Therapeutic Lifestyle Changes Research Articles

Incorporating Lifestyle Medicine into Occupational Medicine Practice - ACOEM Guidance Statement.

Lifestyle Medicine (LM) utilizes evidence-based therapeutic lifestyle changes to address lifestyle factors that impact health, performance, and injury risk and recovery. By integrating LM principles into clinical care, workplace policies, and programs, along with other evidence-based methods, occupational and environmental medicine clinicians and medical directors can enhance worker health and performance, manage chronic disease, and facilitate faster recovery from injury and illness. This guidance addresses approaches that can be used in the clinic and workplace to address tobacco, substance misuse, nutrition, physical activity, overweight/ obesity, sleep, mental well-being, and social connectedness.

Le coroscanner peut-il être réalisé en dépistage à grande échelle en prévention des syndromes coronaires aigus et de l'insuffisance cardiaque ischémique ?

Coronary CT-Scan permits non-invasive visualization of all stages of coronary artery atherosclerosis allowing early therapeutic interventions, lifestyle changes and accurate follow-up all of which result in an improved prognosis. We discuss the possibility of a systematic coronary CT-scan in the global population at certain ages such as fifty or sixty years-old (or both). May this strategy decrease the onset of myocardial infarction or ischemic chronic heart failure thus improving quality (and quantity) of life? May it also reduce the medical costs for the individual and the society? Is it technically possible to deploy such a strategy? What would be the obstacles for its set up and what solutions might be proposed?

Effect of therapeutic lifestyle changes on patients with overweight/obesity and non-alcoholic fatty liver disease: A randomized controlled trial

BackgroundNon-alcoholic fatty liver disease is a liver condition that is increasing globally. Unfortunately, there are no successful or approved pharmacological treatments for non-alcoholic fatty liver disease. Hence, this study aimed to investigate the effect of therapeutic lifestyle changes on patients with overweight/obesity and non-alcoholic fatty liver disease. MethodsA prospective, parallel-group, randomized controlled trial was conducted. The patients were randomized into intervention and control groups using tables with random numbers. In the control group, routine health guidance was provided for 3 months, while in the intervention group, diversified lifestyle intervention was provided. The body composition, visceral fat area, abdominal circumference, and body mass index of the control and intervention groups were compared before and after the intervention. Descriptive statistics, paired t-tests, and linear regression models were used for data analysis. ResultsA total of 115 participants (57 in the intervention group and 58 in the control group) completed the study. The intervention groups had significantly greater high-density lipoprotein cholesterol levels, basal metabolic rate, muscle mass, and questionnaire scores than the control groups (P < 0.05). Furthermore, the intervention participants had lower body mass index, abdominal circumference, triglyceride levels, low-density lipoprotein cholesterol levels, and fatty liver index (P < 0.05). ConclusionsTherapeutic lifestyle changes therapy for non-alcoholic fatty liver disease patients with overweight/obesity can significantly control body mass index, improve blood lipid levels, reduce fatty liver and body fat rates, improve basic metabolism, alleviate disease, and improve quality of life. More research is needed to determine the long-term impact of therapeutic lifestyle changes in high-risk groups.

Effectiveness of the Therapeutic Lifestyle Change Diet Intervention to Improve Biochemical Markers of Cardiovascular Diseases in HIV-Infected Patients with Dyslipidemia

Introduction: This randomized controlled trial study aimed to investigate the effectiveness of therapeutic lifestyle change (TLC) diet intervention by the registered dietitians. Methods: Eighty-two people living with HIV (PLHIV) with dyslipidemia were randomly allocated to the intervention group as well as another 82 PLHIV with dyslipidemia to the control group. Participants in the intervention group were instructed to meet the registered dietitians every 2 weeks at weeks 0, 2, 4, 6, and 12 (a totally of 12 weeks) to receive individual medical nutrition therapy according to the TLC diet principles, while the participants in the control group only received routine health care service. Results: Triglycerides, total cholesterol, and LDL cholesterol of the intervention group were significantly lower than those of the control group at the endpoint (p < 0.05). In addition, these biomarkers and C-reactive protein of the intervention group were significantly lower when compared with their baseline (p < 0.05). The overall dietary habits of participants in the intervention group were significantly improved at the end of the study (p < 0.05). Conclusion: The medical nutrition therapy intervention based on the TLC diet is effective in improving blood lipid profiles among PLHIV with dyslipidemia.

