Arterial hypertension at children – permanent increase in arterial pressure is higher than the 95th percentile according to the tsentilny table for certain age, sex and growth. It is shown by headaches, dizziness, decrease in visual acuity, sinkopalny states. Is followed by symptoms of the disease which became the reason of increase in pressure: pathologies of heart and kidneys, endocrine violations, obesity etc. Diagnostics begins with fixing of the fact of numerous increase in arterial pressure. Further the complex of laboratory and tool researches is conducted. Etiotropny therapy, a rational diet, prevention of stresses is shown. Hypotensive medicines are applied.
Arterial hypertension at children
Arterial hypertension occurs at children much more less than at adults, and at the same time remains to one of the most widespread chronic diseases in pediatrics. According to various researches, occurrence of this pathology among children and teenagers makes from 1 to 18%. Relevance of a disease is connected with features of therapy at children's age. Use of not all groups of medicines is possible. Besides, the pathologies leading to development of malignant arterial hypertension in children often come to light. Now the number of children with an excess weight and the burdened heredity on chronic diseases grows owing to what arterial hypertension is diagnosed at earlier age.
The reasons of arterial hypertension at children
In development of a disease participation of three pathophysiological mechanisms is supposed: increases in volume of the circulating blood, increases in warm emission and increase in the general peripheral resistance. The first mechanism meets at hyperactivity of sympathetic nervous system. The second mechanism is characteristic of states after infusional therapy, is observed against the background of a renal failure and surplus of mineralkortikoid. The third pathogenetic link in development of arterial hypertension in children is found at hypersensibility of fabrics to catecholamines or at increase in their concentration in blood (for example, at a feokhromotsitoma), and also meets at tumors of kidneys.
Arterial hypertension at children develops in the presence of the contributing factors more often. The burdened heredity on hypertensia, diabetes, obesity, and also on any listed above states participating in pathogenesis of increase in arterial pressure concerns to them. Besides, the disease is often diagnosed for children with the high level of uneasiness and after a critical or chronic stressful situation. Many diseases of nervous system and kidneys can provoke arterial hypertension at children, for example, encephalitis and meningitis, craniocereberal injuries, sharp glomerulonefrit etc.
Violation of electrolytic and hormonal exchange of any etiology also increases risk of development of arterial hypertension in children. Increase in pressure is quite often noted at hereditary syndromes, malformations of heart, vessels and bodies of respiratory system. A nosology are considered especially dangerous because the increase in arterial pressure provoked by them often is resistant to therapy. In particular, it belongs to the parenchymatous diseases of kidneys, endocrine violations caused by catecholamines, mineralokortikoida and glucocorticoids. Obesity also belongs to the factors burdening the course of arterial hypertension at children.
Classification and symptoms of arterial hypertension at children
Uniform classification of extents of increase in arterial pressure at children does not exist. Most often domestic pediatricians rely on classification of E.Nadezhdina according to which allocate three stages of arterial hypertension at children. The stage of I is reversible and is divided into two phases: IA – increase in pressure at the time of emotional pressure, IB – the periodic increase in pressure which is stopped independently. The first stage is considered a prehypertensive state. The stage of IIA is followed by continuous, but unstable increase in pressure, at a stage of IIB permanent increase in pressure is noted. The stage of III is diagnosed for children seldom, characterized by accession of organ damages (vessels of a brain, eyes, extremities, etc.).
At initial stages arterial hypertension at children is shown by increased fatigue, headaches, dizziness. Children of younger age are not able to show complaints therefore it is important to pay attention to short wind, especially when feeding, an insufficient increase in weight, lag in development. In process of progressing of a disease deterioration in sight, especially during the periods of elevated pressure, loss of consciousness on type to a syncope is possible. Also in most cases there are symptoms of the disease which served as the reason of development of arterial hypertension in children. If it is about hereditary pathologies, often there are typical phenotypical signs.
