Problematic issues of pathogenesis, diagnosis, prevention and approaches to the treatment of arterial hypotension in children (literary data, own researches)
DOI:
https://doi.org/10.15574/PP.2023.95.86Keywords:
arterial hypotension, pathogenesis, classification, heredity, diagnosis, daily blood pressure monitoring, childrenAbstract
Arterial hypotension (AHT) is an actual problem in pediatrics. It is a symptom complex characterized by a decrease in systemic blood pressure (BP) and accompanied by a number of clinical symptoms that reflect a decrease in blood flow and perfusion pressure in all organs and tissues.
Purpose - to summarize data from the literature and own experience regarding diagnosis, pathogenetic and clinical features of the course and principles of treatment of AHT in children.
Results. A review of modern literary data showed a wide range of etiopathogenetic mechanisms of AHT formation and a high specific weight of primary AHT in the pediatric population. A modern method of accurate diagnosis of AHT is daily blood pressure monitoring (DBPM). According to the results of DBPM conducted by us in 677 children aged 8-17 years with complaints of BP fluctuations, AHT was established in 107 (15.8%) examined. AHT in girls occurred almost twice as often compared to boys - 66.4% versus 33.6% (p<0.0001). In 64.5% of cases there was labile AHT, in 33% - stable AHT of the first stage, in 2.5% of children - stable AHT of the II stage. There were no gender differences in the frequency of different degrees of AHT.
Conclusions. The issue of low BP is an urgent problem in pediatrics. According to the results of DBPM, AHT is detected in 15.8% of children aged 8-17 years and has a mostly labile course. AHT requires in-depth study in order to develop new preventive and therapeutic measures and to alleviate the consequences in children.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
References
Alabed S, Sabouni A, Al Dakhoul S, Bdaiwi Y. (2020, Jul 23). Beta-blockers for congestive heart failure in children. Cochrane Database Syst Rev. 7 (7): CD007037. https://doi.org/10.1002/14651858.CD007037.pub4; PMid:32700759 PMCid:PMC7389334
Banker A, Bell C, Gupta-Malhotra M, Samuels J. (2016, Jul 19). Blood pressure percentile charts to identify high or low blood pressure in children. BMC Pediatr. 16: 98. https://doi.org/10.1186/s12887-016-0633-7; PMid:27430884 PMCid:PMC4950817
Barrett JS, Hirankarn S, Holford N, Hammer GB, Drover DR, Cohane CA et al. (2015, Jul 28). A hemodynamic model to guide blood pressure control during deliberate hypotension with sodium nitroprusside in children. Front Pharmacol. 6: 151. PMID: 26283961; PMCID: PMC4516882. https://doi.org/10.3389/fphar.2015.00151
Bistola V, Arfaras-Melainis A, Polyzogopoulou E, Ikonomidis I, Parissis J. (2019, Nov 4). Inotropes in Acute Heart Failure: From Guidelines to Practical Use: Therapeutic Options and Clinical Practice. Card Fail Rev. 5 (3): 133-139. https://doi.org/10.15420/cfr.2019.11.2; PMid:31768269 PMCid:PMC6848944
Buonocore F, Achermann JC. (2020, Jan). Primary adrenal insufficiency: New genetic causes and their long-term consequences. Clin Endocrinol (Oxf). 92 (1): 11-20. Epub 2019 Oct 30. https://doi.org/10.1111/cen.14109; PMid:31610036 PMCid:PMC6916405
Burke GL, Arcilla RA, Culpepper WS, Webber LS, Chiang YK, Berenson GS. (1987, Jan). Blood pressure and echocardiographic measures in children: the Bogalusa Heart Study. Circulation. 75 (1): 106-114. https://doi.org/10.1161/01.CIR.75.1.106; PMid:2947739
Colucci L, Bosco M, Ziello AR, Rea R, Amenta F, Fasanaro AM. (2012, Dec 11). Effectiveness of nootropic drugs with cholinergic activity in treatment of cognitive deficit: a review. J Exp Pharmacol. 4: 163-172. https://doi.org/10.2147/JEP.S35326; PMid:27186129 PMCid:PMC4863555
