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高血圧 の この 子供 は 二次 高血圧 を 患い て いる か : 合理的な臨床検査の体系的レビュー
James T Nugent1,2, Kuan Jiang2, Melissa C Funaro3
1Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
JAMA
|March 28, 2023
まとめ
子供と青年の2次高血圧を特定することは極めて重要です. 家族の病歴や 年少さ 体重の低下 血圧のパターンなどの要因は 二次的な原因の疑いを高めます
科学分野:
- 小児腎臓科と心臓科
- 高血圧 の 診断 の 正確 さ
背景:
- 現在のガイドラインでは,すべての子供と青少年における高血圧の二次原因の評価を推奨しています.
- 不必要な診断検査を避けるには,一次高血圧と二次高血圧を区別することが不可欠です.
研究 の 目的:
- 小児患者 (≤21歳) の初次高血圧と二次高血圧の区別において,臨床歴,身体検査,24時間出院式血圧モニタリング (ABPM) の診断的有用性を評価する.
主な方法:
- 2022年1月までの主要データベース (MEDLINE,PubMed Central,Embase,Web of Science,Cochrane Library) で体系的な文献検索が行われました.
- 含まれている研究では,主および二次高血圧の小児患者の臨床的特徴が記述されました.
- データは,ランダム効果モデリングを使用して,さまざまな臨床結果の感度,特異性,確率比 (LRs) を計算するために合成されました.
主要な成果:
- メタアナリシスには,4210人の参加者を含む30の研究が含まれており,第2次高血圧の罹患率はプライマリケアでは9. 0%,サブスペシャリティクリニックでは44%であった.
- 2次高血圧の強い指標には,家族歴の2次高血圧 (LR,4. 7),低体重パーセンチル (LR,4. 5),早産歴 (LR,2. 3~2. 8),および6歳未満の年齢 (LR,2. 2~2. 6) が含まれていた.
- マイクロアルブミヌーリア (LR,13) と血清尿酸の低下 (LR,2. 1- 6. 3) が重要な検査結果でした. ABPMの昼間および夜間静脈血圧の増加 (LR,4. 8) も二次高血圧を示した.
- 肥満 (LR,0. 34) と高血圧の家族歴 (LR,0. 42) は二次高血圧の確率を低下させた.
結論:
- 2次高血圧と1次高血圧を明確に区別する臨床的徴候や症状は存在しない.
- 二次高血圧の家族歴,年少,低体重,および特定のABPMの発見を含む要因の組み合わせは,二次高血圧の疑いを高めます.
- これらの発見は,診断戦略を導き,一次高血圧の不必要な検査を減らすのに役立ちます.
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