Arterial Hypertension In Children Research Articles

Development of Losartan Orally Disintegrating Tablets by Direct Compression: a Cost-Effective Approach to Improve Paediatric Patient's Compliance.

The development of suitable dosage forms is essential for an effective pharmacological treatment in children. Orally disintegrating tablets (ODTs) are attractive dosage forms that avoid swallowing problems, ensure dosage accuracy and are easy to administer as they disintegrate in the oral cavity. This study aimed to develop ODTs containing losartan potassium (LP) for the treatment of arterial hypertension in children. The ODTs, produced by the cost-effective manufacturing process of direct compression, consisted of a mixture of diluent, superdisintegrant, glidant and lubricant. Five superdisintegrants (croscarmellose sodium, two grades of crospovidone, sodium starch glycolate and pregelatinized starch) were tested (at two concentrations), and combined with three diluents (mannitol, lactose and sorbitol). Thus, thirty formulations were evaluated based on disintegration time, hardness and friability. Two formulations, exhibiting the best results concerning disintegration time (< 30s), hardness and friability (≤ 1.0%), were selected as the most promising ones for further evaluation. These ODTs presented favourable drug-excipient compatibility, tabletability and flow properties. The in vitro dissolution studies demonstrated 'very rapid' drug release. Preliminary stability studies highlighted the requirement of a protective packaging. All quality properties retained appropriate results after 12months of storage in airtight containers. In conclusion, the ODTs were successfully developed and characterised, suggesting a potential means to accomplish a final prototype that enables an improvement in childhood arterial hypertension treatment.

Risk factors for the development of arterial hypertension in children and young people in present-day developments

In modern society, there is an intensive increase in the incidence of hypertension among young people, which is mainly due to lifestyle features and associated risk factors. Purpose. To analyze the results of Russian and foreign scientific research concerning the study of risk factors in the development of hypertension in children and young people. Material and methods. A qualitative analysis of the current data available in the literature on the risk factors of hypertension and its prevention has been carried out. Results. It has been established that the occurrence of arterial hypertension in childhood is influenced not only by hereditary factors, but also by a number of environmental risk factors. Conclusion. Further research is needed to study new and established risk factors that need to be considered when conducting primary prevention of the disease in children and young people from the high-risk group.

Obesity and Arterial Hypertension in Children: Systematic Review

Overweight, obesity, and arterial hypertension in children have become a serious and growing public health problem in this group. However, there is a lack of updated data to determine whether these conditions correlate. This systematic review was designed and developed following the “Preferred Reporting Items in Systematic Reviews and Meta-Analyses” (PRISMA) statement, performed through a bibliographic search in the SciELO (Scientific Electronic Library Online), MEDLINE (National Library of Medicine), and LILACS (Latin American and Caribbean Health Sciences Literature) databases. Finally, 7 studies were included in the quantitative analysis based on 5,364 subjects considered, and 14 studies were used for the qualitative analysis contributing to the discussion on the investigated topic. The presence of pre-AHT and early-stage AHT was high in all the studies, mostly in overweight and obese children, which, through the results, demonstrate that these values and the increase in BP are closely related to the increase in BMI (SciELO Scientific Electronic Library Online), MEDLINE (National Library of Medicine); LILACS (Latin American and Caribbean Health Sciences Literature). Overweight and obesity in children contribute to a serious health problem. Being necessary to verify the opinions of the authors in recent years in relation to the relationship between these variables and the presence of hypertension in children. A systematic review was designed following the statement "Preferred Reporting Items in Systematic Reviews and Meta-Analyses" (PRISMA). A search was carried out in the Scielo, Google academic, PubMed, Latindex databases. Finally, 7 studies were included in the quantitative analysis based on 5,364 topics considered. Concluding that the presence of preHBP and HBP in the early stage was high in all the studies, mainly in overweight and obese children, which, through the results, demonstrates that these values and the increase in BP are closely related to the increase in BMI.

Are the Classical Symptoms of Hypertension in Children Still Sensitive Enough?

