Impacto de uma nova diretriz na prevalência de hipertensão arterial sistêmica em uma população atendida numa clínica de cardiologia pediátrica
Palavras-chave:
Pressão arterial, Hipertensão, DiretrizesResumo
Fundamentos: a utilização da nova diretriz publicada em 2017 determinaria um aumento da prevalência de HAS na população pediátrica, principalmente nos pacientes com sobrepeso e obesidade.
Objetivos: verificar se a nova diretriz publicada em 2017 determinaria um aumento da prevalência de HAS na população pediátrica.
Métodos: estudo de corte retrospectivo baseado na análise de 17.083 prontuários eletrônicos de crianças atendidas num centro de cardiologia pediátrica no nordeste brasileiro. Foram incluídas pacientes de 8 a 13 anos e com os seguintes dados: gênero, peso, altura, pressão arterial sistólica (PAS) e diastólica (PAD), além do IMC (índice de massa corpórea) que foi calculado. Um total de 2.936 prontuários foram elegíveis para análise. Somente o primeiro valor da PA foi utilizado. Todos os valores de PA foram categorizados de acordo com o guideline prévio de 2014 e o mais atual guideline publicado em 2017.
Resultados: pacientes classificados como tendo uma pressão sanguínea normal pelo The Fourth Report, 4% mudaram para categorias de PA anormal ao aplicar o guideline de 2017. Aproximadamente 10,7% dos casos mudaram de categoria entre os diferentes guidelines.
Conclusões: houve um aumento significante de distúrbios pressóricos com a aplicação do guideline de 2017 em crianças e adolescentes em relação ao The Fourth Report, reforçando a evidência que tais mudanças aumentaram significativamente a prevalência de hipertensão arterial na população pediátrica.
Downloads
Referências
Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017; 317(2):165–82. Available from: https://jamanetwork.com/ journals/jama/fullarticle/2596292.
Still JL, Cottom D. Severe hypertension in childhood. Arch Dis Child. 1967;42(221): 34–9 Available from: https://adc.bmj.com/content /archdischild/42/221/34.full.pdf.
Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta‐regression analysis. Circulation. 2008;117(25):3171‐3180 (2008). Available from: https://www.ahajournals.org /doi/10.1161/CIRCULATIONAHA.107.730366.
Flynn JT, Kaelber DC, Baker-Smith CM, et al; Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. Available from: https://pediatrics.aappublications. org/content/140/3/e20171904?utm_medium=referral&utm_source=r360.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 114 (2 Suppl 4th Report):555‐576 (2004). Available from: https://www.nhlbi.nih.gov/files/docs/resources/heart/hbp_ped.pdf.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018;71(6):1269–324. Available from: https://www.ahajournals.org/doi/10.1161/HYP.0000000000000066.
Al Kibria GM, Swasey K, Sharmeen A, Day B. Estimated Change in Prevalence and Trends of Childhood Blood Pressure Levels in the United States After Application of the 2017 AAP Guideline. Prev Chronic Dis. 2019; 16:180528. Available from: https://www.cdc.gov/pcd/issues/2019/18_0528.htm.
Chiolero A, Cachat F, Burnier M, Paccaud F, Bovet P. Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight. JHypertens. 2007; 25(11):2209‐2217. Available from: https://journals.lww.com/ jhypertension/ Abstract/2007/11000/ Prevalence_of_ hypertension_in_schoolchildren_based.7.aspx.
Sharma AK, Metzger DL, Rodd Cj. Prevalence and Severity of high Blood pressure Among Children based on the 2017 American Academy of Pediatrics Guidelines. JAMA Pediatr. 2018; 172 (6): 557-565. Available from: https://www.ncbi.nlm.nih.gov /pmc/articles/PMC6137536/.
Kuczmarski RJ, Ogden CL, Guo SS. et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11. 2002;((246)):1-19012043359. Available from: https://books.google.com.br/books?hl=pt-BR&lr=&id=M5wdrRMgR1oC&oi=fnd&pg=PA1&ots=SJnGNweI3u&sig=XbqWUYxmbQT0fmRjLv-KLqZ0wWg&redir_esc=y#v=onepage&q&f=false.
Condren M, Carter J, Mushtaq N, et al. The impact of new guidelines on the prevalence of hypertension in children: A cross‐sectional evaluation. J Clin Hypertens. 2019; 1- 6. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13512.
Kharbanda EO, Asche SE, Dehmer SP, et al. Impact of updated pediatric hypertension guidelines on progression from elevated blood pressure to hypertension in a community-based primary care population, J. Clin. Hypertens. 21 (2019) 560–565. Available from: https://onlinelibrary.wiley. com/doi/full/10.1111/jch.13539#.
Khoury M, Philip R. Khoury, Dolan L.M., et al. Clinical Implications of the Revised AAP Pediatric Hypertension Guidelines. PEDIATRICS. 2018;142 (2). Available from: https://pediatrics. aappublications.org/content/142/2/e20180245.
Kit BK, Kuklina E, Carroll MD, et al. Prevalence of and Trends in Dyslipidemia and Blood Pressure Among US Children and Adolescents, 1999-2012. JAMA Pediatr. 2015;169(3):272–279. Available from: https://jamanetwork.com/ journals/jamapediatrics/article-abstract/2089642.
Sorof JM, Lai D, Turner J, et al. Overweight, Ethnicity, and the Prevalence of Hypertension in School-Aged Children. PEDIATRICS, 2004; 113 (3). Available from: https://pediatrics. aappublications.org/content/113/3/475.short.
Moreira NF, et al. Obesidade: principal fator de risco para hipertensão arterial sistêmica em adolescentes brasileiros participantes de um estudo de coorte. Arq Bras Endocrinol Metab, 2013;57 (7): 520-526. Available from: http://www.scielo.br/ scielo.php?pid=S0004-27302013000700004& script=sci_arttext&tlng=es.
Chen X, Wang U. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation. 2008; 117(25): 3171-80. Available from: https://www.ahajournals.org/doi/10.1161 /CIRCULATIONAHA.107.730366
Theodore RF, Broadbent J, Nagin D, 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. Available from: https://www.ahajournals.org/doi /full/10.1161/hypertensionaha.115.05831.
Tirosh A, Afek A, Rudich A, et al. Progression of normotensive adolescents to hypertensive adults: a study of 26,980 teenagers. Hypertension. 2010; 56(2): 203-209. Available from: https://www. ahajournals.org/doi/10.1161/HYPERTENSIONAHA.109.146415.
