medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-4-41-44medalphabet-4286Research ArticleСтатьиДиагностика маскированной артериальной гипертензии у детей – роль самоизмерения АДDiagnosis of masked hypertension in children – the role of self-measured blood pressureКрамаренкоВ. М.KramarenkoV. M.

Крамаренко Владислав Михайлович - аспирант кафедры детских болезней.

Волгоград

Postgraduate Student, Department of Pediatrics.

Volgograd

kramarenkowm@yandex.ruКомарьА. М.KomarA. M.

Комарь Анастасия Михайловна - к.м.н., доцент кафедры детских болезней

Волгоград

Candidate of Medical Sciences, Associate Professor, Department of Pediatrics.

Volgograd

a.m.ledyaeva@gmail.comКомарьП. А.KomarP. A.

Комарь Павел Андреевич - ассистент кафедры детских болезней.

Волгоград

Assistant, Department of Pediatrics.

Volgograd

plamonocranii@gmail.comЛедяевМ. Я.LedyaevM. Ya.

Ледяев Михаил Яковлевич - д.м.н., профессор, заведующий кафедрой детских болезней.

Волгоград

Doctor of Medical Sciences, Professor, Head of the Department of Pediatrics.

Volgograd

ledyaevmikhail@gmail.comФГБОУ ВО «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации (ФГБОУ ВО ВолгГМУ Минздрава РоссииРоссияFederal State Budgetary Educational Institution of Higher Education «Volgograd State Medical University» of the Ministry of Health of the Russian FederationRussian Federation20252104202504Современная функциональная диагностика (1)4144Copyright © Крамаренко В.М., Комарь А.М., Комарь П.А., Ледяев М.Я., 20252025Крамаренко В.М., Комарь А.М., Комарь П.А., Ледяев М.Я.Kramarenko V.M., Komar A.M., Komar P.A., Ledyaev M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4286

Маскированная артериальная гипертензия у детей (МАГ) определяется при артериальном давлении (АД) менее 95 процентиля для офисного АД (АДоф) и более или равном 95 процентилю при суточном мониторировании АД (СМАД). Частота встречаемости МАГ у детей вариабельна и может достигать 60% в зависимости от исследуемой группы или метода измерения АД.

Цель исследования – определить распространенность МАГ и роль самоизмерения АД в домашних условиях (АДдом) в диагностике МАГ у детей.

Материалы и методы

Материалы и методы. В ходе простого неинтервенционного исследования 149 детей (84 мальчика, 65 девочек) в возрасте от 10 до 17 лет (средний возраст 14,34±1,91) с АДоф<95 процентиля, проведено сравнение величины АДоф с показателями АДдом и СМАД.

Результаты и обсуждение

Результаты и обсуждение. Количество пациентов с МАГ 1 степени составило 28,9%. Распространенность МАГ среди мальчиков составила 29,7%, среди девочек – 27,7%. У 48,3% пациентов, по данным домашнего самоизмерения, систолическое АДдом было более 95 процентиля, из них у 54,2% пациентов, установлена МАГ методом СМАД. Лишь у 5,2% пациентов с нормальным АДдом, выявлена МАГ по данным СМАД. В группе МАГ оказалось 74,4% пациента с избытком массы тела и ожирением, причем в подгруппе с ожирением преобладали мальчики – 84%.

Заключение

Заключение. Полученные результаты указывают на важную роль самоизмерения АД у детей в домашних условиях, как показание к проведению СМАД у детей для диагностики МАГ, несмотря на отсутствие стандартных процедур и использование различных приборов при проведении домашнего самоизмерения АД. Фенотип вероятного пациента с МАГ в практике врача-педиатра: мальчик-подросток с ожирением и эпизодами повышенного АД при самоизмерении в домашних условиях.

Masked hypertension (MH) in children is defined as having office blood pressure (BPoff) below the 95th percentile and ambulatory blood pressure monitoring (ABPM) values at or above the 95th percentile. The prevalence of MH in children varies and can reach up to 60%, depending on the study population or the method of BP measurement.

Objective

Objective. The aim of this study was to determine the prevalence of MH and the role of self-measured blood pressure at home (BPhome) in the diagnosis of MH in children.

Materials and methods

Materials and methods. In a simple non-interventional study, 149 children (84 boys, 65 girls) aged 10 to 17 years (mean age 14.34±1.91) with BPoff below the 95th percentile were examined. A comparison was made between BPoff, BPhome, and ABPM.

Results and discussion

Results and discussion. The proportion of patients with stage 1 MH was 28.9%. The prevalence of MH among boys was 29.7%, and among girls, it was 27.7%. According to home self-measurements, 48.3% of patients had systolic BPhome above the 95th percentile, and among them, 54.2% were diagnosed with MH using ABPM. Only 5.2% of patients with normal BPhome were found to have MH based on ABPM. In the MH group, 74.4% of patients were overweight or obese, with boys predominating in the obesity subgroup (84%).

Conclusion

Conclusion. The results highlight the important role of self-measured BP at home in children as an indication for ABPM to diagnose MH, despite the lack of standardized procedures and the use of various devices for home BP measurement. The likely phenotype of a patient with MH in pediatric practice is an adolescent boy with obesity and episodes of elevated BP during home self-measurement.