The available literature is scarce on the initial symptoms of arterial hypertension in children. Our study aimed to analyze the initial clinical profile of patients referred to the hospital with suspected hypertension and those diagnosed with hypertension for the first time during a hospitalization for other reasons. This study was a retrospective analysis of medical records in 471 patients. More than half of the patients showed no symptoms. The most common symptom reported was a headache-28% (132) of patients. The diagnosis of elevated blood pressure or hypertension was more frequent in asymptomatic patients (P = 0.001). Headaches were seen more often in healthy patients than in patients with hypertension. Newly diagnosed hypertension is mainly diagnosed in asymptomatic children. Moreover, the symptoms previously described in the literature as the most common did not prove to be predictive of hypertension in our study.

Arterial Hypertension in Children and Adolescents and Its Relation with Low Birth Weight as Expression of an Intermediate Stage between the Perinatal Period and Adult Hypertension - A New Piece in the Arterial Hypertension Puzzle?

Arterial Hypertension in Children and Adolescents and Its Relation with Low Birth Weight as Expression of an Intermediate Stage between the Perinatal Period and Adult Hypertension - A New Piece in the Arterial Hypertension Puzzle?

Psychoemotional status and arterial hypertension in children: search for correlation and clinical application

Arterial hypertension is a common problem in pediatrics that requires close attention from pediatricians and pediatric cardiologists. Scientific discoveries describing molecular-genetic interactions in disease progression unfortunately do not always help practitioners and patients to achieve full control of the disease. The anatomo-physiologic features of childhood have forced researchers to search for new reference points that can help clinicians select effective therapies. In recent years, clinicians and psychologists have noted a steady increase in anxiety disorders in childhood and adolescence. Approximately 32% of adolescents have symptoms of anxiety that are mostly ignored and not corrected. In the future, such patients have a significantly increased risk of developing not only psychiatric abnormalities, but also cardiovascular diseases. Assessment of the patient's psychoemotional status may become an important factor in the selection of complex treatment, which will provide a personalized approach to the therapy of arterial hypertension in a child and prevent the development of its long-term consequences.

Pediatric hypertension as an early manifestation of cardiovascular disease in children.

In adults, cardiovascular events associated with arterial hypertension (AH) have a major impact on morbidity and mortality. In light of recent findings, AH in children has been interpreted as early cardiovascular disease (CVD), while exposure to CV risk factors in children proves to be a predictor of subclinical CVD in adults. The American College of Cardiology/American Heart Association has recently updated the classifications for measuring blood pressure (BP) in adults and children. Primary AH in children is generally asymptomatic, and it is associated with a family history of AH, overweight/obesity, and normal morphofunctional characteristics of the urinary system. The younger the child and the higher the BP, the greater the likelihood of secondary AH. The investigation into the etiology of AH begins with a detailed anamnesis, which should include clinical information and details on the use of medication, smoking, and alcohol consumption from the perinatal period to the time of consultation. Modifying risk factors by reducing weight, decreasing alcohol consumption and increasing vegetable intake from childhood to adulthood has been associated with the resolution of AH in the childhood-adulthood transition, and with the reversal of cardiometabolic adverse effects in non-obese adult individuals. Pharmacological therapy should be initiated in cases of symptomatic AH, AH secondary to chronic kidney disease or diabetes mellitus, presence of target organ lesions, stage 2 AH with no modifiable cause and resistant AH unresponsive to lifestyle changes.

Risk Factors for the Development of Obesity in Children

Obesity is one of the most urgent problems of modern medical science. While 43 million children were overweight and obese in 2010, the disease is now reaching epidemic proportions. The combination of obesity and hyperuricemia is the two main factors in the progression and spread of arterial hypertension in children. Research has been carried out to identify risk factors for the development of obesity in children. 55 patients with arterial hypertension and exogenous constitutional obesity were examined. Patient selection was based on body mass index (BMI) and waist circumference in obese children. Waist-to-hip ratio was an indicator of abdominal obesity. The results of the study showed that both low birth weight and overweight at birth are risk factors for obesity. Heredity is one of the main risk factors for obesity and cardiovascular disease. A relationship has been established between body mass index, lipid and carbohydrate metabolism with previously identified risk factors, as well as an inverse relationship between birth weight and body mass index.

