perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2019-64-4-114-127perinatology-939Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУFOR THE PRACTITIONERДиагностика и лечение артериальной гипертензии у детей и подростков в свете новых клинических рекомендаций Американской академии педиатрииDiagnostics and treatment of arterial hypertension in children and adolescents, overview of new clinical guidelines of the American Academy of Pediatricshttps://orcid.org/0000-0001-5562-6594АгапитовЛ. И.AgapitovL. I.

д.м.н., зав. кафедрой терапевтических дисциплин,

Пятигорск

Рyatigorsk

l.i.agapitov@pmedpharm.ruhttps://orcid.org/0000-0002-5834-4012ЧерепнинИ. В.CherepninaI. V.

преподаватель кафедры терапевтических дисциплин,

357532 Пятигорск, проспект Калинина, д. 11

Рyatigorsk

Пятигорский медико-фармацевтический институт – филиал ФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава РоссииРоссияPyatigorsk Medical Pharmaceutical Institute – branch of Volgograd State Medical UniversityRussian Federation201915092019644114127Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20192019Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/939

Представлен аналитический обзор клинических рекомендаций Американской академии педиатрии от  2017 г. «Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents». В документе даны новые нормативные значения артериального давления у детей, заменен термин «предгипертензия» на «повышенное артериальное давление», предложена упрощенная классификация артериальной гипертензии у подростков старше 13 лет, пересмотрены рекомендации по проведению суточного мониторирования артериального давления и эхокардиографии. Уточнены критерии диагностики повышенной массы миокарда левого желудочка. Изменены целевые уровни артериального давления. Новое руководство, безусловно, способствует оптимизации диагностики и  лечения артериальной гипертензии у  детей. Вместе с  тем необходим дальнейший всесторонний анализ клинических рекомендаций и  оценка их практической значимости для педиатрии.

The article analyzes clinical guidelines oftheAmericanAcademy ofPediatrics dd 2017 “ClinicalPractice Guideline forScreening andManagement of High Blood Pressure in Children and Adolescents”. This document contains new values of blood pressure in children, replaces the term “prehypertension” with the term “elevated blood pressure”, provides a simplified classification of arterial hypertension in adolescents over 13 years and revisesthe guidelinesfor daily blood pressure monitoring and echocardiography. The documentspecifiesthe criteria for diagnosing increased body weight of the left ventricular myocardium, changesthe target blood pressure levels. This new guidelines helps to optimize the diagnostics and treatment of hypertension in children. At the same time there is need for further comprehensive analysis of clinicalrecommendations and assessment of their practicalsignificance for pediatrics.

