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.

Reasons for variability in data on the prevalence of arterial hypotension

• Heterogeneity of the examined patients.
• Use of different blood pressure standards in research.
• Conducting examinations in different seasons of the year (the prevalence of arterial hypotension increases in the winter-spring period, when daily changes in meteorological conditions require additional stress on the regulatory systems).
• Conducting the examination at different times of the day (daily changes in blood pressure in healthy children are 10-16 mm Hg, blood pressure is highest at 12-15 p.m., lowest at 3-4 a.m.).
• The different climatic and geographical conditions in which the studies were conducted (in northern regions, cold contributes to spasm of peripheral vessels and an increase in blood pressure, while living in a hot climate contributes to vasodilation and a decrease in blood pressure).

Methodology for determining and assessing blood pressure

To diagnose arterial hypotension, it is necessary to correctly determine the level of blood pressure.

Rules for determining blood pressure

• Blood pressure should be measured several times (at least 3 times) at intervals of 3 minutes.
• Blood pressure measurements should be taken in the first half of the day, no earlier than 1 hour after physical education classes or tests, in comfortable conditions after a five-minute rest.
• Blood pressure should be measured in a sitting position, with the elbow at the level of the heart.
• It is necessary to use the cuff size taking into account the child's age, corresponding to the length of the arm circumference.
• The first phase of Korotkoff sounds is taken as systolic blood pressure; the fifth phase of Korotkoff sounds or the fourth phase in the case of the “phenomenon” of infinite sound is taken as diastolic blood pressure.

Criteria for diagnosing low blood pressure There are two main approaches to developing criteria for low blood pressure. They use average age indicators (unified criteria) or centile distribution of blood pressure indicators taking into account age, gender and height.

Centile indicators of systolic and diastolic blood pressure. They are obtained on the basis of a mass examination of children and adolescents of the same age and sex. After obtaining the blood pressure measurement data, a curve of the distribution of blood pressure indicators is plotted and a centile distribution scale is created. Arterial hypotension is defined as blood pressure values below the 10th centile of the distribution curve in the pediatric population with three measurements.

Unified criteria for arterial hypotension

Age	Systolic blood pressure, mmHg	Diastolic blood pressure, mmHg
7-9 years	80	40
10-13 years	85	45
14-15 years old	90	50
16-17 years old	90	55

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