Automated Retinal Vessel Analysis Based on Fundus Photographs as a Predictor for Non-Ophthalmic Diseases-Evolution and Perspectives.

The study of retinal vessels in relation to cardiovascular risk has a long history. The advent of a dedicated tool based on digital imaging, i.e., the retinal vessel analyzer, and also other software such as Integrative Vessel Analysis (IVAN), Singapore I Vessel Assessment (SIVA), and Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE), has led to the accumulation of a formidable body of evidence regarding the prognostic value of retinal vessel analysis (RVA) for cardiovascular and cerebrovascular disease (including arterial hypertension in children). There is also the potential to monitor the response of retinal vessels to therapies such as physical activity or bariatric surgery. The dynamic vessel analyzer (DVA) remains a unique way of studying neurovascular coupling, helping to understand the pathogenesis of cerebrovascular and neurodegenerative conditions and also being complementary to techniques that measure macrovascular dysfunction. Beyond cardiovascular disease, retinal vessel analysis has shown associations with and prognostic value for neurological conditions, inflammation, kidney function, and respiratory disease. Artificial intelligence (AI) (represented by algorithms such as QUantitative Analysis of Retinal vessel Topology and siZe (QUARTZ), SIVA-DLS (SIVA-deep learning system), and many others) seems efficient in extracting information from fundus photographs, providing prognoses of various general conditions with unprecedented predictive value. The future challenges will be integrating RVA and other qualitative and quantitative risk factors in a unique, comprehensive prediction tool, certainly powered by AI, while building the much-needed acceptance for such an approach inside the medical community and reducing the "black box" effect, possibly by means of saliency maps.

Comparative analysis of methods for evaluating myocardial hypertrophy in children with arterial hypertension

Relevance: over the past decades, the prevalence of arterial hypertension (AH) in the pediatric population has increased significantly, but there are still many open questions related to the diagnosis and course of the disease, the validity of the choice of antihypertensive therapy and the risks of target organ injury. In clinical practice, patients with hypertension are observed by a team of specialists of various profiles, and a unified approach to managing the disease is not always formed between them. Underestimation of risk factors, late detection of target organ injury and untimely start of antihypertensive therapy significantly increase the risks of an unfavorable, progressive course of the disease, aggravating the further prognosis. Strict adherence to the methods of diagnosing the disease and its potential consequences recommended by the professional community of pediatric cardiologists ensures an adequate initiation of drug therapy, which allows not only to control the course of hypertension, but also to prevent the development of long-term complications. Objective: to analyze the indicators obtained using the formula recommended by pediatric cardiologists compared to the routine method for detecting left ventricular myocardial remodeling in children with AH. Materials and methods: a cross-sectional, cohort, non-randomized study, which included 92 patients with newly diagnosed primary arterial hypertension, who were not receiving antihypertensive therapy at the time of the examination. The standard linear dimensions of the walls and cavities of the heart were assessed during echocardiography. The results were evaluated by the standard Fisher’s test, the xi2 test in the Statistica 9 software. The sample excluded children-athletes, patients with secondary hypertension, overweight, congenital heart disease and cardiomyopathy. All children were tested the same according to the current Federal Clinical Guidelines “Diagnosis and treatment of arterial hypertension in children and adolescents”. Results: the usage of the recommended formula is not only significantly more often allowed to identify the early stages of LV myocardial hypertrophy, but has great sensitivity. The routine method for calculating LV remodeling showed the norm much more often even in case of severe violation of the geometry of the heart. Conclusion: untimely detection of LV myocardial hypertrophy leads to late initiation of antihypertensive therapy, underestimation of risk factors, which increases the risk of an unfavorable course of the disease and the occurrence of long-term cardiovascular complications at a young age.

MICROCIRCULATORY PREDICTORS OF THE FORMATION OF PRIMARY ARTERIAL HYPERTENSION IN CHILDHOOD

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&lt;0.05) and the level of diastolic blood pressure (r=0.69, p&lt;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).

Pulmonary arterial hypertension in children with congenital heart disease: a deeper look into the role of endothelial progenitor cells and circulating endothelial cells to assess disease severity.

