Arterial hypotension (hypotension) in children

Arterial hypotension in children is a symptom reflecting various degrees of decreased arterial pressure. It should be emphasized that the more precise term for decreased arterial pressure is hypotension (from the Greek hypo- little and Latin tensio - tension). According to modern concepts, the term "tonia" should be used to describe muscle tone, including smooth muscles of the vascular wall, the term "tension" - to designate the magnitude of fluid pressure in vessels and cavities. This terminological inaccuracy (arterial hypotension), firmly rooted in the literature and professional lexicon of doctors, can be justified by the fact that decreased tone of precapillaries and arterioles most often acts as the main hemodynamic cause of prolonged decrease in arterial pressure.

The importance of the problem of primary arterial hypotension is due to the widespread prevalence of the disease among children and adolescents, the dynamism and diversity of clinical manifestations, and a marked decrease in physical and mental performance, which leads to the development of school maladjustment syndrome and a sharp decline in the quality of life.

While this problem in adults has been the subject of many scientific papers, much less attention has been paid to this condition in pediatric literature. Recent statistical data indicate an increase in the prevalence of arterial hypotension, including in young people. The origins of hypotension in adults should be sought in childhood and adolescence. Hypotonic disease does not develop immediately, but goes through the stage of neurocirculatory (vegetative-vascular) dystonia syndrome of the hypotonic type. Every year, there are more and more indications that hypotonic conditions are more common in children and adolescents than in adults, and can subsequently develop into arterial hypertension, as well as be a risk factor for coronary heart disease.

To this day, the issue of how arterial hypotension should be assessed: as a symptom or a disease, is discussed in the literature. According to E.V. Gembitsky, the theory of neurocirculatory hypotension (primary) and hypotonic conditions currently constitutes an independent section of cardiology. Even in early works on arterial hypotension, which appeared at the beginning of the 20th century, researchers drew attention to the heterogeneity of people with low blood pressure and identified three groups of patients. In one group of subjects, in addition to low blood pressure, there were no other deviations from the norm. In such cases, arterial hypotension began to be assessed as a variant of individual normal blood pressure, and, at the suggestion of G.F. Lang, it is customary to designate it as physiological hypotension in Russian literature. In other cases, blood pressure decreased against the background of various diseases, which was assessed as symptomatic hypotension. In the third group, a decrease in blood pressure predominated in the clinical picture of the disease and resembled the clinical picture of neurosis, which was considered as primary hypotension.

According to WHO criteria, the term "essential or primary hypotension" refers to low blood pressure in the absence of an obvious cause for its occurrence, while the term "secondary hypotension" refers to low blood pressure whose cause can be identified.

Cardiologists in most cases put an equal sign between the terms "primary, or essential. arterial hypotension" and "hypotonic disease", implying by this an independent disease in which the main clinical symptom is a chronic decrease in systolic or diastolic blood pressure for an unknown reason.

In modern literature, more than 20 different terms are used to denote arterial hypotension. The most frequently used terms are: constitutional hypotension, essential hypotension, primary hypotension, chronic collapse state, hypotonic disease, neurocirculatory dystonia of the hypotonic type, neurocirculatory hypotension.

The terms "constitutional hypotension" and "essential hypotension" are most often used in foreign literature. In domestic literature, preference is given to such names as "primary arterial hypotension", "neurocirculatory dystonia" and "hypotonic disease".

Hypotonic disease is a persistent decrease in blood pressure, which is accompanied by pronounced symptoms in the form of dizziness, headache, and orthostatic dysregulation.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Epidemiology of arterial hypotension

The prevalence of arterial hypotension, according to various authors, ranges from 0.6 to 29% among adults and from 3 to 21% among children. Its prevalence increases with age. Thus, if among children of primary school age it is 1-3%, then among children of senior school age it is 10-14%. Girls suffer from arterial hypotension somewhat more often than boys.