Lifestyle Medicine's Role in Common Hormonal Disorders: A Case-Based Discussion.

Hormonal disorders like PCOS (Polycystic Ovary Syndrome), autoimmune thyroid disease (AITD) including Hashimoto's thyroiditis, male hypogonadism are commonly encountered in clinical practice in the US and worldwide, with rising frequency. These typically affect patients during young or middle age, compared with other common chronic illnesses like type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, where onset may usually be in middle or older age. Multiple studies point to the role of disordered lifestyle health behaviors as contributory to these endocrinopathies, and conversely therapeutic lifestyle changes leading to improvement in signs, symptoms, biochemical markers, and sequelae of these conditions. This article presents 3 different real life case studies of the conditions enlisted above and documents the positive impact of lifestyle improvements on their disease condition. Therapeutic lifestyle behaviors are an extremely useful and important component of management of these familiar endocrinologic disorders, and clinicians need to routinely counsel their patients about healthy lifestyle interventions when treating these common syndromes.

Research Progress in the Clinical Treatment of Familial Hypercholesterolemia.

Familial hypercholesterolemia (FH) is an autosomal dominant inheritable disease with severe disorders of lipid metabolism. It is mainly marked by increasing levels of plasma total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), xanthoma, corneal arch, and early-onset coronary heart disease (CHD). The prevalence of FH is high, and it is dangerous and clinically underdiagnosed. The clinical treatment for FH includes both pharmacological and non-pharmacological treatment, of which non-pharmacological treatment mainly includes therapeutic lifestyle change and dietary therapy, LDL apheresis, liver transplantation and gene therapy. In recent years, many novel drugs have been developed to treat FH more effectively. In addition, the continuous maturity of non-pharmacological treatment techniques has also brought more hope for the treatment of FH. This paper analyzes the pathogenic mechanism and the progress in clinical treatment of FH. Furthermore, it also summarizes the mechanism and structure-activity relationship of FH therapeutic drugs that have been marketed. In a word, this article provides a reference value for the research and development of FH therapeutic drugs.

Lifestyle Medicine Performance Measures: An Expert Consensus Statement Defining Metrics to Identify Remission or Long-Term Progress Following Lifestyle Medicine Treatment.

The objective of this expert consensus process was to define performance measures that can be used to document remission or long-term progress following lifestyle medicine (LM) treatment. Expert panel members with experience in intensive, therapeutic lifestyle change (ITLC) developed a list of performance measures for key disease states, using an established process for developing consensus statements adapted for the topic. Proposed performance measures were assessed for consensus using a modified Delphi process. After a series of meetings and an iterative Delphi process of voting and revision, a final set of 32 performance measures achieved consensus. These were grouped in 10 domains of diseases, conditions, or risk factors, including (1) Cardiac function, (2) Cardiac risk factors, (3) Cardiac medications and procedures, (4) Patient-centered cardiac health, (5) Hypertension, (6) Type 2 diabetes and prediabetes, (7) Metabolic syndrome, (8) Inflammatory conditions, (9) Inflammatory condition patient-centered measures, and (10) Chronic kidney disease. These measures compose a set of performance standards that can be used to evaluate the effectiveness of LM treatment for these conditions.

