北京市412例儿童18年后血压纵向对照调查

Blood pressure tracking from childhood to adulthood in 412 individuals

目的探讨北京市412例儿童18年后血压变化轨迹的规律。方法对1987年开展的“北京地区儿童血压研究”队列人群于2005年进行追访，采用同样的方法测量血压并进行心血管相关因素的健康体检。结果①18年间平均收缩压（SBP）和舒张压（DBP）水平均随年龄增长而升高，升高幅度表现为SBP〉DBP，男性〉女性。青春期前，男、女血压均随年龄增长而升高，青春期后，血压升高幅度减缓，男性仍随年龄增加而升高，女性随年龄变化趋势不明显。②儿童期血压与成年期血压呈现正相关关系，控制成年体重指数（BMI）和身高，男性两个时期SBP偏相关系数为0．23（P〈0．01），DBP偏相关系数为0．29（P〈0．01）；女性两个时期SBP偏相关系数为0．38（P〈0．01），DBP偏相关系数为0．19（P〈0．01）。③分别按儿童期SBP／DBP〈P25、～P50、～P75、～P90、～P95、≥P9，分组，控制成年身高、BMI、年龄和男、女成年期SBP／DBP均值都随儿童期血压百分位水平升高而增加。④血压正常的儿童，成年后血压仍正常的比例为53．5％（174／325）；高血压儿童，成年后血压仍偏高的比例为75．0％（42／56）。随儿童期血压升高，成年高血压的患病率呈上升趋势（趋势检验，χ^2=41．5，P〈0．001）。结论儿童青少年时期血压随年龄的变化趋势与其身体发育之间存在密切联系；血压轨迹现象由儿童期持续至成年期，随儿童期血压升高，成年高血压的患病率呈上升趋势，高血压的防治工作应从儿童时期抓起。

Objective To examine the tracking of BP from childhood to adulthood. Methods The ＂Beijing children and adolescents BP study cohort＂ consisted of 2505 subjects of 6-18 years old who were enrolled in the baseline BP investigation in 1987. Among them, 412 individuals aged 23-37 years old were successfully followed up in 2005. In this study, clinical examinations and questionnaire about risk factors of CVD were carried out. Threerecords of blood pressure measurement were obtained by trained observers by use of a standardized mercury sphygmomanometer after a 5-minute sitting rest. The classification for hypertension in children and adolescents was based on the BP percentile of healthy children, which was set up during the 1987 study. Results ①From 1987 to 2005, the mean value of systolic blood pressure （SBP） level and diastolic blood pressure（DBP） level were increased with age in both males and females, while it increased more among males than among females. And the SBP level increased more than the DBP level. Before puberty, the BP level increased with age in both males and females. After puberty, the increase of BP level was more significantly in males than in females. ②Taking account of adult height and BMI, there was a positive correlation between the two BP levels during childhood and adulthood, （for SBP r = 0.23, P 〈 0.01 in males, and r = 0.38, P 〈 0.01 in females ; for DBP r = 0.29, P 〈 0.01 in males and r = 0.19, P 〈 0.01 in females） , varying by age and sex. ③Dividing the subjects into groups according to SBP and DBP levels during childhood respectively, ie 〈 P25, - P50, - P75, - P90, P95,≥ P95, after controlling for adult height ,BMI, SBP（DBP） and age , SBP/DBP level in adulthood increased with SBP/DBP level percentile during childhood in both males and females. ④53.5% （ 174/325 ） of subjects whose BP levels were normal in adults were those children and adolescents whose BP levels were normal at baseline; 75% （42/56） of subjects whose BP levels were ＂high normal＂ in adults were those children and adolescents who were hypertensive at baseline. Prevalence rates of hypertension were 9. 5% （ 31/325 ） , 19.4% （ 6/31 ） ,42.9% （ 24/56 ） in 2005 for individuals whose baseline BP level was ＂normal＂, ＂high normal＂ and ＂hypertension＂ respectively （test for trend, χ^2 =40. 129, P =0. 000）. Conclusions The trend of BP level changed with age was tightly associated with body growth. The results presented the evidence of BP tracking from childhood, through adolescence, to adulthood. The prevalence rates of hypertension in adult increased with baseline BP level. Strategies and program implication of hypertension prevention should begin as early as in childhood.