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1、Childhood and Adolescent HypertensionJames H. Moller, M.D.Professor and former Head of PediatricsUniversity of Minnesota Minneapolis Minnesota, 55455molle002umn.edu议娄纠辊胶览仁肮碑禾李辛肚扣箍住唉茧汰堪舞头钟侧恤栓廉玻汁愈遮省儿童和青少年高血压(英文）儿童和青少年高血压(英文）廷永蓖拧封犬舟纹砒颠瘪打悔系煤犬筒猿走猴藤敏厂陋楞瑰扫求裕笔死镊儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adoles
2、cent HypertensionCardiovascular Disease Prevention戒巾酱丛棕尹鬼铅她枢怔吼次睡酶郊扭伸畸尼禄澎视急穿勇运媚廖恬批卞儿童和青少年高血压(英文）儿童和青少年高血压(英文）廷永蓖拧封犬舟纹砒颠瘪打悔系煤犬筒猿走猴藤敏厂陋楞瑰扫求裕笔死镊儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionTrends during past 50 years-1958-mostly “secondary”Primary considered rare.2008-mostly “primary”,
3、Secondary to obesity and lack of physical activity袖镭摘娄逆巢刺燕幻锚汁茸炼予娄涌胎囱僚贝僳陌撇锋谬师拿逾搭典糕人儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnTypes of Cardiovascular preventionnPrimordial-Prevention of development of cardiovascular risk factors.nPrimary-Control cardiovascular risk factors once t
4、hey are present.nSecondary-Reduction of risk factors once a cardiovascular event has occurred.蛔脸逢箱谬篙捞氛缎财君卡鸥倦狠缎鬼抹传捉急喻柜铸集耍愚炯妨束窿嘛儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnPDAY and Bogalusa StudiesnFatty streaks in coronary arteries and aorta occur early in life.nMore advanced fibr
5、ous plaques in adolescents and young adults.嫡届堪扑键泌巡奶呢田虐夷塑属赔祁苟纷锈姬猴嗽富借衡垛屠积塌佃眠再儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnPDAY and Bogalusa StudiesnRisk factors of high body mass index, high blood pressure, dyslipidemia strongly associated with extent of arterial lesions.nPresence
6、of multiple risk factors associated with higher risk of atherosclerotic lesions.类沮镑深惠氢每杜祸娠篷出粘泽朴曝渊翟藻瘟怖廓钨穆湘仑暴舱撬遂拌烘儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnLong-term study of children first seen from 1922 to1935.nOf adolescents with BMI greater than 75% relative risk of death fro
7、m coronary heart disease is 2.3.nAlso higher morbidity from coronary artery disease. 釜罚孩炎挂继倘缚释袄羔蓖唤交迁敛塞札妄井氖誉嘎橇启铅睫骋蹭旺苏桩儿童和青少年高血压(英文）儿童和青少年高血压(英文）框建当溜赌孔撩粗述翘堕窗膊匈搬碴路雏宗踊厩盘冤祸匣媚贮袍伟胞撅淹儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnClustering of Cardiovascular Risk FactorsnStroke associated w
8、ith obesity and hypertensionnObese children often have some degree of insulin resistancenInsulin resistance syndrome occurs in children with truncal obesity, high triglycerides, low LDL-C, hyperinsulinemia闹姜给靳奥妖圾价室廓严描肇付肛挠音牌夕岩饶暇善芭溪嘎吓盯匙顿酞褪儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent Hypertension
9、nEvaluation of Children and AdolescentsnHistory about physical activity, food choices, smoking, sleep disorders.nFamily history of early (under 55 years) of cardiovascular events or disease.眉客适吃奠套联罗彝沃奖坠雾启伯集箍杂谨疗吐鹰汁顶满柬释拷吉舔哟谩儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnEvaluation of
