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Go Back       IAR Journal of Medical Case Reports | IAR J Med Cse Rep. 2(3), | Volume:2 Issue:3 ( June 20, 2021 ) : 42-45
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DOI : 10.47310/iarjmcr.2021.v02i03.010       Download PDF       HTML       XML

Hypertension in Pediatric Age


Article History

Received: 20.05.2021 Revision: 30.05.2021 Accepted: 10.06.2021 Published: 20.06.2021


Author Details

Muhammad Abass Muhammad1, Osama S. Nadhum2, and Tareq Khudhair Jasim Al-Amar3


Authors Affiliations

1Ministry of Health, Baghdad Al-Karkh Health Directorate, Central Pediatric Teaching, Hospital, Baghdad, Iraq

2Ministry of Health of Kurdistan-Iraq, Erbil Health Directorate, Rizgary Hospital, Erbil, Iraq

3Ministry of Health, Baghdad Al-Rusafa Health Directorate, AL-Shaheed Al-Sadir Hospital, Baghdad, Iraq


Abstract: Hypertension is an independent disease and one of the major risk factors contributing to the development of coronary heart disease, myocardial infarction, stroke, and ultimately disability and mortality. The appearance of hypertension in childhood is fraught with the risk of its maintenance in later years and an unfavorable prognosis in connection with the occurrence of the above-mentioned cardiovascular diseases. The paper aims to know the description of the problems and cases of high blood pressure in children at a Hospital, Baghdad, Iraq. Data were collected from Baghdad Hospital, where 40 children with high blood pressure were collected. A full study was conducted on the causes related to taking the patient's specifications and according to various sources, arterial hypertension (AH) is recorded in 1-3% of all children, in most cases, high blood pressure in children is secondary to diseases of the kidneys, heart, blood vessels, and endocrine diseases. However, in adolescents in the absence of signs of these diseases, a diagnosis of essential hypertension can be established, especially if a moderate rise in blood pressure is associated with increased weight and/or a familial predisposition to hypertension. More pronounced high blood pressure usually indicates a causal role for kidney damage.


Keywords: hypertension, pediatric, blood.


INTRODUCTION

The prevalence of hypertension in the adult population is 44%. In children and adolescents, this indicator fluctuates at the level of 2.4-18% with age, in 33-42% of children, blood pressure remains elevated, and in 17-26% it turns into hypertensive, therefore, in pediatric practice, this problem is not Widespread, but remains very relevant, as the formation of cardiovascular disease (CVD) in adults begins in childhood and adolescence.


According to the definition of hypertension in children/adolescents, it is a pathological condition accompanied by a constant or periodic increase in blood pressure compared to the age norm, which is 60-70 / 30-35 mm Hg for the fetus. the art., for a one-month-old baby - 85/40 mm Hg. Art., 1 year - 95/50 mm Hg. art. In the future, there is an increase in systolic blood pressure of an average of 2 mmHg. art. per year, diastolic blood pressure - by 0.5-1 mm Hg. art. In the year.


Once the child reaches the age of three, it is recommended that blood pressure be monitored during regular preventive checkups. Blood pressure values ​​that require a physician's attention are >110/70 mm Hg. art. For children under 10 years old and >120/80 mm Hg. art. For children over 10 years old.


High blood pressure in children can be primary - with no obvious cause and secondary - linked to some other diseases. In the vast majority of cases, it is the secondary condition that is observed, when with various kidney diseases, endocrine pathologies, including thyrotoxicosis (increased function of the thyroid gland), some tumors, and cardiovascular diseases (stenosis of the aorta, stenosis of the aorta. Oral, valvular insufficiency) can lead to increased blood pressure in the aorta, opening the vegetative duct High blood pressure can be a side effect of medications, such as cold medicines and hormonal drugs such as prednisone.


Primary arterial hypertension in schoolchildren and adolescents, as a rule, is found at an initial, still reversible stage. Genetic predisposition plays an important role in its development. Hormonal changes during puberty, physical inactivity, the tendency to obesity, excess nutrition, nervous stress during studies, conflict situations in the family or school, smoking and alcohol consumption, some climatic, geographical, and meteorological factors contribute to an increase in blood pressure. An increase in blood pressure in a teenager is often discovered by chance, rarely accompanied by complaints. Many young patients are overweight and tall. If there are still complaints, then they are usually - headache, dizziness, heart pain, palpitations, shortness of breath, easy fatigue, weakness, irritability, and memory impairment. Pronounced emotional instability is often observed. Most often, in adolescents, systolic pressure temporarily rises and decreases with the normalization of the system. Sometimes this procedure is not enough, medications are required.


METHOD

The statistical and descriptive side were used to register hypertensive patients, as 40 children were registered From Baghdad Hospital, Iraq, you are the variables that were studied: age in years, sex, and the percentage of height in pressure as the value of. was calculated Mean ±SD and p-value for the patient by program SPSS 25


The results of multicenter studies indicate that active antihypertensive therapy using modern and highly effective antihypertensive drugs that have not only antihypertensive, but also an additional organic effect, reduces the risk of stroke, myocardial infarction, and other cardiovascular diseases and reduces the rate of Mortality in patients, And the continuous increase in blood pressure above the 95th percentile according to the percentile scale for a particular age, sex, and height. It manifests itself in headache, dizziness, decreased visual acuity, fainting.