A therapeutic lifestyle changes elective and its impact on student knowledge, empathy, and perceptions

Background and purposeEngaging in therapeutic lifestyle changes (TLC) such as healthy eating and physical activity can help prevent or manage various conditions. This study's purpose is to describe a TLC elective course and examine its impact on student knowledge, empathy, and perceptions of confidence with lifestyle modifications counseling. Educational activity and settingAn elective was developed to increase student pharmacists' knowledge and confidence in educating patients about lifestyle modifications. Activities were intended to foster student empathy. A questionnaire, given at course initiation and conclusion, incorporated a knowledge quiz and Kiersma-Chen Empathy Scale (KCES). Student perceptions of confidence were assessed at course conclusion. FindingsKnowledge significantly increased (P < .001) from 54.1% at course initiation to 75% at course conclusion when comparing average quiz scores. Average KCES scores (out of 105 points) were 84.9 (n = 26) and 86 (n = 22) at course initiation and conclusion, respectively, showing no significant change in empathy scores (P = .01). For each course topic, most students reported being somewhat or very confident in their TLC counseling abilities at course conclusion. SummaryAn elective course significantly improved TLC knowledge and perceived confidence regarding TLC counseling was high at course conclusion. Although there was no significant change in KCES scores, including dedicated TLC instruction in pharmacy curricula can help students build knowledge and confidence in TLC counseling in preparation for pharmacy practice.

Predictors of Progressing Toward Lifestyle Change Among Participants of an Interprofessional Lifestyle Medicine Program.

Therapeutic lifestyle change can be challenging, and not every attempt is successful. To identify predictors of making progress toward lifestyle change among patients who participate in a lifestyle medicine program. This was a single-center, retrospective cohort study of 205 adults who enrolled in a goal-directed, individualized, interprofessional lifestyle medicine program. The primary outcome was whether, by the end of participation with the program, a patient reported making progress toward lifestyle change. Candidate predictors included sociodemographic, psychological, and health-related variables. Among 205 patients (median (IQR) age 58 (44-66) years, 164 (80%) female), 93 (45%) made progress toward lifestyle change during program participation. A predictor of making progress was being motivated by stress reduction (OR 2.8 [95% CI 1.1-7.6], P = .038). Predictors of not making progress included having a primary goal of losing weight (OR .3 [.2-.8], P = .012) and having a history of depression (OR .4 [.2-.7], P = .041). To maximize a patient's likelihood of successfully making lifestyle changes, clinicians and patients may consider focusing on identifying goals that are immediately and palpably affected by lifestyle change. Additional research is warranted to identify effective program-level approaches to maximize the likelihood of success for patients with a history of depression.

Polypharmacy and its associated factors among patients with co-morbid hypertension and diabetes in a municipal hospital in Ghana

Background/aimPatients with co-morbid hypertension and diabetes may take several medicines. Although multiple medications may aid in the management of their condition, they also raise the likelihood of drug interactions and unfavorable drug reactions. This study therefore evaluated polypharmacy and its associated factors in patients with co-morbid hypertension and diabetes. MethodologyThis was a cross-sectional study with data collection spanning a 3-months period. Patients attending their review clinic in a municipal hospital in Ghana were interviewed with a pre-tested semi-structured questionnaire to collect data on socio-demographic characteristics, prescription medicines, therapeutic lifestyle changes, blood pressure management and fasting blood glucose. Polypharmacy was defined as the use of five or more medicines in a single day. ResultsOf the 338 patients with co-morbid hypertension and diabetes, (18 %, n = 61) were men and (82 %, n = 277) were women. Most of the study participants (40.2 %, n = 136) were between 55 and 64 years. Polypharmacy (≥5 medications) was observed in (64.8 %, n = 219) of the participants and being male [cOR = 2.29, 95 % CI (1.18 – 4.42), p = 0.014] and living in a rural setting [cOR = 2.46, 95 % CI (1.13 - 5.34), p = 0.023] were significantly associated with more than the two-fold increased risk of having polypharmacy compared to being female and living in an urban setting respectively. Most patients were on biguanides (89.1 %, n = 301), angiotensin receptor blockers (68.6 %, n = 232), calcium channel blockers (66.6 %, n = 225) and sulphonylurease (53.8 %, n = 182). ConclusionPolypharmacy is common in patients with co-morbid hypertension and diabetes, and is associated with sex, marital status, and residential status. Healthcare providers must carefully consider these associated factors when prescribing or modifying treatment plans for their patients.