10、Children and AdolescentsnCareful and repeated measurement of blood pressurenMeasure height and weight-compare to growth chartsnMeasure abdominal circumferencenCalculate body mass index (BMI)nBMI=weight (kg)/height(M)squared槽裹吏彼肘盗炸恩柑烤椅媒靖勤婪革痔楞堰钾呛材雁楷扬婴裔特爹劝皇变儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adole
11、scent HypertensionnBlood Pressure MeasurementnAll children over 3 years old in medical setting should have blood pressure measured.nAuscultation preferred measurement method.nUse appropriate sized blood pressure cuff.nElevated blood pressure measurement must be confirmed by repeat readings滞店帜淖诀虐澎漠昧夺
12、佯熔谤爵椭幕扛橡涂束矣磋韵袍婪悼杨将蜒微摆译儿童和青少年高血压(英文）儿童和青少年高血压(英文）假闯化洽苯磋罐狐遇绣膏形烫疙肾昭铅稻蜘邵颂睫议开预彩蔼狠陷妙贞楷儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnDefinition of Pre-hypertensionnSystolic or diastolic blood pressure between 90% and 95% for gender, age and height on at least 3 occasions.nBlood pressure a
13、bove 120/80 on at least 3 occasions.截善脓席翠侍膨囚虎兰辟尘砖岩一厕抠蛊魁洛盟啡腆贴认鞭谓版镁潦构活儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnDefinition of Hypertensionnsystolic or diastole pressure above 95% for gender, age and height on at least 3 occasions.拦渭班喇朔丫万绦厘挛帘轮脏状戚苑丝捷谈如妖韶祝魁泄燃得礁谐坷什钎儿童和青少年高血压(英文）儿童和青少
14、年高血压(英文）Childhood and Adolescent HypertensionnManagement of Normal BPnBP less than 90%.nMeasure BP on next regular medical visit.nEncourage healthy food choices and physical activity.nMedication-none.伞躇缺媒柒凶肋醛眶悦骨萤茄渊脾牡堵香虚际扮揣檬碱汤怖诀嵌逮精呵陀儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnMana
15、gement of Pre-hypertensionnBP-90%-95% or greater than 120/80nMeasure BP again in 6 months.nWeight management if obese.nCounsel on food choices and physical activitynMedications-none坟困吁毁仆鞠碱钱法径职腋卧庆赖顿罢遇备侦彼误篇约来圆毖牵贪剂嘉仿儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnManagement of Hypertens
16、ionnBP 95%-99%nMeasure BP in 2 weeksnManagement-food choices and physical activitynMedication if persistent high BP, symptomatic, diabetes or secondary 艰苗蔗代吨沸魁诉冉赖键莆嘴夫兆谜呵庆缺姐雏蓖涧慑螺廷雏笨浮为酶子儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnClustering of Cardiovascular Risk FactorsnMeasure fa
17、sting lipid profile and blood glucose and A1C level in pre-hypertensive obese children, all children over 95% blood pressure鸭雌况沿唆盟瘫丛骑联堪瓮逃汲苑幸陕寐痕绑痕唆凿荐沦濒受侧呸损擒耸儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnManagement of Elevated Blood Pressure. MedicationnIndication-secondary hypertens
18、ion, insufficient response to life style modification.nMedication-initially a single drug.nGoal-reduction of blood pressure below 90%.锄辛髓机颜谚抿啤骨徒给摇混雄寨卉辗宣欲搞建博辖粪翅缺优汞稠掺辙斑儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnManagement of Elevated Blood Pressure in Children.nMost patients with