Hypostases demonstrate violations from cardiovascular system or kidneys. At disorders of hormonal exchange the virilization, gipogonadizm signs can be observed. The crescent-shaped face, strips of stretching (striya) is characteristic of Cushing's syndrome. The increased perspiration and visual increase in a thyroid gland allow to suspect a thyrotoxicosis. Lag in physical development can speak well for congenital heart diseases and vessels. Much less often arterial hypertension at children is shown only by increase in pressure and is not followed by other symptomatology.
Diagnosis of arterial hypertension at children
It is possible to suspect a disease at measurement of arterial pressure by means of a cuff. Pressure is considered raised when is above the 95th percentile on a scale for the defined age and a sex. Once fixed hypertensia is the indication to two repeated measurements with an interval of 2 minutes. Also measurements on other hand and legs in a standing position are taken and lying. This measure allows to avoid hyper diagnostics as the so-called "syndrome of a white dressing gown" often occurs at children. Fizikalny inspection gives the chance to find the excess weight and symptoms of various diseases.
The huge role in diagnosis of arterial hypertension at children is played by careful collecting the anamnesis. Cases of arterial hypertension at other family members, and also presence of chronic diseases at the child can come to light (especially heart troubles, kidneys and endocrine violations). Anamnestichesky data can confirm reception of hormonal medicines, is more rare – the drugs which are also promoting increase in pressure. For exact fixing of hypertensia daily monitoring of arterial pressure is shown. It allows to exclude a factor of the increased situational uneasiness and to determine the frequency of increase in pressure.
The following block of diagnosis of arterial hypertension at children – comprehensive laboratory examination. The condition of kidneys is estimated according to the general analysis of urine, ultrasonography and a Doppler research. Also the level of electrolytes in urine and blood is defined. The hormonal profile is investigated: hormones of a thyroid gland, kidneys, adrenal glands, sex hormones. The research of cardiovascular system provides carrying out the ECG, EhoKG and X-ray analysis. KT and MRT to children are appointed at suspicion to tumoral educations. The tolerance test to glucose excludes risk of development of diabetes and insulin resistance. Inspection of an eye bottom, vessels of extremities is obligatory.
Treatment, the forecast and prevention of arterial hypertension at children
Treatment is performed after an exception of all possible reasons of increase in pressure. The hypertension as it is almost always possible to find the hypertensia reason is seldom diagnosed for children, unlike adults. Therefore an important point is performing etiotropny therapy. At tumors, cysts and other similar educations surgical removal is shown. Operation often is required at a stenosis of renal arteries. In general therapy of arterial hypertension at children begins with the non-drug methods including a rational diet (or directed to weight reduction), refusal of addictions, physical activity and psychological consultation if necessary.
Medicamentous therapy of arterial hypertension at children has certain age features. For the purpose of a lowering of arterial pressure diuretics, β-adrenoblokator, APF inhibitors, blockers of calcic tubules and antagonists of receptors of angiotensin II are resolved. Most often treatment of arterial hypertension at children begins with purpose of tiazidny and tiazidopodobny diuretics. It also allows to compensate insufficient function of kidneys somewhat. APF inhibitors are used in treatment of children of younger age as have high efficiency in combination with safety. β-adrenoblokator are more urgent at the increased warm emission, but are applied with care in view of side effects (nausea, vomiting, a bronchospasm, etc.).
The separate block of therapy of arterial hypertension at children – treatment of hypertensive crisis. Hypertensive crisis represents permanent and substantial increase of arterial pressure. Medicines of planned therapy are not used as have accumulative effect, besides, their action, as a rule, is delayed on time. Arterial pressure is normalized by means of α-adrenoblokator and peripheral vazodilatator. Medicines of these groups quickly reduce pressure. Are used only by doctors in the conditions of medical institutions as at introduction monitoring of a condition of the child is necessary.
The forecast is defined by the reasons of development of arterial hypertension in children and a disease stage. Early diagnostics and adequate therapy allow to refuse at normalization of pressure hypotensive means and further to carry out only non-drug therapy. At the same time, exist a nosology, the creating conditions for arterial hypertension at children, resistant to treatment. In this case increase in pressure often progresses and leads to organ violations in the form of an angiopatiya of a retina, decrease in mental abilities, the alternating lameness, heart failure etc. Prevention consists in timely diagnostics and elimination of the contributing factors.