhoodandAdolescentHypertensionTheFourthReportontheDiagnosis,Evaluation,andTreatmentofHighBloodPressureinchildrenandAdolescents.Pediatrics2004;114;555-576儿童和青少年高血压ChildhoodandAdolescentHyper31ChildhoodandAdolescentHypertensionAmericanHeartAssociationGuidelinesforPrimaryPreventionofAtheroscleroticCardiovascularDiseaseBeginninginChildhood.Circulation2003:107:1562-1566儿童和青少年高血压ChildhoodandAdolescentHyper32ChildhoodandadolescentHypertensionCardiovascularHealthinChildren.AStatementforHealthProfessionalsfromCommitteeonatherosclerosis,HypertensionandObesityintheYoung.AmericanHeartAssociationCirculation2006:106:143-160儿童和青少年高血压ChildhoodandadolescentHyper33儿童和青少年高血压儿童和青少年高血压34