Arterial hypotension (hypotension) in children

Arterial hypotension in children is a symptom that reflects different degrees of lowering blood pressure. It should be emphasized that more accurately lowered arterial pressure means the term hypotension (from Greek hypo- small and latent tensio -tension). According to modern concepts, the term "... Tones" should be used to describe the tone of muscles, including the smooth muscles of the vessel wall, the term "... Tensia" - to denote the magnitude of the pressure of liquids in the vessels and cavities. This terminological inaccuracy (arterial hypotension), firmly entrenched in the literature and professional vocabulary of physicians, can be justified by the fact that a decrease in the tone of precapillary and arterioles most often acts as the main hemodynamic cause of prolonged lowering of blood 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 variety of clinical manifestations, the marked decrease in physical and mental performance, which leads to the development of the school disadaptation syndrome and a sharp decline in the quality of life.

If a lot of scientific work is devoted to this problem in adults, then in the pediatric literature this state is paid much less attention. Statistical data of recent years indicate an increase in the prevalence of arterial hypotension, including in young people. The origins of adult hypotension should be sought in childhood and adolescence. Hypotonic disease does not develop immediately, but passes through the stage of the syndrome of non-viro-circulatory (vegetovascular) dystonia according to the hypotonic type. Every year there is more and more evidence that hypotonic conditions are more common in children and adolescents than in adults, and can subsequently move into arterial hypertension, and also be a risk factor for coronary heart disease.

Until now, the literature discusses the question of how to treat arterial hypotension: as a symptom or a disease. In the opinion of E.V. Gembitsky, the doctrine of non-circulatory hypotension (primary) and hypotonic states at the present time constitutes an independent section of cardiology. Even in the early work on arterial hypotension, which appeared in the early XX century, the researchers drew attention to the heterogeneity of people with low blood pressure and identified three groups of patients. In one group of subjects, except for low blood pressure, there were no other abnormalities. In such cases, arterial hypotension began to be regarded as a variant of individual normal blood pressure, and at the suggestion of G.F. Langa in the domestic literature it is usually referred to as physiological hypotension. In other cases, blood pressure decreased against a background of various diseases, which was regarded as symptomatic hypotension. In the third group, the reduction in blood pressure prevailed in the clinical picture of the disease and resembled a clinical picture of neurosis, which was considered as a primary hypotension.

According to WHO criteria, the term "essential, or primary, hypotension" means low blood pressure in the absence of an obvious cause of its appearance, under the term "secondary hypotension" - low blood pressure. The cause of which can be identified.

Cardiologists in most cases put an equal sign between the terms "primary, or essential. Arterial hypotension "and" hypotonic disease ", implying under 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 the modern literature, more than 20 different terms are used to refer to arterial hypotension. The most commonly used terms are: constitutional hypotension, essential hypotension, primary hypotension, chronic collapoid state, hypotonic disease, hypotonic type neurocirculatory dystonia, neurocirculatory hypotension.

The terms "constitutional hypotension" and "essential hypotension" are most often used in foreign literature. In the 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 severe symptoms in the form of dizziness, headache, orthostatic dysregulation.

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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. So, if among the children of primary school age it is 1-3%, then among the children of the senior school age - 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 difficult and insufficiently studied are the pathogenesis of arterial hypotension. There are several theories of the origin of the disease: constitutional-endocrine, vegetative, neurogenic, humoral.

In accordance with this theory, arterial hypotension arises from the primary reduction of vascular tone due to insufficient function of the adrenal cortex. In subsequent studies, it was found that with arterial hypotension, the mineralocorticoid, glucocorticoid and androgen functions of the adrenal gland decrease. In children of primary school age with stable arterial hypotension, the glucocorticoid function of the adrenal cortex is reduced, and in children of the senior school age, glucocorticoid and mineralocorticoid.

Pathogenesis of arterial hypotension

Symptoms of arterial hypotension

Clinical manifestations of primary arterial hypotension in children are variable and diverse. Often, patients present numerous complaints that reflect concomitant changes from the CNS (headache, reduced physical and mental performance, dizziness, emotional lability, sleep disturbances, autonomic paroxysms), cardiovascular system (pain in the heart, palpitation), gastrointestinal tract (loss of appetite, pain in the epigastric region and along the bowel, not related to eating, feeling of heaviness in the stomach, aerophagia, vomiting, nausea, flatulence, constipation). Among other complaints may be intolerance of travel on transport, prolonged subfebrile condition, attacks of feeling lack of air, arthralgia, myalgia.

The prevalence of these or other complaints in children and adolescents with arterial hypotension is within wide limits. The most common are cephalalgia (90%), fatigue and weakness (70%), emotional lability (72%). In half of cases, there are increased irritability (47%), decreased physical performance (52%), dizziness (44%), cardialgia (37%). Less frequently, patients complain of decreased appetite, abdominal pain, complaints related to dyspeptic and dyskinetic intestinal disorders (22%), vegetative paroxysms (22%), fever (18%), epistaxis (12%), syncope (eleven%). Myalgia (8%). Arthralgia (7%).

Symptoms of arterial hypotension

Classification of arterial hypotension

At the present time several classifications of hypotonic states have been proposed. The first classification was made at the XXth International Congress in Montpellier (France) in 1926, according to which primary and secondary arterial hypotension was identified. The most practical application was found in the NS classification. Molchanov (1962). The advantage of this classification is the isolation 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 blood pressure with various physical illnesses is accompanied by the appearance of similar subjective and objective symptoms similar to those with primary arterial hypotension. This similarity extends to the features of changes in hemodynamics and the flow of reflex reactions.

Symptomatic arterial hypotension

Diagnosis of arterial hypotension

When collecting an anamnesis, the data on hereditary complications for cardiovascular diseases are refined, and the age of manifestation of cardiovascular pathology in relatives should be specified. It is necessary to find out the peculiarities of pregnancy and labor in the mother with the purpose of revealing possible perinatal pathology, special attention should be paid to the level of arterial pressure in the mother during pregnancy. It is important to remember that low blood pressure in the mother during pregnancy contributes to the defeat of the central nervous system and creates the prerequisites for the formation of arterial hypotension in the child.

It is necessary to find out the presence of psychotraumatic circumstances in the family and school that contribute to the occurrence of arterial hypotension, disturbances in the day regimen (lack of sleep) and nutrition (irregular, inadequate nutrition). It is necessary to assess the level of physical activity (physical inactivity or, on the contrary, increased physical activity, for example, employment in sports sections, which can lead to a syndrome of sports overexertion).

Diagnosis of arterial hypotension

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

Treatment of arterial hypotension

Non-drug treatment methods for arterial hypotension include normalization of the daily regimen, dynamic sports, massage, diet, diuretic herbs, physiotherapy, and psychological methods.

Treatment of arterial hypotension