What is Hypertension in Children?
Arterial hypertension is a disease that, in recent years, not only people of ages have been ill, but also children and adolescents. The popular name for hypertension is hypertension, but in fact it is only one of the options for hypertension.
Types of arterial hypertension:
- primary
- secondary (symptomatic)
In primary hypertension in children, systolic and / or diastolic blood pressure rises for no apparent reason. The development of the disease depends on many factors, including neurohumoral, hemodynamic and genetic. Also, the appearance of arterial hypertension in a child largely depends on the state of the endothelium. Endothelium – a single layer of cells that cover the inner surface of the blood, lymphatic vessels, heart cavities.
Labile arterial hypertension is a form of the primary type of this disease, which is manifested by an unstable increase in blood pressure during the day. Single pressure measurements show normal values. But during the day the blood pressure in the child changes.
Stable arterial hypertension is a form of the primary type of this disease, which is manifested by a persistent increase in the blood pressure of the child, both at night and during the day.
Hypertensive disease is also manifested in impaired endothelial function and damage to organs (kidneys, heart, retina, brain vessels). The disease is diagnosed mainly for adolescents from the age of 16, if the symptoms of hypertension last more than 12 months. If a child is younger than 16 years old, and he has lesions of the above listed organs, he is also diagnosed with hypertension.
Secondary arterial hypertension occurs if there are pathological processes in different organs and systems.
Causes of Hypertension in Children
Hypertensive diseases tend to those children and adolescents who have excess weight. Also among the risk factors are such bad habits as smoking and drinking alcohol. Excess intake of sodium chloride with food and psychoemotional stress, which can also provoke hypertension in children, negatively affect the body.
Primary arterial hypertension occurs in those who lead a sedentary lifestyle and in patients with diabetes. Secondary arterial hypertension is the result of such diseases:
– kidney diseases (acute and chronic glomerulonephritis, renal artery stenosis, diabetic nephropathy, chronic pyelonephritis, etc.)
– cardiovascular diseases (aortic valve insufficiency, aortic coarctation, erythremia, open arterial duct)
– endocrine disorders (Itsenko-Cushing’s disease, pheochromocytoma, hyperparathyroidism, Cohn syndrome)
Also, the causes of secondary arterial hypertension can be the use of drugs, the toxic effect of certain substances and pregnancy (this reason should not be excluded in case of hypertensive illness in female adolescents).
Pathogenesis during Hypertension in Children
Blood pressure is characterized by such indicators as the minute volume of blood circulation (IOC) and total peripheral vascular resistance (OPS). The reasons for the increase in pressure lie in the rise of the OPSS and the growth of the IOC. Between these two indicators, the principle of compensation. That is, changes in one factor lead to changes in another.
In most patients with essential arterial hypertension, the main component of pathogenesis is a permanently elevated level of OPSS. In adolescents, a sign of the development of essential hypertension at the very beginning of it is the lack of a response to OPS in response to physical exertion.
The main stages of the development of hypertension (according to neurogenic theory):
- negative psychoemotional stress leads to increased excitation of the sympathetic centers
- a spasm of resistance vessels and a constantly high level of OPS, which leads to arterial hypertension
- myocyte hypertrophy
- vessel wall thickens, narrowing the lumen of resistive vessels
- OPSS acquires character, arterial hypertension becomes irreversible
- vasoconstriction also captures the adducting arterioles of the renal nephrons, arterial hypertension becomes renal vascular, often malignant
In blood plasma, there is a high activity of renin in not all patients with a diagnosis of “essential arterial hypertension”. For such patients, a salt-free diet is added to the results, which helps to reduce the volume of extracellular fluid, which is reflected in a decrease in blood pressure. The intake of salt in large quantities into the body with food increases the IOC.
The hereditary factor is manifested through genetically determined defects of transmembrane ion transfer. Inside the body, as a result of this, sodium is retained, the heart’s preload is growing, a steady, increased vasospasm of resistance vessels appears.
To determine the cause of primary arterial hypertension at the molecular level is very difficult. There are suggestions that the genetic predisposition to the disease in question is associated with the structural features of the angiotensinogen gene.
Symptoms of Arterial Hypertension in Children
Symptoms of hypertension in children may not manifest for a long time. Sometimes, before the onset of complications, neither the child nor his parents know about the disease, unless they regularly measure the pressure of the baby with the help of a tonometer.
The main symptom of this disease is a persistent increase in blood pressure. If the pressure rises from time to time, it still does not mean hypertension. For example, during stress, the pressure is always high, but then the body calms down – and the pressure returns to normal. Fear of doctors can cause stress, increased pressure. Therefore, for some people, when measuring the pressure in the hospital, it is elevated, and when measured independently at home, it is normal.
Additional symptoms of arterial hypertension: dizziness, headache, front sight, tinnitus. If such organs as the brain, heart, kidneys, eyes, blood vessels are affected, a whole complex of other symptoms manifests itself. The person may deteriorate the memory, the child may lose consciousness (if the brain is affected).
Prolonged arterial hypertension causes kidney damage. Then symptoms such as nocturia and polyuria appear. Therefore, when diagnosing the disease under consideration, not only they measure pressure, but also check the state of the target organs listed above.