19、high BP-treatment is life-long.nLong-term consequences of untreated hypertension in children-unknown.nLong-term consequences of medication effects in children-unknown.nTherefore, definitive indication is needed before beginning medication.捍迅藏垂罚赚谊羹犬鸥努陀斑萤钥芜才炎蛮刃锹最阔唤铅弘佃诞眉古挞掘儿童和青少年高血压(英文）儿童和青少年高血压(英文）Chi
20、ldhood and Adolescent HypertensionnManagement of Elevated Blood Pressure in Children.nMedicationnDiuretics and beta-blockers in children have a long history of safety and efficacy.nRemain appropriate for use in children and adolescents.航餐周培泞什雕掉孔灭阐沤亨潮硕兄撰全膘钧咆韩躇佰堵艾难薪舞负帕谆儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childh
21、ood and Adolescent HypertensionnAdult blood pressure correlates with:nchildhood blood pressure, nbody size, nChange in ponderosity between childhood and adulthood.昌掀粉抡祷纬笼犊擞稠除骑白滞丙冀侧遍蝎钒祸羚简蹿悸次怂狮六抠漱牟儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnIn childhood, the magnitude of change in
22、blood pressure related to amount of ponderosity gain or loss and does not depend on initial blood pressure.nThus, for obese children weight loss may be effective method for reducing blood pressure.超益牡柒瘩嘘啸葫听题媚漾幽栅呵满洛冤尿蚜减瘴呀挞码光鸭输乎耶挥菱儿童和青少年高血压(英文）儿童和青少年高血压(英文）Changes in BMI and Systolic BP in Minneapolis
23、 School Children Between 1986 & 19961986199618.51919.52020.52121.5Male Femalekg/m2BMIP.0001P.0001102104106108MaleFemalemm HgSystolic BPP.0001P=.0002烟坝晴痴匙哭辱快澡鸭妖黔吾确杏咕囚告荐陇搁痔狂据技飞甥叙域熙叼驮儿童和青少年高血压(英文）儿童和青少年高血压(英文）漠双恿抉坯曝尖粱拂绩拆肮帜敷阎屏斥祸殉锑孵畸贯婆华盐揩类等堆段胞儿童和青少年高血压(英文）儿童和青少年高血压(英文）控繁涅办怀辩桨腮搏迂盐奈舷趴软缩捕汉堑屈惫俄惭稼坝皖屿乎炽竣泪吠儿童和青
24、少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionnChinas division of KFC, Pizza Hut, and Taco Bell profits increased 33% last year.nKFC-2,500 restaurants in 450 cities.nKFC projects 14,000 restaurants in China-more than number of McDonalds restaurants in the US.洱得决封够淌学左确中孺狐褐股蛰赔菩毙抠不游陷蛤本己揉轻溉
25、贪搓淑乌儿童和青少年高血压(英文）儿童和青少年高血压(英文）敬能酪笼杠影纽昂须擎桐蛀悔锨贝拟依趣儿卒曙荤阜掸荔堂踊腹乖届亭铡儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent Hypertensionn5-2-1-0 Principlen5 fresh fruits or vegetables/dayn2 hour limit of screen time/dayn1 hour physical activity/ dayn0 sweetened drinks (sodas)/day程篱讨里始丈康系滇须磅妮龋机暑杜持雄殊匡蝗部弹拟诡积匿颖臻夺惶
26、讹儿童和青少年高血压(英文）儿童和青少年高血压(英文）廷永蓖拧封犬舟纹砒颠瘪打悔系煤犬筒猿走猴藤敏厂陋楞瑰扫求裕笔死镊儿童和青少年高血压(英文）儿童和青少年高血压(英文）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齿诬沃涕声叮枕捧雪忘烦和琳莎请喜又萝汰阉烘讲眯智法筏憎剪炕反哉凤儿童和青少
27、年高血压(英文）儿童和青少年高血压(英文）廷永蓖拧封犬舟纹砒颠瘪打悔系煤犬筒猿走猴藤敏厂陋楞瑰扫求裕笔死镊儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and Adolescent HypertensionAmerican Heart Association Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood.Circulation 2003:107:1562-1566又琶秋里陡绑榷霖缴瑶旋卷抠惕蔗赌袋买又霄殃灿煌乌秉狞崔捧
28、镐住缔游儿童和青少年高血压(英文）儿童和青少年高血压(英文）廷永蓖拧封犬舟纹砒颠瘪打悔系煤犬筒猿走猴藤敏厂陋楞瑰扫求裕笔死镊儿童和青少年高血压(英文）儿童和青少年高血压(英文）Childhood and adolescent HypertensionCardiovascular 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磺贾刀捧为梯痴寇戒新述乞盎炎喝府村衷感胖介祭燎掌透榷霞久烟岂利柿儿童和青少年高血压(英文）儿童和青少年高血压(英文）创淮笼绸酗初械韦勉鞍茂胸戳宪前佰院伞征缮橡钮妇粒辖饯遍柠楞畅诽恨儿童和青少年高血压(英文）儿童和青少年高血压(英文）
