Ambulatorni monitoring krvnog pritiska

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Ambulatorni monitoring krvnog pritiska

Arterijska hipertenzija 1 od 4 adultne osobe pati od HTA HTA u 49% ishemijskih bolesti srca!!! HTA u 62% cerebrovaskularnih bolesti!!! Prevalanca HTA u pedijatriji do 4 do 10% MERENJE krvnog pritiska?!?!

VS PREDNOSTI AMKP AMKP Jednokratna merenja Parametri hipertenzije - Srednji dnevni i noćni pritisak - Sistolno opterećenje - Dnevno - noćni pad pritiska Bolja senzitivnost i stratifikacija rizika LV mass index Diferencijacija primarne i sekundarne hipertenzije Ne prate dnevne varijacije Hipertenzija belog mantila i maskirana hipertenzija Niska senzitivnost (60-80%) Svako 5 dete lažno negativno Leandro et al. J.Am Coll Cardiol 2000 Cohen et al. Circulation 1999

AMKP-principi rada Auskultacija - Korotkofljevi tonovi Cuff oscilometrija: detekcija oscilacija P u manžetni (sistolni). Algoritmi za izračunavanje dijastolog P Volumetrijska oscilometrija: detekcija pulsacija u manžetni (sistolni i srednji P) Učestalost merenja: Dan: na 30 min Noć: na 60 min

AMKP & Oštećenja ciljnih organa Hipertrofija leve komore Intima-medija zadebljanje karotidne arterije Krutost arterija Oštećenje bubrega

Indikacije !!! Sekundarna hipertenzija 2. Hipertenzija belog mantila Renal Williams Sy Cushing sy Anorexia nervosa CoAo 2. Hipertenzija belog mantila Učestalost oko 40% 3. Maskirana hipertenzija Učestalost 5-25%

Indikacije !!! 4. Prehipertenzija granične vrednosti (oko 20% od 95 percentila) 5. CV faktori rizika gojaznost, insulinska rezistencija 6. Precizno ispitivanje krvnog pritiska u hroničnim bolestima povezanih sa hipertenzijom Hronična bolest bubrega Dijabetes melitus tip I 7. Efikasnost anti HTA terapije

Analiza rezultata Aparat programiran da isključi netačna merenja Poželjna uspešnost 75% i više Normativi (Soergel et al., Wuhl et al.) Prosečne vrednosti krvnog pritiska (24h, dnevni, noćni) Sistolno i dijastolno opterećenje (manje od 25-30%) Dnevno-noćni pad pritiska (10% i veći)

KLASIFIKACIJA HIPERTENZIJE uz AMKP Jednokratno SSP (AMKP) SO (%) (AMKP) Normalno < 95 percentil <25 HT belog mantila > 95 percentil Maskirana HT >25 Prehipertenzija 25-50 Umerena hipertenzija Teška hipertenzija 50 Lurbe et al., Hypertension 2008

MANE AMKP Normativi za decu!!! Primena kod dece manjeg uzrasta Niske vrednosti TA (manje precizno) Aritmije Trombocitopenije Poremećaji koagulacije Alergije na latex

ZAKLJUČAK AMKP „Zlatni standard“ u dijagnostici hipertenzije belog mantila i maskirane hipertenzije Predikcija rizika oštećenja ciljnih organa Hipertenzija je izlečiva bolest!

Preporučujemo! Pediatric Ambulatory Blood Pressure Monitoring: Indications and Interpretations The Journal of Clinical Hypertension Vol 14 | No 6 | June 2012 Ambulatory Blood Pressure Monitoring in Children and Adolescents: Recommendations for Standard Assessment (Hypertension. 2008;52:433-451.)