An increase in blood pressure in older children and adolescents occurs, filed by various authors, in 5 – 10% of cases. It should be emphasized that the increase in blood pressure does not yet give rise to a diagnosis of hypertension, since in many cases these phenomena are transient in nature. However, the detection of arterial hypertension must necessarily lead to a comprehensive examination of the child to establish its cause.
Arterial hypertension in childhood can be caused by various diseases: glomerulonephritis , pheochromocytoma , congenital malformations of the heart ( coarctation of the aorta), kidneys and their vessels; in young children – infectious diseases that occur with toxicoexicosis and sensitization of the body, the consequences of a birth injury to the skull. A hereditary predisposition and neurohumoral dysregulation of vascular tone play a role . There is an activation of the function of the sympathetic-adrenal system, an increase in the sensitivity of adrenoreceptors to catecholamines (which may be hereditary). This leads to an increase in systolic ejection and cardiac output with normal peripheral vascular resistance (i.e., with normal vascular tone). In some patients, vasoconstriction occurs with an increase in peripheral vascular resistance.
In children of high school age and adolescents, neuropsychic overstrain and mental fatigue with limited physical activity (irrational daily routine) may be important, especially with prolonged exposure to these factors. These points may be the cause of primary arterial hypertension.
Three forms of arterial hypertension in children are distinguished (M. Ya. Studenikin ): vascular vegetative dystonia of the hypertensive type, hypertension, and symptomatic (secondary) hypertension.
In most cases, children do not complain, increased pressure is detected by chance during mass preventive examinations. However, in some cases, headache, increased irritability and fatigue, dizziness are noted. From the side of the heart, a resistant apical impulse is detected, functional noise is heard, sometimes an II tone accent above the aorta. Systolic blood pressure exceeds the age norm, and during exercise rises by 2.7 – 5.4 kPa.
In the development of hypertension, there are three stages: transient, labile and stable. Changes in blood pressure with an increase in systolic and then diastolic in parallel with changes in organs (heart, kidneys, on the fundus) are gradually increasing.
Primary arterial hypertension must be differentiated with diseases in which an increase in pressure is the leading symptom ( glomerulonephritis , pituitary and adrenal tumors, etc.). A typical clinic of these diseases helps to establish the correct diagnosis.
Arterial hypertension is more often reversible. In some cases, increased blood pressure is persistent and is the initial phase of hypertension.
With secondary arterial hypertension, therapy of the underlying disease is necessary. Primary arterial hypertension in some cases with the vegetodystonic genesis of vascular disorders and a slight increase in blood pressure requires only the organization of a rational regime of the day, the expansion of motor activity with limited mental work. It is necessary to slightly reduce the training load, to ensure prolonged sleep and stay in the fresh air. Useful sports and exercise, but without participating in competitions. The purpose of sedatives (valerian, bromides, seduxen, elenium, trioxazine ), antihistamines and others, physiotherapy (electrophoresis according to the method of G. Kassil with solutions of calcium, magnesium salts) are shown .
In the absence of a therapeutic effect and high blood pressure, the patient is sent to a hospital and p- adrenoblockers ( anaprilin , inderal , obzidan , trazikor , wisken ) are included in the treatment regimen . Treatment begins with minimal doses, and then after 10 days the dose is increased ( anaprilin , trazikor 0.01 – 0.02 g 2 times a day, then – 0.03 g 2 times a day). Continue treatment for 2 to 3 months or more. Rauwolfia preparations in such patients are ineffective. B- Adrenergic blockers can not be used for bronchial asthma, signs of myocardial damage (according to ECG). In the absence of effect, especially in adolescents, as well as in stage II and III arterial hypertension, rauwolfia – raunatin preparations are used (0.002 – 0.003 g 1 – 2 times per day), reserpine (0.1 – 0.15 mg 3 times a day). Parallel used dihlotiazid – hydrochlorothiazide (1 every 2 – 3 days).
Treatment with rauwolfia preparations is carried out until a clear effect is obtained (lowering blood pressure), after which they are transferred to maintenance doses (2 to 3 months). If this therapy does not work, patients with high blood pressure are prescribed ganglion blockers – pentamine , isoprine and others with mandatory hemodynamic control and compliance with the appropriate regimen.
The correct regime of the day, physical education, sports, a fairly long sleep.