Çocukluk çağı hipertansiyonunda etyoloji, risk faktörleri ve hedef organ hasarının belirlenmesi ve tedavi seçeneklerinin karşılaştırılması
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Date
2014
Authors
Uysal, Berfin
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Çocukluk çağında hipertansiyon, erişkinlerde olduğu gibi önemli bir morbidite ve mortalite nedenidir. Bu çalışmada, 1 Ocak 2012 ile 31 Aralık 2013 tarihleri arasında Uludağ Üniversitesi Çocuk Nefroloji Polikliniği'ne başvuran, hipertansiyon tanısı alan ve düzenli takip edilen hastaların demografik özellikleri, hedef organ hasarları, aldıkları tedaviler ve tedaviye yanıtları geriye dönük olarak değerlendirildi ve hipertansiyon etyolojisi araştırıldı. Çalışmaya dahil edilen 231 hastanın ortalama yaşı 14.4±4.5, ortalama tanı yaşı 11.4±4.7 olarak belirlendi. Hastaların %50.6'sı (n=117) primer hipertansiyon, %49.4'ü (n=114) sekonder hipertansiyon tanısı aldı. Primer hipertansiyonlu hastaların 20'sinde aile öyküsü varken, sekonder hipertansiyonlu hastaların sadece 7'sinde aile öyküsü mevcuttu, aradaki fark anlamlı bulundu (p=0.01). Yirmi dört hasta fazla kilolu, 36 hasta obez olarak değerlendirildi. Hastaların %8.7'sinde diyabet, %7.4'ünde kronik böbrek hastalığı mevcuttu. Böbrek nakli yapılmış olan hastaların 20'si hipertansiyon tanısı ile izlenmekte idi. Hedef organ hasarı değerlendirildiğinde; hastaların 47'sinde(%20.3) hipertansif retinopati, 30'unda (%13) sol ventrikül hipertrofisi ve 59'unda (25.5) proteinüri olduğu görüldü. Hastaların insülin direnci veya diyabeti olması ile hedef organ hasarı gelişmesi açısından anlamlı fark bulunmadı. Tedavide, 94 hastaya yaşam tarzı değişikliği, 60 hastaya kalsiyum kanal blokeri, 22 hastaya anjiotensin converting enzim inhibitörü,19 hastaya beta bloker ve geri kalan hastalara kombine tedavi düzenlendi. Vakalarımızın %76.2'sinde tedaviye yanıt alındı. Primer hipertansiyon ve sekonder hipertansiyon arasında tedaviye yanıt açısından anlamlı fark saptanmadı (p=0.28). Sonuç olarak değişen yaşam tarzı ve kötü beslenme alışkanlıkları nedeni ile çocuklarda hipertansiyon görülme sıklığı artmaktadır.
Hypertension in childhood is a serious cause of mortality and morbidity as in adulthood. Demographic profiles, treatment regimens, response to treatment and etiology of Hypertension were reviewed in children diagnosed with hypertension in this study. Children diagnosed with hypertension in outpatient clinics of Pediatric Nephrology Department of Uludag University between January 1, 2012 and December 31, 2013 were reviewed retrospectively in this study. The mean age of 231 patients diagnosed as hypertensive was 14.4±4.5 with a mean age of 11.4±4.7 at the time of diagnosis 135 of whom were male and 96 of whom were female. One hundred seventeen patients (50.6%) were classified as having primary hypertension and 49.4% of the patients were classified as having secondary hypertension. Twenty patients with primary hypertension had family history whereas 7 patients with secondary hypertension had family history, this difference was statistically significant (p=0.01). Twenty four patients were defined as overweight and 36 patients were defined as obese. 8.7% of the patients had diabetes whereas there were 17 children with chronic kidney disease.Twenty patients with renal transplantation patients were found to be hypertensive. Hypertensive retinopathy, left ventricular hypertrophy and proteinuria were found in 47 (20.3%), 30 (13%) and 59 (25.5%) patients respectively. There was no association between end organ damage and younger age at the time of diagnosis. Insulin resistance or diabetes were not detected to be associated with end organ damage. Ninety four patients were advised life style changes, 60 patients were treated by calcium channel blockers, 22 patients by angiotensin converting enzyme inhibitors, 19 patients by beta blockers and the rest of the patients by combined therapy. Treatment was efficient in 76.2% of the patients. Response to treatment did not differ between primary and secondary hypertension (p=0.28). In conclusion, the incidence of hypertension in children is increasing because of altering life style and nutrition status of children. In this study, the demographic profiles, etiologies, treatment regimens, response to treatment were reviewed in children with hypertension.
Hypertension in childhood is a serious cause of mortality and morbidity as in adulthood. Demographic profiles, treatment regimens, response to treatment and etiology of Hypertension were reviewed in children diagnosed with hypertension in this study. Children diagnosed with hypertension in outpatient clinics of Pediatric Nephrology Department of Uludag University between January 1, 2012 and December 31, 2013 were reviewed retrospectively in this study. The mean age of 231 patients diagnosed as hypertensive was 14.4±4.5 with a mean age of 11.4±4.7 at the time of diagnosis 135 of whom were male and 96 of whom were female. One hundred seventeen patients (50.6%) were classified as having primary hypertension and 49.4% of the patients were classified as having secondary hypertension. Twenty patients with primary hypertension had family history whereas 7 patients with secondary hypertension had family history, this difference was statistically significant (p=0.01). Twenty four patients were defined as overweight and 36 patients were defined as obese. 8.7% of the patients had diabetes whereas there were 17 children with chronic kidney disease.Twenty patients with renal transplantation patients were found to be hypertensive. Hypertensive retinopathy, left ventricular hypertrophy and proteinuria were found in 47 (20.3%), 30 (13%) and 59 (25.5%) patients respectively. There was no association between end organ damage and younger age at the time of diagnosis. Insulin resistance or diabetes were not detected to be associated with end organ damage. Ninety four patients were advised life style changes, 60 patients were treated by calcium channel blockers, 22 patients by angiotensin converting enzyme inhibitors, 19 patients by beta blockers and the rest of the patients by combined therapy. Treatment was efficient in 76.2% of the patients. Response to treatment did not differ between primary and secondary hypertension (p=0.28). In conclusion, the incidence of hypertension in children is increasing because of altering life style and nutrition status of children. In this study, the demographic profiles, etiologies, treatment regimens, response to treatment were reviewed in children with hypertension.
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Keywords
Hipertansiyon, Çocuk, Etyoloji, Hedef organ hasarı, Hypertension, Children, Etiology, End-organ damage
Citation
Uysal, B. (2014). Çocukluk çağı hipertansiyonunda etyoloji, risk faktörleri ve hedef organ hasarının belirlenmesi ve tedavi seçeneklerinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.