детиподросткиартериальная гипертензиядиагностикалечениерекомендацииchildrenadolescentsarterial hypertensiondiagnosticstreatmentrecommendationsReferencesАлександров А.А., Кисляк О.А., Леонтьева И.В., Розанов В.Б. Диагностика, лечение и профилактика артериальной гипертензии у детей и подростков. Российские рекомендации (второй пересмотр). Кардиоваскулярная терапия и профилактика 2009; 8(4): Приложение 1: 1–32.Aleksandrov A.A., Kisljаk O.A., Leont’eva I.V. Rozanov V.B. Diagnosis, treatment, and diagnosis of hypertension in children and adolescents: Russian recommendations (second revision. Kardiovaskulyarnaya terapiya i profilaktika (Cardiovascular therapy and prevention) 2009; 8 (4): Suppl 1: 1–32. (in Russ.).Клинические рекомендации по детской кардиологии и ревматологии. Под ред. М.А. Школьниковой, Е.И. Алексеевой. Москва: Ассоциация детских кардиологов России, 2011; 503.Clinical practice guidelines for pediatric cardiology and rheumatology. M.A. Shkolnikova, E.I. Alekseeva (eds). Moscow: Assotsiatsiya detskikh kardiologov Rossii, 2011; 503. (in Russ)Chen X., Wang Y. Tracking of blood pressure from childhood to adul-йood: a systematic review and metaregression analysis. Circulation 2008; 117(25): 3171–3180. DOI: 10.1161/CIRCULATIONAHA.107.730366Chen X., Wang Y. Tracking of blood pressure from childhood to adul-йood: a systematic review and metaregression analysis. Circulation 2008; 117(25): 3171–3180. DOI: 10.1161/CIRCULATIONAHA.107.730366Flynn J.T., Kaelber D.C., Baker-Smi-й C.M., Blowey D., Carroll A.E., Daniels S.R. et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140(3): e20171904. DOI: 10.1542/peds.2017-1904Flynn J.T., Kaelber D.C., Baker-Smi-й C.M., Blowey D., Carroll A.E., Daniels S.R. et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140(3): e20171904. DOI: 10.1542/peds.2017-1904Hansen M.L., Gunn P.W., Kaelber D.C. Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298(8): 874–879. DOI: 10.1001/jama.298.8.874Hansen M.L., Gunn P.W., Kaelber D.C. Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298(8): 874–879. DOI: 10.1001/jama.298.8.874McNiece K.L., Poffenbarger T.S., Turner J.L., Franco K.D., Sorof J.M., Portman R.J. Prevalence of hypertension and prehypertension among adolescents. J Pediatr 2007; 150(6): 640–644, 644.e1. DOI: 10.1016/j.jpeds.2007.01.052McNiece K.L., Poffenbarger T.S., Turner J.L., Franco K.D., Sorof J.M., Portman R.J. Prevalence of hypertension and prehypertension among adolescents. J Pediatr 2007; 150(6): 640–644, 644.e1. DOI: 10.1016/j.jpeds.2007.01.052Chiolero A., Cachat F., Burnier M., Paccaud F., Bovet P. Prevalence of hypertension in schoolchildren based on repeated measurements and association wi-й overweight. J Hypertens 2007; 25(11): 2209–2217. DOI: 10.1097/HJH.0b013e3282ef48b2Chiolero A., Cachat F., Burnier M., Paccaud F., Bovet P. Prevalence of hypertension in schoolchildren based on repeated measurements and association wi-й overweight. J Hypertens 2007; 25(11): 2209–2217. DOI: 10.1097/HJH.0b013e3282ef48b2Koebnick C., Black M.H., Wu J., Mayra P. M., Smith N., Kuizon B. et al. High blood pressure in overweight and obese youth: implications for screening. J Clin Hypertens (Greenwich) 2013; 15(11): 793–805. DOI: 10.1111/jch.12199Koebnick C., Black M.H., Wu J., Mayra P. M., Smith N., Kuizon B. et al. High blood pressure in overweight and obese youth: implications for screening. J Clin Hypertens (Greenwich) 2013; 15(11): 793–805. DOI: 10.1111/jch.12199Skinner A.C., Perrin E.M., Moss L.A., Skelton J.A. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med 2015; 373(14): 1307–1317. DOI: 10.1056/NEJMoa1502821Skinner A.C., Perrin E.M., Moss L.A., Skelton J.A. Cardiometabolic risks and severity of obesity in children and young adults. N Engl J Med 2015; 373(14): 1307–1317. DOI: 10.1056/NEJMoa1502821Archbold K.H., Vasquez M.M., Goodwin J.L., Quan S.F. Effects of sleep patterns and obesity on increases in blood pressure in a 5-year period: report from the Tucson Children’s Assessment of Sleep Apnea Study. J Pediatr 2012; 161(1): 26–30. DOI: 10.1016/j.jpeds.2011.12.034Archbold K.H., Vasquez M.M., Goodwin J.L., Quan S.F. Effects of sleep patterns and obesity on increases in blood pressure in a 5-year period: report from the Tucson Children’s Assessment of Sleep Apnea Study. J Pediatr 2012; 161(1): 26–30. DOI: 10.1016/j.jpeds.2011.12.034Li A.M., Au C.T., Ng C., Lam H.S., Ho C.K.W., Wing Y.K. A 4-year prospective follow-up study of childhood OSA and its association with BP. Chest 2014; 145(6): 1255–1263. DOI: 10.1378/chest.13-1333Li A.M., Au C.T., Ng C., Lam H.S., Ho C.K.W., Wing Y.K. A 4-year prospective follow-up study of childhood OSA and its association with BP. Chest 2014; 145(6): 1255–1263. DOI: 10.1378/chest.13-1333Theodore R.F., Broadbent J., Nagin D., Ambler A., Hogan S., Ramrakha S., et al. Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertension 2015; 66(6): 1108–1115. Doi: 10.1161/HYPERTENSIONAHA.115.05831Theodore R.F., Broadbent J., Nagin D., Ambler A., Hogan S., Ramrakha S., et al. Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertension 2015; 66(6): 1108–1115. Doi: 10.1161/HYPERTENSIONAHA.115.05831Mozaffarian D., Benjamin E.J., Go A.S., Arnett D.K., Blaha M.J., Cushman M. et al. Writing Group Members; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133(4): 447–454. DOI: 10.1161/CIR.0000000000000366Mozaffarian D., Benjamin E.J., Go A.S., Arnett D.K., Blaha M.J., Cushman M. et al. Writing Group Members; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133(4): 447–454. DOI: 10.1161/CIR.0000000000000366Salice P., Ardissino G., Zanchetti A., Ghiglia S. Age-dependent differences in office (OBP) vs ambulatory blood pressure monitoring (ABPM) in hypertensive children and adolescents: 8C.03. J Hypertens 2010; 28: e423–e424. DOI: 10.1097/01.hjh.0000379493.32284.c8Salice P., Ardissino G., Zanchetti A., Ghiglia S. Age-dependent differences in office (OBP) vs ambulatory blood pressure monitoring (ABPM) in hypertensive children and adolescents: 8C.03. J Hypertens 2010; 28: e423–e424. DOI: 10.1097/01.hjh.0000379493.32284.c8Леонтьева И.В., Агапитов Л.И. Суточное мониторирование артериального давления в дифференциальной диагностике артериальной гипертензии у подростков. Росcийский кардиологический журнал 2000; 4(24): 18–23.Leont’eva I.V., Agapitov L.I. Ambulatory blood pressure monitoring in diagnosis of hypertension in adolescents. Rossiiskii kardiologicheskii zhurnal (Russian Journal of Cardiology) 2000; 4 (24):18–23. (in Russ.).Bjelakovic B., Jaddoe V.W., Vukomanovic V., Lukic S. The relationship between currently recommended ambulatory systolic blood pressure measures and left ventricular mass index in pediatric hypertension. Curr Hypertens Rep 2015; 17(4): 534. DOI: 10.1007/s11906-015-0534-4Bjelakovic B., Jaddoe V.W., Vukomanovic V., Lukic S. The relationship between currently recommended ambulatory systolic blood pressure measures and left ventricular mass index in pediatric hypertension. Curr Hypertens Rep 2015; 17(4): 534. DOI: 10.1007/s11906-015-0534-4Gupta-Malhotra M., Banker A., Shete S., Hashmi S.S., Tyson J.E., Barratt M.S. et al. Essential hypertension vs. secondary hypertension among children. Am J Hypertens 2015; 28(1): 73–80. DOI: 10.1093/ajh/hpu083Gupta-Malhotra M., Banker A., Shete S., Hashmi S.S., Tyson J.E., Barratt M.S. et al. Essential hypertension vs. secondary hypertension among children. Am J Hypertens 2015; 28(1): 73–80. DOI: 10.1093/ajh/hpu083Baracco R., Kapur G., Mattoo T., Jain A., Valentini R., Ahmed M., et al. Prediction of primary vs secondary hypertension in children. J Clin Hypertens (Greenwich) 2012; 14(5): 316–321. DOI: 10.1111/j.1751-7176.2012.00603.xBaracco R., Kapur G., Mattoo T., Jain A., Valentini R., Ahmed M., et al. Prediction of primary vs secondary hypertension in children. J Clin Hypertens (Greenwich) 2012; 14(5): 316–321. DOI: 10.1111/j.1751-7176.2012.00603.xGambelunghe A., Sallsten G., Borne Y., Forsgard N., Hedblad B., Nilsson P. et al. Low-level exposure to lead, blood pressure, and hypertension in a population-based cohort. Environ Res 2016; 149: 157–163. DOI: 10.1016/j.envres.2016.05.015Gambelunghe A., Sallsten G., Borne Y., Forsgard N., Hedblad B., Nilsson P. et al. Low-level exposure to lead, blood pressure, and hypertension in a population-based cohort. Environ Res 2016; 149: 157–163. DOI: 10.1016/j.envres.2016.05.015Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28(1): 1–39.e14. DOI: 