Expanding options of supportive care in IgA nephropathy.

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide, with a potentially serious prognosis. At present, management of IgAN is primarily based on therapeutic lifestyle changes, and excellent blood pressure control and maximized supportive treatment with the combination of inhibition of the renin-angiotensin-aldosterone system with either inhibitors of angiotensin-converting enzyme or angiotensin II receptor blockers and inhibitors of sodium-glucose cotransporter-2, and possibly in the future also with endothelin antagonists. Supportive care currently represents the cornerstone of treatment of IgAN. Targeted-release formulation of budesonide should replace systemic corticosteroids in patients with higher proteinuria and active histological lesions. New treatment options are aimed at immunopathogenesis of IgAN including depletion or modulation of Galactose-deficient-Immunoglobulin A1-producing B cells, plasma cells, and the alternate and/or lectin pathway of complement. The exact place of monoclonal antibodies and complement inhibitors will need to be determined. This article reviews potential supportive therapies currently available for patients with IgAN.

Potential Therapeutic Strategies in the Treatment of Metabolic-Associated Fatty Liver Disease.

Metabolic-associated Fatty Liver Disease is one of the outstanding challenges in gastroenterology. The increasing incidence of the disease is undoubtedly connected with the ongoing obesity pandemic. The lack of specific symptoms in the early phases and the grave complications of the disease require an active approach to prompt diagnosis and treatment. Therapeutic lifestyle changes should be introduced in a great majority of patients; but, in many cases, the adherence is not satisfactory. There is a great need for an effective pharmacological therapy for Metabolic-Associated Fatty Liver Disease, especially before the onset of steatohepatitis. Currently, there are no specific recommendations on the selection of drugs to treat liver steatosis and prevent patients from progression toward more advanced stages (steatohepatitis, cirrhosis, and cancer). Therefore, in this Review, we provide data on the clinical efficacy of therapeutic interventions that might improve the course of Metabolic-Associated Fatty Liver Disease. These include the drugs used in the treatment of obesity and hyperlipidemias, as well as affecting the gut microbiota and endocrine system, and other experimental approaches, including functional foods. Finally, we provide advice on the selection of drugs for patients with concomitant Metabolic-Associated Fatty Liver Disease.

Nutritional Status and Risk of Sarcopenia among Hospitalized Older Adults Residing in a Rural Region in Turkey.

This study aimed to determine the prevalence of sarcopenia and its associated factors in community-dwelling older adults at risk of malnutrition based on the Mini Nutritional Assessment (MNA), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI). The study participants were 345 adults aged &gt;65 years who visited Geriatric Internal Medicine outpatient clinics. The study included people without acute illness for whom the risk of malnutrition could be assessed and appropriate measurements taken. At the baseline visit, participants' data and measurements were gathered. The primary data included sociodemographic details, anthropometric measurements, malnutrition screening tests, and functional assessments. The participants' mean age was 76.21±5.59 years, and 57.1% were men (n=97). The prevalence rate of sarcopenia was 45.5%. Compared to individuals without sarcopenia, those with it were older; had lower MNA, PNI, and GNRI scores; and had lower muscle mass, muscle strength, and lower leg circumferences (p&lt;0.001). After adjusting for potential confounding factors, we found that sarcopenia, advanced age, male sex, high risk of malnutrition, calf circumference, and a low PNI score were all significantly associated with a low GNRI score (p&lt;0.001). Sarcopenia was significantly associated with advanced age, male sex, and high risk of malnutrition. Patients' nutritional and functional status should always be assessed for therapeutic interventions and lifestyle changes.

Lifestyle Medicine Intensivist Competencies: 2023 Expert Consensus Update.

