儿童期Korotkoff第Ⅳ、Ⅴ音的差异及对成年高血压的预测价值

Study on the impact of the choice of diastolic Korotkoff phase in childhood on prediction to adult hypertension

目的探讨儿童青少年期Korotkoff第Ⅳ音（K4）与第Ⅴ音（K5）的差异及对成年高血压的预测价值，为选择血压测量方案和制定儿童血压评价标准提供依据。方法2005年追访1987年建立的“北京儿童血压研究”队列人群，基线儿童期K4、K5作为舒张压（DBP），采用WHO1996年标准诊断基线儿童期高血压；成年期记录K5作为DBP，采用《中国高血压防治指南（2005年修订版）》诊断成年期高血压。比较儿童期K4、K5的差异及对成年高血压的预测价值。结果1987年基线调查6～17岁学龄儿童2505人，2005年追访到412人。基线K4-K5差值的几何均数为（10．1±1．7）mmHg（1mmHg=0．133kPa），并随年龄增长而下降；除青春期外，其他年龄男女之间K4-K5的差异无统计学意义。各年龄组K4-K5差值的分布构成有统计学意义（P〈0．001），6～9岁、10～12岁、13～15岁、16～17岁分别有59．6％、60．5％、56．3％和45．1％的儿童K4与K5差值大于10mmHg。按WHO标准，采用K4、K5为DBP诊断高血压检出率分别为5．0％和2．4％。儿童期K4与成年期血压的相关程度优于K5；且能预测成年期高血压。结论当使用汞测压计测量儿童血压时，采用K4记录DBP，能更真实地反映儿童血压水平，使不同儿童的DBP水平具有可比性；并且K4与成年DBP的关联度更高，即轨迹现象更强，更能体现儿童血压水平对成年高血压的预测价值。

Objective The best approach for blood pressure （BP） measurement in children remains controversial, especially on the choice of Korotkoff phase 4 （K4） vs. Korotkoff phase 5 （KS） for diastolic BP （DBP） and to compare the differences between K4 and K5 in school-aged children and their predictions to hypertension in adult. Methods The ＂Beijing children and adolescents BP study＂ cohort population consisted 2505 school-aged children aged 6 to 17 at baseline survey in 1987, when datum of systolic BP （SBP）, DBP measured using K4 and KS,were collected respectively. Among them, 412 individuals with 220 males and 192 females at age of 23-37 years old, were successfully followed up and invited to take part in a clinical examination including anthropometric measurements, St3P and DBP recordings, and a questionnaires in 2005. Method for the BP measurements at both baseline and followed-up was by auscultation with a standard sphygmomanometer. Child hypertension at baseline was diagnosed according to the age-specific cutoffs recommended by the World Health Organization in 1996 （WHO 1996）. Adult hypertension was diagnosed according to the China Guideline for Hypertension Prevention and Control issued in 2005. Partial correlation coefficients were calculated to describe the association of K4 and K5 in childhood with SBP and DBP level in adulthood. Multivariate logistic regression analysis was conducted to examine the impact of choice of K5 and K4 as Dt3P in childhood on prediction to the hypertension in adulthood. Potential confounders such as gender and adult-height were controlled for. Results At baseline, the prevalence rates of hypertension were 5.0 % with DBP measured using K4, and 2.4 % with DBP measured using KS, respectively. The geometric mean difference value of K4 minus K5 （K4 - K5 ） was （10.1±1.7 mm Hg） （1 mm Hg= 0. 133 kPa） for the 2505 school-aged children, and decreased as age increased. There was no significant difference regarding the values of K4 K5 between males and females in all age groups except for children who at pubertal stage. The distribution of K4 - K5 value across age groups was statistically significant （P〈0.001）, 59.6% ,60.5% ,56.3% and 45.1% of children who aged 6-9 years,10-12 years, 13-15 years,and 16-17 years with their K4 K5 value over 10 mm Hg. K4 in childhood was better correlated to both SBP and DBP in adulthood than K5. In general, K4 seemed to be superior to K5 in predicting hypertension in adulthood. The odds ratios of hypertension in adulthood were 1.69（95%CI：1.11-2.00）, 1.45（1.05-2.02）, 2.18（1.37-3.47）, and 1.66（1.07-2.59） with each 5 mmHg increasing of K4 measured in children aged 6-9 years, 10d2 years, 13-15 years, and 16-17 years, respectively. The agreement diagnosis between child hypertension and adult hypertension was higher for childhood DBP measured using K4 （20.2 % ） than that using K5 （ 12.8 % ）. Conclusion There was significant difference between K4 and K5 in Chinese children and adolescents. Choice of diastolic Korotkoff blood pressure could affect DBP tracking from childhood into adulthood. K4 seemed superior to K5 when using auscultator technique to measure DBP.