Corrado C. (2015). Blood pressure measurement in children. Ital J Pediatr. 41; 2: A19. https://doi.org/10.1186/1824-7288-41-S2-A19; PMCid:PMC4707609
Divisón-Garrote JA, Banegas JR, De la Cruz JJ, Escobar-Cervantes C, De la Sierra A, Gorostidi M et al. (2016, Sep). Hypotension based on office and ambulatory monitoring blood pressure. Prevalence and clinical profile among a cohort of 70,997 treated hypertensives. J Am Soc Hypertens. 10 (9): 714-723. Epub 2016 Jun 27. https://doi.org/10.1016/j.jash.2016.06.035; PMid:27451950
Divisón-Garrote JA, Ruilope LM, de la Sierra A, de la Cruz JJ, Vinyoles E, Gorostidi M et al. (2017, May 1). Magnitude of Hypotension Based on Office and Ambulatory Blood Pressure Monitoring: Results from a Cohort of 5066 Treated Hypertensive Patients Aged 80 Years and Older. J Am Med Dir Assoc. 18 (5): 452.e1-452.e6. Epub 2017 Feb 27. https://doi.org/10.1016/j.jamda.2017.01.015; PMid:28246017
Gooding HC, Milliren CE, Austin SB, Sheridan MA, McLaughlin KA. (2016, Jan-Feb). Child Abuse, Resting Blood Pressure, and Blood Pressure Reactivity to Psychosocial Stress. J Pediatr Psychol. 41 (1): 5-14. Epub 2015 May 15. https://doi.org/10.1093/jpepsy/jsv040; PMid:25979082 PMCid:PMC4723669
Google Scholar. (2023). Peculiarities of daily blood pressure monitoring and iron content in children with arterial hypotension. [Google Scholar. (2023). Особливості добового моніторингу артеріального тиску та вміст заліза у дітей з артеріальною гіпотензією]. URL: https://scholar.google.com/citations?view_op=view_citation&hl=ru&user=0dAoaacAAAAJ&citation_for_view=0dAoaacAAAAJ:u-x6o8ySG0sC].
Gorący I, Dawid G, Iewoniewska B. (2013). Genetics of the reninangiotensin system with respect to cardiac and blood pressure phenotypes in healthy newborn infants. A J Renin Angiotensin Aldosterone Syst. 14 (4): 337-347. https://doi.org/10.1177/1470320312450531; PMid:22772796
Hannah DM, Tressler TB, Taboada CD. (2017, Oct 2). Nonimmune hydrops fetalis due to autosomal recessive hereditary spherocytosis. Case Rep Womens Health. 16: 4-7. https://doi.org/10.1016/j.crwh.2017.09.003; PMid:29594000 PMCid:PMC5842958
James FW, Schwartz DC, Kaplan S, Spilkin SP. (1982, Oct). Exercise electrocardiogram, blood pressure, and working capacity in young patients with valvular or discrete subvalvular aortic stenosis. Am J Cardiol. 50 (4): 769-775. https://doi.org/10.1016/0002-9149(82)91232-2; PMid:6214941
Kliegman RM, St Geme III JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. (2020). Nelson Textbook of Pediatrics. 2-Volume Set, 21th Edition: 574.
Koehler RC. (2021, Sep 23). Regulation of the Cerebral Circulation During Development. Compr Physiol. 11 (4): 2371-2432. https://doi.org/10.1002/cphy.c200028; PMid:34558670 PMCid:PMC9789530
Lewis S, DePass A, Hagerman RJ, Lozano R. (2022). Case Reports of Aortic Aneurism in Fragile X Syndrome. Genes. 13; 9: 1560. https://doi.org/10.3390/genes13091560; PMid:36140728 PMCid:PMC9498845
Lissak G. (2018, Jul). Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environ Res. 164: 149-157. Epub 2018 Feb 27. https://doi.org/10.1016/j.envres.2018.01.015; PMid:29499467
Marushko YuV, Khomych OV, Hyshchak TV. (2015). Peculiarities of daily monitoring of blood pressure and iron content in children with arterial hypotension. Collection of scientific works of the staff of the NMAPO named after P.L. Shupyk. 24 (3): 308-313. URL: http://nbuv.gov.ua/UJRN/Znpsnmapo_2015_24(3)__52.
Marushko YuV, Khomych OV, Hyshchak TV. (2016). The role of group B vitamins in the treatment of primary arterial hypotension. Children's doctor. 2 (47). URL: https://d-l.com.ua/ua-issue-article-482.