The objective of this expert consensus process was to identify the competencies that lifestyle medicine (LM) Intensivists should be expected to have within their skill set. Expert panel members with experience in intensive, therapeutic lifestyle change (ITLC) updated and expanded a previously published set of competencies for this intensive LM practice, using an established process for developing consensus statements adapted for the topic. The previously published set of competencies was discussed for possible revision and expansion. Proposed changes were assessed for consensus using a modified Delphi process. The expert panel revised the original list of 34 competencies, maintaining the 6 initial proposed topics that were previously published as Specialist Competencies: (1) Practice-Based Learning and Improvement, (2) Patient Care and Procedural Skills (3) Systems-Based Practice, (4) Medical Knowledge, (5) Interpersonal and Communication Skills, and (6) Professionalism. After a series of meetings and an iterative Delphi process of voting and revision, a final set of 46 competency statements for LM Intensivists achieved consensus. These competencies define the scope of practice and desired skill set for LM Intensivists. Further, these competencies establish a standard for certification of LM Intensivists.

Lifestyle Medicine Implementation in 8 Health Systems: Protocol for a Multiple Case Study Investigation.

Lifestyle medicine (LM) is the use of therapeutic lifestyle changes (including a whole-food, plant-predominant eating pattern; regular physical activity; restorative sleep; stress management; avoidance of risky substances; and positive social connection) to prevent and treat chronic illness. Despite growing evidence, LM is still not widely implemented in health care settings. Potential challenges to LM implementation include lack of clinician training, staffing concerns, and misalignment of LM services with fee-for-service reimbursement, but the full range of factors facilitating or obstructing its implementation and long-term success are not yet understood. To learn important lessons for success and failure, it is crucial to understand the experiences of different LM programs. This study aims to describe in depth the protocol used to identify barriers and facilitators impacting the implementation of LM in health systems. The study team comprises team members at the American College of Lifestyle Medicine (ACLM), including staff and researchers with expertise in public health, LM, and qualitative research. We recruited health systems that were members of the ACLM Health Systems Council. From among 15 self-nominating health systems, we selected 7 to represent a diversity of geographic location, type, size, expertise, funding, patients, and LM services. Partway through the study, we recruited 1 additional contrasting health system to serve as a negative case. For each case, we conducted in-depth interviews, document reviews, site visits (limited due to the COVID-19 pandemic), and study team debriefs. Interviews lasted 45-90 minutes and followed a semistructured interview guide, loosely based on the Consolidated Framework for Implementation Research (CFIR) model. We are constructing detailed case narrative reports for each health system that are subsequently used in cross-case analyses to develop a contextually rich and detailed understanding of various predetermined and emergent topics. Cross-case analyses will draw on a variety of methodologies, including in-depth case familiarization, inductive or deductive coding, and thematic analysis, to identify cross-cutting themes. The study team has completed data collection for all 8 participating health systems, including 68 interviews and 1 site visit. We are currently drafting descriptive case narratives, which will be disseminated to participating health systems for member checking and shared broadly as applied vignettes. We are also conducting cross-case analyses to identify critical facilitators and barriers, explore clinician training strategies to facilitate LM implementation, and develop an explanatory model connecting practitioner adoption of LM and experiences of burnout. This protocol paper offers real-world insights into research methods and practices to identify barriers and facilitators to the implementation of LM in health systems. Findings can advise LM implementation across various health system contexts. Methodological limitations and lessons learned can guide the execution of other studies with similar methodologies. DERR1-10.2196/51562.

Telehealth vs In-Person Shared Medical Appointments for an Intensive Therapeutic Lifestyle Change Program for Patients With Type 2 Diabetes and Prediabetes

