Úvod a metódy: Cieľom štúdie bolo zhodnotiť vzťah medzi obezitou a závažnosťou hypertenzie u detí a adolescentov. Do štúdie bolo zaradených 109 pacientov s primárnou obezitou vo veku 7–18 rokov (14,1 ± 3,1). Pacienti boli rozdelení do 3 skupín podľa stupňa obezity na základe smerodajnej odchýlky body mass indexu (SDS BMI): Skupina 1 (n = 27): BMI SDS >1,65 a <3,28; Skupina 2 (n = 55): BMI SDS >3,29 a <4,91; Skupina3 (n = 27): BMI SDS >4,92. Definícia a hodnotenie stupňa hypertenzie bolo založené na posúdení percentilu priemernej hodnoty krvného tlaku v porovnaní s normami pre detský vek a nálože krvného tlaku (BP load), ktoré boli získané z 24-hodinového monitorovania krvného tlaku (ABPM). Výsledky: Normálny krvný tlak sa zistil iba u 24 % detí, 25 % malo prehypertenziu, 3 % hypertenziu a 48 % závažnú hypertenziu (BP load viac ako 50 %). Závažnosť hypertenzie stúpa signifikantne so stupňom obezity (p = 0,0027). Denný systolický (SDS = 0,32; 1,24; 1,86), diastolický (SDS = -0,42; 0,56; 0,93) a stredný arteriálny (SDS = -0,01; 0,85; 1,36) tlak stúpa signifikantne s BMI, kým nočný tlak ostáva elevovaný nezávisle od stupňa obezity. Izolovaná nočná hypertenzia bola pozorovaná u 25 % pacientov a chýbanie nočného poklesu krvného tlaku u 38 % pacientov. Záver: Takmer 50 % detí s obezitou a hypertenziou zistenou pri ABPM trpí závažnou hypertenziou. Hodnota BMI priamo súvisí so závažnosťou hypertenzie u detí a vzostupom krvného tlaku počas dňa.

Introduction and methods: The goal of our study was to analyze the association between obesity and the severity of ambulatory hypertension in obese children. A total of 109 patients with primary obesity ages 7 to 18 years (mean ± SD age 14.1 ± 3.1) were enrolled. Patients were divided into three groups according to body mass index (BMI) Z-scores: group 1 (n=27): BMI >1.65 and <3.28 standard deviation scores (SDS); group 2 (n=55): BMI >3.29 and < 4.91 SDS; group 3 (n=27): BMI >4.92 SDS. Definition and staging of ambulatory hypertension was based on blood pressure (BP) levels and BP load, obtained from ambulatory BP monitoring (ABPM). Results: Only 24% of individuals had ambulatory normotension, 25% had ambulatory prehypertension, 3% had hypertension, and 48% had severe ambulatory hypertension (BP load over 50%). The severity of hypertension increased significantly with the degree of obesity (P=0.0027). Daytime systolic (SDS=0.32, 1.24, 1.86), diastolic (SDS= -0.42, 0.56, 0.93), and mean arterial (SDS= -0.01, 0.85, 1.36) BPs increased significantly with increased BMI, whereas the nighttime pressure remained elevated regardless of the degree of obesity. Isolated nighttime hypertension was observed in 25% of patients and 38% were classified as nondippers. Conclusion: Almost 50% of children with obesity and hypertension detected on ABPM suffer from severe ambulatory hypertension. BMI is associated with the severity of ambulatory hypertension and the increase of daytime BP.

2 detská klinika Lekárska fakulta Univerzity Komenského a Detskej fakultnej nemocnice s poliklinikou Bratislava Slovensko

Division of Nephrology Department of Pediatrics Children's Hospital of Eastern Ontario Ottawa Canada

Association between obesity and the severity of ambulatory hypertension in children and adolescents