Epidemiology of arterial hypotension

[ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Pathogenesis of arterial hypotension

The most complex and poorly studied issues remain the pathogenesis of arterial hypotension. There are several theories of the origin of the disease: constitutional-endocrine, vegetative, neurogenic, humoral.

According to this theory, arterial hypotension occurs due to a primary decrease in vascular tone due to insufficient function of the adrenal cortex. Subsequent studies have shown that arterial hypotension is accompanied by a decrease in mineralocorticoid, glucocorticoid, and androgenic functions of the adrenal glands. In younger schoolchildren with stable arterial hypotension, the glucocorticoid function of the adrenal cortex is decreased, and in older schoolchildren, the glucocorticoid and mineralocorticoid functions are decreased.

Pathogenesis of arterial hypotension

Symptoms of arterial hypotension

Clinical manifestations of primary arterial hypotension in children are variable and diverse. Patients often present numerous complaints reflecting concomitant changes in the central nervous system (headache, decreased physical and mental performance, dizziness, emotional lability, sleep disturbances, vegetative paroxysms), cardiovascular system (pain in the heart, palpitations), gastrointestinal tract (loss of appetite, pain in the epigastric region and along the intestines not associated with food intake, a feeling of heaviness in the stomach, aerophagia, vomiting, nausea, flatulence, constipation). Other complaints may include intolerance to travel by transport, prolonged subfebrile condition, attacks of shortness of breath, arthralgia, myalgia.

The prevalence of various complaints in children and adolescents with arterial hypotension varies widely. The most common are cephalgia (90%), increased fatigue and weakness (70%), emotional lability (72%). In half of the cases, there is increased irritability (47%), decreased physical performance (52%), dizziness (44%), cardialgia (37%). Less often, patients complain of decreased appetite, abdominal pain, complaints associated with dyspeptic and dyskinetic intestinal disorders (22%), vegetative paroxysms (22%), increased body temperature (18%), nosebleeds (12%), fainting (11%). myalgia (8%). arthralgia (7%).

Symptoms of arterial hypotension

Classification of arterial hypotension

Currently, several classifications of hypotonic conditions have been proposed. The first classification was adopted at the 20th International Congress in Montpellier (France) in 1926, according to which primary and secondary arterial hypotension were distinguished. The classification of N.S. Molchanov (1962) has found the greatest practical application. The advantage of this classification is considered to be the identification of the concept of physiological hypotension.

Classification of arterial hypotension

[ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ]

Symptomatic arterial hypotension

Clinical manifestations of symptomatic arterial hypotension depend on the underlying disease. A persistent decrease in arterial pressure in various somatic diseases is accompanied by the occurrence of similar subjective and objective symptoms similar to those in primary arterial hypotension. This similarity extends to the features of changes in hemodynamics and the course of reflex reactions.

Symptomatic arterial hypotension

Diagnosis of arterial hypotension

When collecting anamnesis, data on hereditary burden of cardiovascular diseases is clarified, while it is necessary to clarify the age of manifestation of cardiovascular pathology in relatives. It is necessary to clarify the features of the course of pregnancy and childbirth in the mother in order to identify possible perinatal pathology, special attention should be paid to the level of blood pressure in the mother during pregnancy. It is important to remember that low blood pressure in the mother during pregnancy contributes to damage to the central nervous system and creates the prerequisites for the formation of arterial hypotension in the child.

It is necessary to determine the presence of psychotraumatic circumstances in the family and school that contribute to the development of arterial hypotension, disruptions to the daily routine (lack of sleep) and nutrition (irregular, inadequate nutrition). It is necessary to assess the level of physical activity (hypodynamia or, on the contrary, increased physical activity, for example, classes in sports sections, which can lead to sports overexertion syndrome).

Diagnosis of arterial hypotension

[ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ]

Treatment of arterial hypotension

Non-drug methods of treating arterial hypotension include normalizing the daily routine, engaging in dynamic sports, massage, diet, taking diuretic herbs, physiotherapy, and psychological methods.

Treatment of arterial hypotension