DIAGNOSIS

Arterial hypertension in children is less common than in adults, and at the same time, it remains one of the most common chronic diseases in pediatrics. According to various studies, the incidence of this pathology among children and adolescents ranges from 1 to 18%. The significance of the disease is related to the characteristics of treatment in childhood. Not all groups of drugs can be used. In addition, diseases that lead to malignant arterial hypertension in children are often detected. Currently, the number of children who are overweight and burdened by heredity due to chronic diseases is increasing, as a result of which arterial hypertension is diagnosed at an early age.


It is postulated that three pathophysiological mechanisms are involved in disease progression: increased circulating blood volume increased cardiac output, and increased total peripheral resistance. The first mechanism occurs with increased activity of the sympathetic nervous system. The second mechanism is typical for cases after infusion therapy and is observed against the background of renal failure and an increase in mineralocorticoids. The third pathological link is found in the development of arterial hypertension in children with increased tissue sensitivity to catecholamines or with an increase in their concentration in the blood (for example, with pheochromocytoma), and it also occurs in kidney tumors.


Arterial hypertension in children often develops in the presence of predisposing factors. These include the exacerbated genetics of high blood pressure, diabetes mellitus, obesity, as well as for any of the above conditions that go into causing an increase in blood pressure. In addition, the disease is often diagnosed in children with high levels of anxiety and after an acute or chronic stressful situation. Many diseases of the nervous system and kidneys can lead to high blood pressure in children, such as encephalitis, meningitis, traumatic brain injury, acute glomerulonephritis, etc.


There is no standardized classification for the grades of hypertension in children. Most often, home pediatricians rely on, according to which there are three stages of arterial hypertension in children. The first stage is reversible and is divided into two stages: IA - an increase in pressure at the time of emotional stress, IB - a periodic increase in pressure that stops on its own. The first stage is considered a pre-hypertensive state. Stage IIA is accompanied by a steady but unstable increase in pressure, in stage IIB there is a persistent increase in pressure. The third stage is rarely diagnosed in children and is characterized by damage to organs (vessels of the brain, eyes, limbs, etc.)


The disease can be suspected by measuring blood pressure with a cuff. Blood pressure is considered elevated when it is above the 95th percentile on a scale for a certain age and gender. Once the hypertension is stabilized, it is an indication of two repeated measurements with an interval of two minutes. Measurements are also taken on the other arm and legs while standing and lying down. This procedure avoids overdiagnosis since the so-called "white coat syndrome" often occurs in children. A physical examination can help detect excess weight and signs of various diseases.


Treatment of hypertensive crisis is one of the separate blocks of treatment of arterial hypertension in children. A hypertensive crisis is a marked and persistent increase in blood pressure. Medications for scheduled therapy are not used because they have a cumulative effect, in addition, their action, as a rule, is delayed in time. Blood pressure is normalized with alpha-blockers and peripheral vasodilators. Drugs of these groups quickly reduce blood pressure. They are used only by doctors in medical institutions since during the application it is necessary to monitor the condition of the child.


The prognosis is determined by the causes of the development of arterial hypertension in children and the stage of the disease. Early diagnosis and adequate treatment make it possible, with the normalization of pressure, to abandon antihypertensive drugs and in the future carry out only non-pharmacological therapy. At the same time, there are nasal diseases that create conditions for arterial hypertension in children that are resistant to treatment. In this case, an increase in pressure often develops and leads to organ disorders in the form of retinal vasculopathy, decreased intellectual abilities, intermittent claudication, heart failure, etc. Prevention consists of timely diagnosis and elimination of predisposing factors.


RESULT


Table 1- distribution age on the patient

N

Age

5

3-5

20

6 to 9

10

10 to 12

5

13 to 15


Figure image is available at PDF file

Figure 1 – shows the extent of the differences in the distribution


Table 2- Demonstrates moderate high blood pressure

Age

moderate high blood pressure

3-5

>117

6 to 9

>123

10 to 12

>128

13 to 15

>139


Table 3- explain severe high blood pressure

Age

moderate high blood pressure

3-5

>127

6 to 9

>131

10 to 12

>135

13 to 15

>145


The level of blood pressure is determined by two main factors: vascular strength and extracellular fluid volume. In the early stages of hypertension, an increase in arterial smooth muscle tone can be mediated by activation of the sympathetic vascular system through stimulation of postsynaptic a1 receptors and b receptors. Presynaptic by circulating adrenaline, followed by norepinephrine release. Moreover, the process involves blood circulation and local vasoconstrictor (endothelial) hormones, the action of which is opposed by vascular pressure systems.


In pediatric practice, essential hypertension is practically not diagnosed. Where in 60% of cases, hypertension is accompanied by symptoms, it is possible to establish a primary cause of the disease. With proper, timely treatment and available features of regulatory, exchange, regeneration, and other systems inherent in the growth of the body, there is a reserve to prevent the development of complications. Each age group of children with hypertension has its etiological priority.


CONCLUSION

In the case of premature birth, low birth weight, congenital heart disease, and some kidney problems, blood pressure checks should be performed during infancy.


High blood pressure in younger children is associated with health conditions such as congenital heart defects, kidney disease, genetic conditions, or hormonal disorders, and in older children, especially those who are overweight. Early treatment helps avoid side effects caused by high blood pressure Factors


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