СМАДмаскированная артериальная гипертензиясамоизмерение АДдетиABPMmasked hypertensionself-measured blood pressurechildrenReferencesPickering T.G., Davidson K., Gerin W., Schwartz J.E. Masked hypertension. Hypertension. 2002;40(6):795–796. https://doi.org/10.1161/01.hyp.0000038733.08436.98.Pickering T.G., Davidson K., Gerin W., Schwartz J.E. Masked hypertension. Hypertension. 2002;40(6):795–796. https://doi.org/10.1161/01.hyp.0000038733.08436.98.Matsuoka S., Awazu M. Masked hypertension in children and young adults. Pediatr Nephrol. 2004;19(6):651–654. https://doi.org/10.1007/s00467-004-1459-3.Matsuoka S., Awazu M. Masked hypertension in children and young adults. Pediatr Nephrol. 2004;19(6):651–654. https://doi.org/10.1007/s00467-004-1459-3.Seeman T., Sulakova T., Stabouli S. Correction to: Masked Hypertension in Healthy Children and Adolescents: Who Should Be Screened?. Curr Hypertens Rep. 2023;25(11):421. https://doi.org/10.1007/s11906-023-01271-3Seeman T., Sulakova T., Stabouli S. Correction to: Masked Hypertension in Healthy Children and Adolescents: Who Should Be Screened?. Curr Hypertens Rep. 2023;25(11):421. https://doi.org/10.1007/s11906-023-01271-3Александров А.А., Кисляк О.А., Леонтьева И.В. Клинические рекомендации. Диагностика, лечение и профилактика артериальной гипертензии у детей и подростков. Системные гипертензии. 2020;17(2):7_35. https://doi.org/10.26442/2075082X.2020.2.200126Aleksandrov A.A., Kisliak O.A., Leontyeva I.V. Clinical guidelines on arterial hypertension diagnosis, treatment and prevention in children and adolescents. Systemic Hypertension. 2020;17(2):7–35. https://doi.org/10.26442/2075082X.2020.2.200126.So H.K., Yip G.W., Choi K.C., et al. Association between waist circumference and childhood-masked hypertension: A community-based study. J Paediatr Child Health. 2016;52(4):385–390. https://doi.org/10.1111/jpc.13121.So H.K., Yip G.W., Choi K.C., et al. Association between waist circumference and childhood-masked hypertension: A community-based study. J Paediatr Child Health. 2016;52(4):385–390. https://doi.org/10.1111/jpc.13121.Flechtner-Mors M., Neuhauser H., Reinehr T., et al. Blood pressure in 57,915 pediatric patients who are overweight or obese based on five reference systems. Am J Cardiol. 2015;115(11):1587–1594. https://doi.org/10.1016/j.amjcard.2015.02.063.Flechtner-Mors M., Neuhauser H., Reinehr T., et al. Blood pressure in 57,915 pediatric patients who are overweight or obese based on five reference systems. Am J Cardiol. 2015;115(11):1587–1594. https://doi.org/10.1016/j.amjcard.2015.02.063.Anstey D.E., Pugliese D., Abdalla M., Bello N.A., Givens R., Shimbo D. An Update on Masked Hypertension. Curr Hypertens Rep. 2017;19(12):94. Published 2017 Oct 25. https://doi.org/10.1007/s11906-017-0792-4.Anstey D.E., Pugliese D., Abdalla M., Bello N.A., Givens R., Shimbo D. An Update on Masked Hypertension. Curr Hypertens Rep. 2017;19(12):94. Published 2017 Oct 25. https://doi.org/10.1007/s11906-017-0792-4.Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension [published correction appears in Eur Heart J. 2019 Feb 1;40(5):475. doi: 10.1093/eurheartj/ehy686.]. Eur Heart J. 2018;39(33):3021–3104. https://doi.org/10.1093/eurheartj/ehy339.Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension [published correction appears in Eur Heart J. 2019 Feb 1;40(5):475. doi: 10.1093/eurheartj/ehy686.]. Eur Heart J. 2018;39(33):3021–3104. https://doi.org/10.1093/eurheartj/ehy339.Stergiou G.S., Palatini P., Parati G., et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J Hypertens. 2021;39(7):1293–1302. https://doi.org/10.1097/HJH.0000000000002843.Stergiou G.S., Palatini P., Parati G., et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J Hypertens. 2021;39(7):1293–1302. https://doi.org/10.1097/HJH.0000000000002843.Stergiou G.S., Nasothimiou E., Giovas P., Kapoyiannis A., Vazeou A. Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring. J Hypertens. 2008;26(8):1556–1562. https://doi.org/10.1097/HJH.0b013e328301c411.Stergiou G.S., Nasothimiou E., Giovas P., Kapoyiannis A., Vazeou A. Diagnosis of hypertension in children and adolescents based on home versus ambulatory blood pressure monitoring. J Hypertens. 2008;26(8):1556–1562. https://doi.org/10.1097/HJH.0b013e328301c411.Wuhl E., Hadtstein C., Mehls O., Schaefer F; Escape Trial Group. Home, clinic, and ambulatory blood pressure monitoring in children with chronic renal failure. Pediatr Res. 2004;55(3):492–497. https://doi.org/10.1203/01.PDR.0000106863.90996.76.Wuhl E., Hadtstein C., Mehls O., Schaefer F; Escape Trial Group. Home, clinic, and ambulatory blood pressure monitoring in children with chronic renal failure. Pediatr Res. 2004;55(3):492–497. https://doi.org/10.1203/01.PDR.0000106863.90996.76.Flynn J.T., Kaelber D.C., Baker-Smith C.M., 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. https://doi.org/10.1542/peds.2017-1904.Flynn J.T., Kaelber D.C., Baker-Smith C.M., 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. https://doi.org/10.1542/peds.2017-1904.

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