Endothelial progenitor cells and circulating endothelial cells have been proposed as useful markers of severity and disease progression in certain vascular diseases, including pulmonary arterial hypertension. Our study focused on evaluating the levels of circulating endothelial progenitor cells and circulating endothelial cells in patients with congenital left-to-right shunts and pulmonary hypertension undergoing definitive repair. Endothelial progenitor cells (identified by simultaneous co-expression of CD45dim, CD34 + and KDR2 + surface antibodies) and circulating endothelial cells (identified by simultaneous co-expression of inherent antibodies CD45-, CD31+, CD146 + and CD105+) were prospectively measured in seventy-four children (including children with Down syndrome), median age six years (2.75-10), with clinically significant left-to-right shunts undergoing transcatheter or surgical repair and compared to thirty healthy controls. Endothelial progenitor cells and, particularly, circulating endothelial cells were significantly higher in children with heart disease and pulmonary arterial hypertension when compared to controls. Endothelial progenitor cells showed significant correlation with pulmonary vascular resistance index when measured both systemically (r = 0.259; p = 0.026) and in the superior vena cava (r = 0.302; p = 0.009). Children with Down syndrome showed a stronger correlation between systemic cellularity and pulmonary vascular resistance index (r = 0.829; p = 0.002). Endothelial progenitor cells were reduced along their transit through the lung, whereas circulating endothelial cells did not suffer any modification across the pulmonary circulation. In children with yet to be repaired left-to-right shunts, endothelial progenitor cells and circulating endothelial cell counts are increased compared to healthy subjects.

The hemodynamic aspects of parameters in arterial hypertension in children with overweight and history of cardiovascular diseases

Arterial hypertension, in the context of excess weight, represents an important health problem, and research in the field proves the importance of aggravated family history for the occurrence, evolution and severity of arterial hypertension, as well as suggests that hypertension increases the prevalence of cardiac structural changes. The purpose of the study: evaluation of hemodynamic parameters, electrocardiographic and echocardiographic changes in hypertensive children with excess weight and a family history aggravated by cardiovascular diseases. Material and methods: the study included 75 hypertensive patients, with an average age of 14.7 years, overweight and obese, being divided into two research groups according to the presence of family history (FH) aggravated by cardiovascular diseases: group I-35 hypertensive children, overweight, obese, without aggravated family history; group II-40 hypertensive, overweight and obese children with a family history aggravated by cardiovascular pathology in first-generation relatives up to 45 years old. To assess hemodynamic parameters, all children were examined using ECG, EcoCG and AMBP/24 hours. Results. Through the electrocardiographic method, with statistical significance, signs of hyperfunction of the LV myocardium were determined in 21 (52,5%) patients from the AH, overweight, obese, FH+ and only in 9 (25,7%) from the AH, overweight, obese FH- (p&lt;0.05). Hypertrophy of the LV myocardium was found in 5 (12,5%) cases from the group of children with hypertension, overweight, obese, FH+ and in 4 (11,4%) cases from those with hypertension, overweight, obese FH- (p&gt;0,05). The echocardiographic parameters did not show statistically significant differences, however the values of TSD (30.029±0,973 mm), TDD (47.600± 0,803 mm), IVS (9.629±0.232 mm), PWLV (10.390± 0.800 mm) were increased in the group. of hypertensive, overweight, obese, FH+ children compared to the group of hypertensive, overweight, obese FH- children, and the protocol parameters at AMBP/24 hours were also higher in hypertensive, overweight, obese, FH+ children (p&gt;0,05). Conclusions: arterial hypertension and obesity play an important role in establishing the morphofunctional changes of the heart, and the family history aggravated by cardiovascular diseases is a predictive factor in the evolution of LVH. Electrocardiographic left ventricular hypertrophy was revealed in 12.5% of cases from the group of children with hypertension, overweight, obese, FH+ and 11.4% of cases from those with hypertension, overweight, obese FH- (p&gt;0.05), and echocardiographic parameters of the compartment left heart were more increased in children with aggravated family history.

