KRITIČKI OSVRT NA SAVREMENU DEFINICIJU ARTERIJSKE HIPERTENZIJE KOD DECE

Abstract

The Task Force data have added immeasurably to our understanding of the normal distribution of blood pressure in children. However, the manner in which arterial hypertension is defined in children is not without problems. The main problem is that the current definition of hypertension in children is not based on the end-organ damage assessment, but on the blood pressure height-related percentile distribution of healthy reference population. This could be overcome by introducing the relationship of blood pressure values with sensitive markers of hypertensive sequelae (such as carotid intimal-medial thickness, left ventricle mass index, retinal arteriolar narrowing and arteriovenous nicking as well as microalbumin urinary excretion) to define better the specific blood pressure values with outcomes. Furthermore, the current definition of hypertension based on the demographic and clinical characteristics of the reference population does not consider the normal evolution of reference population, as well as its ethnic differences. In addition, being based on the single occasion measurement in quite position it does not account for the possibility of transient, stress induced elevations in blood pressure known as white coat hypertension. Therefore, incorporation ambulatory 24 h blood pressure data into the definition of arterial hypertension in children may increase the definition reliability for clinical decision – making, although for such reliability the paediatric normative ambulatory blood pressure data should be improved.

Keywords: arterial hypertension; Task Force; blood pressure; children