10.1016/j.echo.2014.10.003Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28(1): 1–39.e14. DOI: 10.1016/j.echo.2014.10.003Killian L., Simpson J.M., Savis A., Rawlins D., Sinha M.D. Electrocardiography is a poor screening test to detect left ventricular hypertrophy in children. Arch Dis Child 2010; 95(10): 832–836. DOI: 10.1136/adc.2009.168377Killian L., Simpson J.M., Savis A., Rawlins D., Sinha M.D. Electrocardiography is a poor screening test to detect left ventricular hypertrophy in children. Arch Dis Child 2010; 95(10): 832–836. DOI: 10.1136/adc.2009.168377Khoury M., Urbina E. Cardiac and Vascular Target Organ Damage in Pediatric Hypertension. Front Pediatr 2018; 24(6): 148. DOI: 10.3389/fped.2018.00148Khoury M., Urbina E. Cardiac and Vascular Target Organ Damage in Pediatric Hypertension. Front Pediatr 2018; 24(6): 148. DOI: 10.3389/fped.2018.00148Lurbe E., Torro I., Garcia-Vicent C., Alvarez J., FernandezFornoso J.A., Redon J. Blood pressure and obesity exert independent influences on pulse wave velocity in you-й. Hypertension 2012; 60(2): 550–555. DOI: 10.1161/HYPERTENSIONAHA.112.194746Lurbe E., Torro I., Garcia-Vicent C., Alvarez J., FernandezFornoso J.A., Redon J. Blood pressure and obesity exert independent influences on pulse wave velocity in you-й. Hypertension 2012; 60(2): 550–555. DOI: 10.1161/HYPERTENSIONAHA.112.194746Falkner B., DeLoach S., Kei-й S.W., Gidding S.S. High risk blood pressure and obesity increase the risk for left ventricular hypertrophy in African-American adolescents. J Pediatr 2013; 162(1): 94–100. DOI: 10.1016/j.jpeds.2012.06.009Falkner B., DeLoach S., Kei-й S.W., Gidding S.S. High risk blood pressure and obesity increase the risk for left ventricular hypertrophy in African-American adolescents. J Pediatr 2013; 162(1): 94–100. DOI: 10.1016/j.jpeds.2012.06.009Yuan W.L., Kakinami L., Gray-Donald K., Czernichow S., Lambert M., Paradis G. Influence of dairy product consumption on children’s blood pressure: results from the QUALITY cohort. J Acad Nutr Diet 2013; 113(7): 936–941. DOI: 10.1016/j.jand.2013.03.010Yuan W.L., Kakinami L., Gray-Donald K., Czernichow S., Lambert M., Paradis G. Influence of dairy product consumption on children’s blood pressure: results from the QUALITY cohort. J Acad Nutr Diet 2013; 113(7): 936–941. DOI: 10.1016/j.jand.2013.03.010Moore L.L., Bradlee M.L., Singer M.R., Qureshi M.M., Buendia J.R., Daniels S.R. Dietary approaches to stop hypertension (DASH) eating pattern and risk of elevated blood pressure in adolescent girls. Br J Nutr 2012; 108(9): 1678–1685. DOI: 10.1017/S000711451100715XMoore L.L., Bradlee M.L., Singer M.R., Qureshi M.M., Buendia J.R., Daniels S.R. Dietary approaches to stop hypertension (DASH) eating pattern and risk of elevated blood pressure in adolescent girls. Br J Nutr 2012; 108(9): 1678–1685. DOI: 10.1017/S000711451100715XKelley G.A., Kelley K.S., Tran Z.V. The effects of exercise on resting blood pressure in children and adolescents: a metaanalysis of randomized controlled trials. Prev Cardiol 2003; 6(1): 8–16.Kelley G.A., Kelley K.S., Tran Z.V. The effects of exercise on resting blood pressure in children and adolescents: a metaanalysis of randomized controlled trials. Prev Cardiol 2003; 6(1): 8–16.Jousilahti P., Laatikainen T., Salomaa V., Pietila A., Vartiainen E., Puska P. 40-year CHD mortality trends and the role of risk factors in mortality decline: The North Karelia Project Experience. Glob Heart 2016; 2: 207–212. DOI: 10.1016/j. gheart.2016.04.004Jousilahti P., Laatikainen T., Salomaa V., Pietila A., Vartiainen E., Puska P. 40-year CHD mortality trends and the role of risk factors in mortality decline: The North Karelia Project Experience. Glob Heart 2016; 2: 207–212. DOI: 10.1016/j. gheart.2016.04.004Puska P., Laatikainen T., Korpelainen V., Vartiaine V. Contribution of the North Karelia Project to International Work in CVD and NCD Prevention and Health Promotion. Glob Heart 2016; 11: 243–246. DOI: 10.1016/j.gheart.2016.04.009Puska P., Laatikainen T., Korpelainen V., Vartiaine V. Contribution of the North Karelia Project to International Work in CVD and NCD Prevention and Health Promotion. Glob Heart 2016; 11: 243–246. DOI: 10.1016/j.gheart.2016.04.009

The authors declare that there are no conflicts of interest present.