TRANSITION PRACTICES OF HYPERTENSIVE YOUTH FROM PEDIATRIC TO ADULT HEALTH CARE AMONG ESH EXCELLENCE CENTRES

Objective: Transition refers to the process of changeover from pediatric to adult health care. In the light of the increasing prevalence of arterial hypertension in children and adolescents we aimed to assess transition practices from pediatric to adult health care among Excellence Centres of the European Society of Hypertension (ESH). Design and method: A 22-question survey was sent out to ESH Excellence Centres in July 2022. Only one answer per excellence center from the center leader was allowed. Results: Forty-nine ESH Excellence centres responded the survey, almost all (98%) affiliated in hospital settings. Specific transition clinics do not exist in 64% of the settings. The median number of young adults diagnosed with childhood hypertension transferred from pediatric clinics to ESH Excellence Centres is 5 per year (interquartile range 2 - 13). In 66% of the centres, the transition process is limited to written medical history (transfer letter). Only 23% centres reported coordinated visits at pediatric and adult clinics. The main criterion for patient transfer to adult clinics is patient age (87% of the centres) with transfer age being at 18 years in 75% of the centres, while 20% reported transfer ages younger than 18 years. In only 9% of the centres patient self-management skills are assessed to decide readiness for transfer to adult clinics. The ESH 2016 guidelines hypertension staging criteria in children and adolescents (Lurbe et al J Hypertens) are applied in 52% of the centres, the ESC/ESH 2018 adult hypertension guidelines (Williams B et al J Hypertens) are used in 21% and national guidelines are used in the remaining centres. Adherence is considered the main challenge during transition process as reported by 68% of the centres, lifestyle by 66%, patients’ lack of understanding of their condition by 50%, and psychosocial issues by 50% of the centres. Fifty-one percent of centres modify treatment after transfer according to adult recommendations, 93% for uncontrolled hypertension and 75% to change in single (combination) pill. Conclusions: Coordination and communication between pediatric and adult units should be reinforced as they are major factors for effective transition into adult health care.

СЕРОСОДЕРЖАЩИЕ АМИНОКИСЛОТЫ И РИСК РАЗВИТИЯ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ У ДЕТЕЙ

Introduction. Currently, sulfur-containing amino acids are potential candidates as risk factors for cardiovascular disease. The purpose: to establish the role of sulfur-containing amino acids and their derivatives in the risk of developing arterial hypertension in children. Matherial and methods. 111 children aged 14 to 18 years were examined. All patients were divided into 3 groups: the 1st group (n=51) consisted of children with arterial hypertension, the 2nd group (n=30) – with high normal blood pressure, the 3rd group – 30 healthy children. The content of sulfur-containing amino acids and their derivatives in blood plasma was determined by high-performance liquid chromatography. Result. The concentration of sulfur-containing amino acids methionine, homocysteine, cysteine and cysteinylglycine in the blood plasma of children with arterial hypertension tend to increase in comparison with the group of healthy children. Pathological decrease in endothelium-dependent vasodilation accompanied by an increase in the concentration of methionine, homocysteine, cysteine, cysteinylglycine, glutathione in blood plasma and a decrease – taurine. A prognostic model has been developed based on the determination of the concentration of homocysteine and cysteinylglycine in the blood plasma of children. With a calculated value of p≥0,44, makes it possible to predict a high probability of arterial hypertension with a sensitivity of 90,2%, a specificity of 66,7% and a diagnostic efficiency of 82,1%. Conclusions. The concentration of sulfur-containing amino acids methionine, homocysteine, cysteine and cysteinylglycine in the blood plasma of children with arterial hypertension tend to increase in comparison with the group of healthy children.

