MICROCIRCULATORY PREDICTORS OF THE FORMATION OF PRIMARY ARTERIAL HYPERTENSION IN CHILDHOOD

Abstract

Introduction. The problem of early diagnosis of arterial hypertension in children is extremely urgent. According to some foreign scientists, the prevalence of this disease among school-age children in the world has been increasing over the past ten years. Children of prepubertal and pubertal age are most prone to the development of arterial hypertension, which is largely determined by vegetative dysfunctions and microcirculation disorders characteristic of these periods of childhood.It has been proven that changes in microcirculation are determined by the variant of arterial hypertension and are a fairly early marker of the degree of damage to target organs.The aim of the study is to study microcirculatory predictors of the formation of primary arterial hypertension in childhood.Material and methods.113 school-age children from the residents of Chernivtsi region and Chernivtsi were examined. The examined children were divided into two groups: the main group consisted of 30 children with arterial hypertension and the control group - 83 children with a normal level of blood pressure.Blood pressure was measured with automatic pressure gauge with removable cuffs, in the morning on both arms, three times with an interval of 2 minutes. Results were evaluated according to percentile tables for age, sex, and height.The recommendations of the American Academy of Pediatrics (AAR) were used to diagnose hypertension in children.Capillaroscopic examination of the nail bed was used to assess the state of peripheral microcirculation in the examined children. Quantitative and qualitative parameters of microcirculation were evaluated.The research was carried out in compliance with the "Rules of Ethical Principles of Conducting Scientific Medical Research with Human Participation" approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EU Directive No. 609 (from 24.11.1986), orders of the Ministry of Health of Ukraine No. 690 from 23.09.2009, No. 944 from 14.12.2009, No. 616 from 03.08.2012.Statistical processing of the data was performed using nonparametric methods of evaluation. Mathematical processing of the data was performed using Microsoft Office Excel and Statistica 10.0.The work was performed within the framework of the planned research work of the Department of Pediatrics, Neonatology and Perinatal Medicine of Bukovinian State Medical University: Chronobiological and adaptation aspects and features of autonomic regulation in pathological conditions in children of different age groups, (№ 0122U002245, term of execution 2022 - 2026).Results. When comparing the quantitative capillaroscopic indicators of the nail bed between the groups, it was found that the children from the main group showed probable differences in individual indicators (reduced linear density, greater distance between capillaries, 2 times less number of anastomoses, change in the shape of capillaries) compared to the control group, which indicates on changes in peripheral microcirculation in children with elevated blood pressure.After conducting a correlation analysis of the obtained data, we found correlations between changes in the microcirculation of the nail bed and indicators of the functional state of the cardiovascular system in the form of changes in the linear density of capillaries and the distance between them, the presence of increased tortuosity of capillaries and "sweetening". Thus, the linear density of capillaries had high correlations with the level of systolic blood pressure (r=0.73, p<0.05) and the level of diastolic blood pressure (r=0.69, p<0.05).When conducting a multifactorial analysis, a clear relationship between changes in the indicators of the state of the cardiovascular system, on the one hand, and the capillaries of the nail bed, on the other, can be traced.Conclusions. 1. Microcirculatory disorders in the capillaries of the nail bed reflect the changes in central hemodynamics and may be early signs of arterial hypertension in children.2. According to the results of the epidemiological analysis, the presence of predictors of the development of primary arterial hypertension in children was established. These factors are a reduced number of capillaries per unit area (OR = 2.54; RR = 2.12; 95% CI 2.06-4.98) and their pathological tortuosity (OR = 1.75; RR = 1.44; 95% CI 1.18-2.63).