Mulkey SB, du Plessis A. (2018). Autonomic nervous system development and its impact on neuropsychiatric outcome - Pediatric Research. Nature. URL: https://www.nature.com/articles/s41390-018-0155-0#citeas. https://doi.org/10.1038/s41390-018-0155-0; PMid:30166644 PMCid:PMC6353676
NCBI. (2023). Dietary Reference Intakes for Sodium and Potassium - NCBI Bookshelf. National Center for Biotechnology Information. URL: https://www.ncbi.nlm.nih.gov/books/NBK538102/ (date of access: 27.04.2023).
Onishi Y, Minoura Y, Chiba Y, Onuki T, Ito H, Adachi T et al. (2015, Aug). Daily Dysfunction of Autonomic Regulation Based on Ambulatory Blood Pressure Monitoring in Patients with Neurally Mediated Reflex Syncope. Pacing Clin Electrophysiol. 38 (8): 997-1004. Epub 2015 Jun 11. https://doi.org/10.1111/pace.12661; PMid:25974151
Panossian A, Seo EJ, Efferth T. (2018, Nov 15). Novel molecular mechanisms for the adaptogenic effects of herbal extracts on isolated brain cells using systems biology. Phytomedicine. 50: 257-284. Epub 2018 Sep 20. https://doi.org/10.1016/j.phymed.2018.09.204; PMid:30466987
Panossian A, Wikman G. (2010, Jan 19). Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel). 3 (1): 188-224. https://doi.org/10.3390/ph3010188; PMid:27713248 PMCid:PMC3991026
Paris G, Gorla SR, Arenas-Morales AJ, Seeherunvong W, Swaminathan S. (2019, Mar). Comparison of echocardiographic changes in children with primary hypertension and hypertension due to mild to moderate chronic kidney disease. Pediatr Nephrol. 34 (3): 487-494. Epub 2018 Oct 1. https://doi.org/10.1007/s00467-018-4096-y; PMid:30276536
PubMed Central (PMC). (2023). Gynecological and Menstrual Disorders in Women with Vasovagal Syncope. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681885 (date of access: 27.04.2023).
PubMed. (2023). Headache Is Associated with Low Systolic Blood Pressure and Psychosocial Problems in German Adolescents: Results from the Population-Based German KiGGS Study - PubMed. URL: https://pubmed.ncbi.nlm.nih.gov/33916726/ (date of access: 27.04.2023).
Schulz J, Huber F, Schlack R, Hölling H, Ravens-Sieberer U, Meyer T et al. (2021, Feb 14). The Association between Low Blood Pressure and Attention-Deficit Hyperactivity Disorder (ADHD) Observed in Children/Adolescents Does Not Persist into Young Adulthood. A Population-Based Ten-Year Follow-Up Study. Int J Environ Res Public Health. 18 (4): 1864. https://doi.org/10.3390/ijerph18041864; PMid:33672943 PMCid:PMC7918102
Stanford Medicine Children's Health. (2023). Stanford Medicine Children's Health - Lucile Packard Children's Hospital Stanford. (date of access: 27.04.2023). URL: https://www.stanfordchildrens.org/en/topic/default?id=electrocardiography-for-children-90-P01785.
Taylor BN, Cassagnol M. (2023). Alpha Adrenergic Receptors - StatPearls - NCBI Bookshelf. National Center for Biotechnology Information. URL: https://www.ncbi.nlm.nih.gov/books/NBK539830.
Velasco-Benitez CA, Falcon AC, Axelrod C, Valdes LF, Saps M. (2022, Feb). Prevalence of joint hypermobility, postural orthostatic tachycardia syndrome (POTS), and orthostatic hypotension in school-children. Andes Pediatr. 93 (1): 53-58. English, Spanish. PMID: 35856948; https://doi.org/10.32641/andespediatr.v93i1.3755
Wagner SL, Koehn C, White MI, Harder HG, Schultz IZ, Williams-Whitt K et al. (2016, Jan). Mental Health Interventions in the Workplace and Work Outcomes: A Best-Evidence Synthesis of Systematic Reviews. Int J Occup Environ Med. 7 (1): 1-14. https://doi.org/10.15171/ijoem.2016.607; PMid:26772593 PMCid:PMC6816521
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Ukrainian Journal of Perinatology and Pediatrics
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “Ukrainian Journal of Perinatology and Pediatrics” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.