Prevalence of pulmonary arterial hypertension in children with down syndrome attending new 500 bedded paediatric hospital, Government Medical College, Srinagar

Background: Children with down syndrome are at increasing risk of developing pulmonary hypertension (PH) due to multiple factors. The high frequency of PH in this population has probable genetic, congenital, and environmental contributions. Methods: This prospective observation study was conducted in the Post Graduate Department of Pediatrics, New Pediatric Hospital GMC Srinagar, on all Indoor/Outdoor patients with karyotype documented cases of Down syndrome over a period of 2 years between December 2020 to December2022. After detailed history and examination routine baseline investigations both screening and diagnostic echocardiography was done. CT was done in selected patients. In some patients, whose history and examination was suggestive of obstructive sleep apnoea (OSA), polysomnography and OSA questionnaire was used to make the diagnosis. Results: This study included 306 children with karyotype documented Down syndrome. Out of them 72 were identified with PAH (Echocardiography documented) and the prevalence was 23.5%. Out of these 72 patients, 41 (57%) were males and 31 (43%) were females with male: female ratio of 1.3:1 and maximum number of patients were present in age group 1-6months. Out of them 60 (83%) patients had underlying echocardiographic documented CHD, 10 (14%) patients had OSA (Obstructive Sleep Apnea) and 2 (3%) had GERD (Gastrointestinal Reflux Disease). Conclusions: The PH is common in children with downs syndrome, is typically transient related to CHD or PPHN but can recur in setting of respiratory disease such as obstructive sleep apnea, intermittent hypoxia and recurrent pneumonia.

Моніторинг стану здоров’я дітей з коарктацією аорти в післяопераційному періоді

Purpose - to improve the observation of children after surgical treatment of the aortic coarctation. Materials and methods. A retrospective analysis of 87 case histories of patients with aortic coarctation in the preoperative period was performed; 44 patients underwent daily blood pressure monitoring, nitric oxide levels in 61 children were determined in the postoperative period; histological examination of 15 coarctated aortic sites was performed; quality of life was assessed in 56 patients with aortic coarctation after surgical treatment. Results. According to daily blood pressure monitoring, an inadequate increase in blood pressure during physical and mental activity was obtained; a violation of the circadian rhythm of blood pressure with insufficient decrease in systolic and diastolic or excessive decrease in diastolic pressure was detected. The results of the assessment of blood pressure variability revealed a significant difference in the standard deviation of the mean daily diastolic blood pressure (62.5 (55; 75)), daily diastolic blood pressure (72.5 (57; 78.5)), and an increase in the circadian systolic blood pressure index (16 (11.5; 17)). The level of nitric oxide in the blood of a group of patients with arterial hypertension was 4.18±0.86 μmol/l (M±SD - mean ± standard deviation). in the control group - 5.51±0.69 μmol/l. Thus, a significant decrease in nitric oxide in the group with arterial hypertension was established (t=-5.45; p&lt;0.001). It was also diagnosed that in the group of patients with stable arterial hypertension, the level of nitric oxide was 3.74±0.79 μmol/l, and in the subgroup of patients with labile hypertension - 4.44±0.80 μmol/l, the subgroups in the content of nitric oxide significantly differed from each other (t=2.91; p&lt;0.01), as well as from the values of the control group: with stable arterial hypertension (t=-6.72; p&lt;0.001) and labile arterial hypertension (t=-4.41; p&lt;0.001). The dependence of the level of nitric oxide in serum on the time of the postoperative period and the type of arterial hypertension was established. The histological features of area of narrowing in the form of foci of necrosis of cells and fibers, areas of hypo- and anelastosis, the presence of newly formed vessels of capillary type were identified and studied. The main factors in reducing the quality of life of patients with coarctation of the aorta in the postoperative period are the presence of arterial hypertension, restriction of physical activity, parents’ оverprotection. Conclusions. Based on the data obtained, an individual observation card of a patient with aortic coarctation was created. A set of clinical, instrumental and laboratory signs that may be a leading role in the occurrence and course of arterial hypertension in children (concomitant cardiovascular and somatic pathologies, initial level of systolic and diastolic blood pressure, level of the final product of nitric oxide in serum, structural features of the aortic wall) has been determined. An original method of examination of patients with aortic coarctation in the postoperative period was proposed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Epicardial Adipose Tissue: A Piece of The Puzzle in Pediatric Hypertension

