Prevention of arterial hypertension

There are several approaches to the prevention of cardiovascular diseases: population strategy, prevention in high-risk groups, family prevention.

Preventive measures in the population strategy should be aimed at the entire children's population in order to prevent bad habits (use of alcohol, drugs, smoking) and promote healthy lifestyles. The preventive program should be oriented not only to the school, but also to the family. At the same time, it is important to spread knowledge about lifestyle and health, to provide the necessary social support for motivation to act in the desired direction. Children need to learn a healthy lifestyle the same way. As they are taught to read, write, count.

Proper nutrition

The daily diet of children should contain all the necessary irreplaceable and replaceable nutritional factors in quantities corresponding to the physiological needs of children and adolescents in basic food substances and energy. Preference should be given to milk and dairy products with a low fat content, which makes it possible to meet the requirements for protein and calcium, while avoiding excessive caloric content. Food should include a variety of vegetables and fruits that serve as sources of vitamins, minerals, starch-containing carbohydrates, organic acids and dietary fiber. Consumption of vegetables should exceed fruit consumption by about half. High consumption of antioxidants from fruits and vegetables helps protect the body from the damaging effects of free radicals. Legumes, peanuts, bread, green vegetables, such as spinach, Brussels sprouts and broccoli, serve as sources of folic acid. Sources of iron - leafy greens of the cabbage family (broccoli, spinach).

Decreased intake of table salt

In children with hypertension, it is necessary to limit the intake of table salt to 70 mmol of sodium per day. It is recommended to use iodized salt, to increase the content of foods rich in potassium and magnesium in the diet. The largest amount of potassium (more than 0.5 g per 100 g of product) is found in apricots, beans, peas, sea cabbage, prunes, izume, potatoes "in uniform".

Decreased body weight

Elimination of excess body weight not only lowers blood pressure, but also reduces sensitivity to salt, and also reduces the manifestations of dyslipidemia and insulin resistance. Children with obesity should more strictly restrict the daily caloric intake of food, reduce the consumption of fats (up to 30% of daily calories). Limit consumption of sugars: sweets, confectionery, sweet drinks (replacing sweet soft drinks with mineral water, freshly squeezed juices).

Physical activity

Physical activity is an important aspect of preventing arterial hypertension. Hypodinamy in children ranks first among other risk factors for cardiovascular disease. The most unfavorable value this risk factor acquires in children of the puberty period. Regular physical training increases the level of oxygenation of children's blood, increases the adaptive capabilities of the cardiovascular system, have a greater positive effect than in adults, contributing to the favorable development of the cardiovascular system. Physical activity is one of the most effective means of combating excess body weight, arterial hypertension. Physical training helps increase the cholesterol content in high-density lipoproteins (anti-atherogenic fraction). According to the methodological recommendations "Hygienic norm of motor activity of children and adolescents 5-18 years old" the norm of organized motor activity should be 4-9 hours for girls, for boys - 7-12 hours. Daily aerobic loads of 30 to 60 minutes are recommended. Dynamic types of physical activity are more preferable: walking, swimming, rhythmic gymnastics, cycling, skating, skiing, dancing. At the same time, children with hypertension are contraindicated static loads: lifting weights, various types of fighting.

The energy expenditure for various types of physical activity

Type of physical activity	Energy consumption, cap / h
Household chores	300
Table tennis	250
Walking	350-450
Dancing	350-450
Basketball	370-450
Work in the garden and the vegetable garden	300-500
Football	600-730
Swimming	580-750
Run	740-920

Prevention of lipid metabolism disorders

Prevention of lipid metabolism disorders should also be included in the complex of measures for arterial hypertension. Variations in lipid metabolism are most often detected in children with a combination of hypertension and obesity, with an increased incidence of triglycerides, a low level of high-density lipoprotein cholesterol. To correct hypertriglyceridemia (more than 1.7 mmol / l), it is advisable to correct excess body weight, the restriction of easily assimilated carbohydrates.

To correct hypercholesterolemia (more than 6.0 mmol / l) in school-age children at high risk, a diet is prescribed that limits fat to less than 20-30% of total caloric value; compliance with the ratio of saturated and unsaturated fatty acids 1: 1; restriction of the intake of cholesterol from 200 to 300 mg% per day.

Principal dispensary observation

Clinical examination is a method of active dynamic observation of the health status of the population, including children and adolescents. All children and adolescents with overgrown heredity for hypertension, high normal blood pressure, hypertension and hypertension are subject to follow-up.

The medical examination includes the following activities:

• the setting for medical registration of all children and adolescents with a hereditary burden of hypertension, high normal arterial pressure, hypertension and hypertension;
• periodic medical examination of these individuals in order to prevent the progression of arterial hypertension;
• a complex of health and medical measures aimed at normalizing blood pressure;
• conducting medical and professional counseling and vocational guidance for children and adolescents with hypertension and hypertension, taking into account their gender and age.

A pediatrician needs to examine children and adolescents with a hereditary heredity for hypertension, a high normal blood pressure every 6 months (the survey is limited to anthropometry and three times the measurement of blood pressure). This contingent should be included in dispensary group I.

When confirming the diagnosis of hypertension (essential or symptomatic) or hypertensive disease of a child or adolescent, the pediatrician observes once every 3-4 months. To determine the volume of diagnostic measures, the development of non-drug and drug treatment tactics and on the management of risk factors for hypertensive disease, the child should be consulted by a cardiothorematologist (with arterial hypertension - 1 every 6 months, with hypertension - 1 every 3 months). According to the testimony, a child or teenager can be consulted by a nephrologist, an ophthalmologist and a neuropathologist. Mandatory studies are conducted at least once a year, additional - on indications.

Children and adolescents with hypertension should be included in the II dispensary group of records, and with hypertension in III.

All the data obtained are entered into the child's medical history (form 112 / y) and the child's medical record (form 026 / y).

Indications for in-patient examination of children and adolescents with arterial hypertension - persistent increase in blood pressure, the presence of vascular crises, ineffective treatment in outpatient settings, the uncertainty of the genesis of arterial hypertension.

[1], [2], [3], [4], [5], [6],