Diagnosis of Arterial Hypertension in Children
Hypertension in a teenager or younger child may be symptomatic. Therefore, the following tests are performed: urinalysis (determination of protein, glucose, urinary sediment), complete blood count with hematocrit determination, determination of cholesterol level, blood test for sugar, determination of LDL, HDL, triglycerides, creatinine and uric acid, sodium and potassium serum. An ECG is also performed. Other examinations may be prescribed by a doctor based on each specific case.
Initial examination of a child with arterial hypertension may include ultrasound of the kidneys, echoCG, ocular fundus examination, chest x-ray, etc. For some cases, the following methods are used for diagnosis: excretory urography, nephrosyntigraphy, plasma renin activity and aldosterone levels. With the help of such studies can identify diseases that often lead to increased blood pressure.
After conducting the above studies, the doctor may be suspicious of reflux or obstructive nephropathy. Then two or more studies are carried out: a micastatic cystourethrography, a survey radiography of the abdominal organs, nephrosyntigraphy with 99 Tc DMSA or excretory urography, determine the activity of renin in the renal veins.
If glomerular diseases are suspected, not only common clinical and biochemical tests are necessary, but also serum tests on autoantibodies, antibodies to DNA, C3, C4 and the level of immunoglobulins, antinuclear factor, ASL-O titer, HBV surface antigen.
Renovascular diseases are diagnosed using Doppler ultrasound, radioisotope and X-ray studies. Also determine the activity of plasma renin in the blood, flowing through the renal veins. In the absence of signs of these groups of diseases, it becomes necessary to exclude endocrine diseases. To this end, it is recommended to determine the daily excretion of catecholamines, electrolytes, aldosterone levels and plasma renin activity.
Treatment of Hypertension in Children
Treatment of moderate arterial hypertension, if internal organs are not affected, begins with non-drug methods. Need to change the lifestyle of a child. Fat children are transferred to proper nutrition, reduce calorie intake. Should increase the physical activity of the child. Smoking adolescents should say goodbye to the habit.
In some cases, doctors prescribe low doses of antihypertensive drugs. You can not use both drugs with the same mechanism of action, as this can lead to increased adverse reactions. Monotherapy is used to treat hypertension in children and adolescents. If it has no effect, then switch to a combination therapy.
Preparations for the treatment of arterial hypertension:
- β1-adrenoreceptor blockers
- angiotensin converting enzyme inhibitors
- diuretics
- calcium channel blockers
- sedative fitosbory
In diabetes and bronchospastic reactions in children, non-selective β-adrenergic blockers of the 1st generation should not be treated, but highly selective β1-blockers are used. If ACE inhibitors have a positive effect, but there are side effects, then doctors are considering the appointment of an AT II receptor blocker.
Children with arterial hypertension put on dispensary observation. The general condition is monitored every two weeks from the prescription of antihypertensive drugs until the pressure stabilizes. After stabilization, the child is examined every 3 months.
When arterial hypertension is established, 1 time in half a year, a control examination is performed at a pediatric cardiovascular surgeon. When hypertension is examined 1 time per season (3 months). Mandatory diagnostic examinations need to be held 1 time in 12 months, if indicated, additional examinations can be prescribed.
Prevention of Arterial Hypertension in Children
1. Limit salt intake (given the salt that is added to ready-made meals). Salt retains water in the body, therefore, the volume of blood circulating through the vessels increases. This leads, in turn, to an increase in the load on the heart and kidneys. Also, a large amount of salt in the diet leads to edema.
2. Normalize overweight. It is often the cause of hypertension in children, even of primary school age. At times, people with obesity are more likely to have high blood pressure than those with normal weight. In obesity, cholesterol is deposited on the walls of blood vessels, narrowing their lumen. This leads to an increase in blood pressure.
To reduce body weight and normalize lipid metabolism, they recommend diet No. 10 – for those who suffer from cardiovascular diseases.
3. Ensure that the child is physically active. Routine physical education, especially if they are not very active, may not be enough. Walk with your child more often. In the courtyard, he can play with friends in active games: football, volleyball, basketball, tennis, badminton. If parents have a habit of running in the morning or in the evening, it will be helpful to take the child with them. Thus, he will inculcate a healthy lifestyle culture.
But before increasing physical activity for the child, you should consult with the pediatrician, check the pressure, and sometimes conduct a general examination of the body. For children who have health problems, a special complex of physiotherapy exercises may be suitable.
4. To help the teenager get rid of bad habits. Parents, giving a negative example to their children (from infancy), foster in them a passion for harmful habits. When buying alcohol with a child, remember, he understands everything even in spite of a very small age. And in a few years, he, too, will reach for the bottle.
Therefore, parents should set the correct example for children so that they do not acquire bad habits and lead a healthy lifestyle. If your child already has negative habits, you can agree to leave them together. After all, support is a very important factor in lifestyle changes. Talk with your children, communicate with them more often, then you will not have to swear in an attempt to wean the child from smoking or alcohol.
Adolescents with bad habits have 3 times higher chances for the diagnosis of “arterial hypertension”. And the more the experience of smoking a child, the harder it is to quit. The disease progresses with time, and then only the rejection of the bad habit will not be enough. It is important to remember and explain to the child.