Epicardial adipose tissue (EAT) is a metabolically active tissue located on the surface of the myocardium, which might have a potential impact on cardiac function and morphology. The aim of this study was to evaluate whether EAT is associated with essential arterial hypertension (AH) in children and adolescents. Prospective cardiovascular magnetic resonance (CMR) study and clinical evaluation were performed on 72 children, 36 of whom were diagnosed with essential AH, and the other 36 were healthy controls. The two groups were compared in volume and thickness of EAT, end-diastolic volume, end-systolic volume, stroke volume, left ventricular (LV) ejection fraction, average heart mass, average LV myocardial thickness, peak filling rate, peak filling time and clinical parameters. Hypertensive patients have a higher volume (16.5 ± 1.9 cm3 and 10.9 ± 1.5 cm3 (t = -13.815, p < 0.001)) and thickness (0.8 ± 0.3 cm and 0.4 ± 0.1 cm, (U = 65.5, p < 0.001)) of EAT compared to their healthy peers. The volume of EAT might be a potential predictor of AH in children. Our study indicates that the volume of EAT is closely associated with hypertension in children and adolescents.

Diagnostics, monitoring and treatment of arterial hypertension in children

The review presents material on the current relevance of AH in children. The prevalence of AH in overweight and obese children aged 6-18 years is 27–47 %, while secondary arterial hypertension remains dominant, especially in children younger than 5 years. AH is a major risk factor for atherosclerosis and cardiovascular disease in adults. The onset of these diseases may occur in childhood or adolescence. The use of modern methods to monitor and control BP is crucial for improving the management of AH and preventing damage to target organs. Twenty-four-hour BP measurements are an important tool in determining the prognosis and treatment of children with AH. AH in children can be classified as primary or essential if there is no identifiable cause, or as secondary AH when it arises from a specific cause. The incidence of primary arterial hypertension increases with age, whereas secondary arterial hypertension predominates in early childhood. The secondary causes of AH also depend on the age of the patient. Thus 34-79 % of patients with secondary forms of arterial hypertension have renal parenchymal disease and impaired renal structure. Signs of AH include headache, visual disturbances, dizziness and nosebleeds. Dyspnoea on exercise, facial paralysis and seizures indicate target organ damage. In children with obesity, diabetes, renal insufficiency, aortic coarctation/repaired coarctation and those receiving medication causing AH, BP should be measured at every visit to the physician. Therapeutic lifestyle changes are an early therapy in the treatment of AH in children. IAPs, BCAAs, BRAs and thiazide diuretics are the most effective drugs for AH in children.

Analysis of the prevalence of arterial hypertension in the child population of the city of Grodno in the pre-covid and during the SARS-CоV-2 pandemic period

BACKGROUND: One of the leading problems in pediatric cardiology in recent years has become arterial hypertension, which worldwide tends to increase the share of this pathology in the structure of cardiovascular diseases.&#x0D; AIM: The aim of the study is to analyze the prevalence of arterial hypertension in the childrens population of Grodno in the pre-COVID period and during the SARS-CoV-2 pandemic.&#x0D; MATERIALS AND METHODS: The level of the incidence of arterial hypertension, gender and age characteristics of the pathology were studied using reports on medical care for children (Form 1 children of the Ministry of Health) for 20102019, analytical and market reports, reviews and certificates of the chief freelance pediatric cardiologist of the Health Department of the Grodno Region, chief physicians and city pediatricians. During the period of work in the time of the SARS-CoV-2 pandemic from January 2021 to September 2021, the course of 99 cases of arterial hypertension in children was analyzed.&#x0D; RESULTS: An increase in the overall incidence of arterial hypertension in children from 55.67 to 99.92 was established in Grodno, and a relative pattern of reliability of incidence occurred, the incidence was 27.33 (2010) and 28.11 (2019) cases per 100,000 children early age, and a 1.5-fold increase in the share of this pathology in the structure of cardiovascular diseases over the analyzed period. Almost the same proportion of cases of arterial hypertension was revealed in the entire childrens population of Grodno both before the pandemic and during the pandemic.&#x0D; CONCLUSIONS: For the period 20102019, an increase in the overall incidence of arterial hypertension in the childrens population of Grodno was revealed. Compared with the pre-COVID period during the SARS-CoV-2 pandemic, the prevalence of newly diagnosed hypertension in the same population has not changed.