In response to Covid-19, the Lifestyle Medicine Clinic at Midland Health elected to utilize telehealth to engage remotely with patients to deliver a 12-week intensive therapeutic lifestyle change (ITLC) program for patients with type 2 diabetes and prediabetes. This program utilized a shared medical appointment (SMA) group visit model. Beginning in May/2020, the program was offered again in-person; however, the telehealth option remained. This study is a retrospective chart review, aimed at comparing pre- and post-program changes in body weight, HbA1c, fasting lipid profile, systolic pressure, and diastolic blood pressure between in-person vs telehealth SMA formats. This study found no statistical difference in ITLC program health outcomes between telehealth vs in-person shared medical groups. At the end of ITLC Programs between both groups, an average weight loss of 9.66 pounds and 1% reduction was noted in ptHbA1C. Total cholesterol reduced by 7.1 mg/dL, and LDL by 15.19 mg/dL. The blood pressure readings showed a reduction in systolic blood pressure of 13.4 mmHg and diastolic blood pressure of 4.14 mmHg. Our results indicated that this novel telehealth delivery model could be equally successful in delivering an intensive therapeutic lifestyle program (ITLC) using an SMA approach to prevent, treat and often put chronic diseases in remission.

Effects of therapeutic lifestyle change diets on blood lipids, lipoproteins, glycemic parameters, and blood pressure: a systematic review and meta-analysis of clinical trials.

Cardiovascular disease is the leading cause of death worldwide. Low-calorie, low-fat therapeutic diets (TDs) developed by the US National Cholesterol Education Program, ie, the Step I and II diets and the therapeutic lifestyle changes diet, are approximately similar and are the initial therapeutic interventional approaches for lifestyle modification. This systematic review with meta-analysis was undertaken to evaluate the effects of TDs diet on blood lipids, apolipoprotein A-1, apolipoprotein B, blood pressure, fasting blood glucose, and insulin. A comprehensive search of the PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar databases until October 2022 was performed to identify clinical trials investigating the effects of TDs on the aforementioned parameters. One investigator screened the records and extracted data, and another reviewed the extracted data. A total of 910 records were retrieved. After records were screened for eligibility, 34 clinical trials met the inclusion criteria. The pooled analysis from the random-effects model revealed a significant reduction in total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein A-1, and apolipoprotein B in the TD intervention group vs the control group. The overall effects of TDs on fasting blood glucose, insulin, and blood pressure were not significant, but the results of subgroup analysis revealed a significant reduction in fasting blood glucose with the Step II diet and an intervention duration of more than 24 weeks. For blood pressure, the Step I diet and an intervention duration of more than 24 weeks resulted in significant reduction. There was no evidence of publication bias, but strong heterogeneity was observed. Therapeutic diets have promising effects on lipid profile parameters, glycemic indexes, and blood pressure, which can promote cardiovascular health. PROSPERO registration no. CRD42021259355.

Effects of monitoring exercise rehabilitation with target intensity on the patient with twice PCI: A case report.

As the core of cardiac rehabilitation (CR), early exercise rehabilitation is beneficial for patients with coronary heart disease (CHD), and center-based CR with target intensity is superior to home-based CR. However, there was no research to observe the effects of exercise rehabilitation on cardiopulmonary exercise capacity, oxygen uptake efficiency slope, endothelial function evaluated as flow-mediated vasodilation (FMD), and blood plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) in CHD patients undergone percutaneous coronary intervention (PCI) for 3 months. A 57-year-old woman had been identified with triple vessel disease and undergone twice PCI for complete revascularization, however, there was no improvement in Lp-PLA2, FMD, and related indicators of cardiopulmonary exercise testing. Coronary angiography showed an 85% stenosis in the middle left anterior descending artery, an 85% stenosis in the proximity of a thick first-diagonal branch, a long 75 to 85% stenosis in the middle left circumflex artery, and a 90 to 95% stenosis in the proximal. The case was diagnosed as CHD. The patient obtained optimal medical therapy comprising therapeutic lifestyle changes, and began monitoring exercise rehabilitation with target intensity 3 months after the second PCI in the CR center. There were changes in cardiopulmonary exercise capacity, oxygen uptake efficiency slope, FMD, and Lp-PLA2 in the patient with 3 apparent stenotic coronary arteries who was done PCI twice, without or with postoperative exercise rehabilitation, respectively. We proved that monitoring exercise rehabilitation training with target intensity could improve the prognosis of chronic coronary syndrome patients, and it was never too late to do regular exercise rehabilitation.

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions.

Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the greater cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension. In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity. In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.

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.