Method for determining high-risk group for developing primary arterial hypertension in school-aged children with excess body weight and normal blood pressure

Abstract

FIELD: pediatrics.SUBSTANCE: body mass index (BMI (kg / m2)) is determined, then, if the BMI value is within the range of one standard deviation to two standard deviations from the median value, taking into account the age and sex of the child, and ambulatory blood pressure (SYSBP and DIABP) is below the 90th percentile, taking into account the age, height, and sex of the child, the microcirculation index (M, conventional units) is assessed in the area of the skin of the forearm using laser Doppler flowmetry before and immediately after physical activity (PA) - 30 squats in 1 minute. Next, the integral indicator is calculated - the index of functional reserve of microcirculation (IFRM) using the formula: M (conventional units) after PA / M (conventional units) before PA; with an IFRM of 0.86 conventional units or less, a high-risk group for the development of primary arterial hypertension is determined.EFFECT: determination of the personalized risk of developing primary arterial hypertension in school-age children with excess body weight and normal blood pressure values, and provision of the opportunity for timely primary prevention (non-drug recommendations for optimizing nutrition and physical activity, psychological correction) in schoolchildren, thereby avoiding the development of cardiovascular risks in subsequent years of their lives.1 cl, 1 tbl, 7 ex

Description

[0001] The invention relates to medicine, namely to pediatrics and pediatric cardiology, and can be used to determine individual risks of developing primary arterial hypertension in school-age children requiring primary prevention. There is a method for forming (defining) risk groups for developing arterial hypertension in adolescents. Risk groups for developing primary (essential) hypertension include children and adolescents with overweight and / or obesity (BMI (kg / m 2) ≥ +1SDS), as well as children with symptoms potentially associated with hypertension (headaches, nosebleeds). The list of risk groups for the development of hypertension in children is presented in the clinical guidelines "Arterial Hypertension in Children" (2025), developed by leading specialists of the Russian Medical Society for Arterial Hypertension and the All-Russian public organization "Association of Pediatric Cardiologists of Russia" (Clinical Guidelines. Hypertension in Children (2025)).

[0002] The disadvantage of this method for determining risk groups for the development of arterial hypertension are:

[0003] - the possibility of errors in determining overweight / obesity based on the body mass index (BMI), since this indicator does not always accurately indicate the true content of fat mass (overdiagnosis (“false” obesity) or underdiagnosis (“hidden” obesity) of obesity are possible);

[0004] - the possibility of registering, on the one hand, headaches without an increase in systemic blood pressure against the background of emotional lability and autonomic dysfunction, often registered in adolescent children (puberty), and on the other hand, the frequent absence of complaints of headaches against the background of high blood pressure;

[0005] - the possibility of registering, on the one hand, episodic nosebleeds without an increase in systemic blood pressure due to mechanical damage to the nasal vessels (inaccurate toilet of the nasal passages) or pathology of the ENT organs (rhinitis, polyps, curvature of the nasal septum), and on the other hand, the frequent absence of nosebleeds in children with systemic hypertension. As is known, excess body fat mass (↑ adipocytes - cells of white adipose tissue), including in case of “hidden” obesity, is accompanied by a change in the production of adipokines (hyperproduction of leptin and a decrease in adiponectin) and the risk of developing endothelial dysfunction, one of the manifestations of which is a violation of the vasomotor function of the endothelium due to an imbalance between vasoconstrictor (endothelin 1, angiotensin II, thromboxane A2, prostaglandin H2, etc.) and vasodilating (nitric oxide, prostacyclin, endothelin depolarization factor, angiotensin I, adrenomedullin, etc.) cytokines.Long-term persistence of endothelial dysfunction against the background of excess fat mass is obviously accompanied by disturbances at the microcirculatory level and increases the risks of hypertension.

[0006] The purpose of the invention is to determine a high-risk group for the development of primary arterial hypertension in overweight school-age children based on the results of an integral indicator - the functional reserve index of microcirculation (FRI = M (conventional units) after FN / M (conventional units) before FN) for the timely implementation of primary prevention of high blood pressure.

[0007] The essence of the invention is that in school-age children with excess body weight (body mass index (BMI), taking into account age and gender, is within the range of one to 2 standard deviations (+1 SD < BMI (kg / m 2) < +2 SD) from the median value) and normal ambulatory arterial pressure (taking into account age, height and gender) by laser Doppler flowmetry (LDF) on the portable device "Lazma PF" in the area of ​​the skin of the forearm determine the perfusion (M, conventional units) before and immediately after physical activity (30 squats in 1 minute); then calculate the integral indicator - the index of the functional reserve of microcirculation (IFRM = M (conventional units) after PE / M (conventional units) before PE). School-age children with IFRM of 0.86 conventional units or less (vasoconstrictive type of response to physical activity) are classified as a high-risk group for the development of primary hypertension, requiring a preventive measures program. The proposed method is carried out as follows. First, anthropometry is performed in school-age children (11-17 years old). Anthropometry includes measurement of height (m) and weight (kg) and calculation of body mass index (BMI).Body mass index is calculated as the ratio of body weight in kilograms to the square of height in meters (kg / m). 2 ) (Clinical guidelines. Obesity in children (2024)).

[0008] In case of overweight (body mass index (BMI) taking into account age and gender is within the range of one to two standard deviations (+1 SD < BMI (kg / m 2 () < +2 SD) from the median value) ambulatory BP is determined with an individual cuff selection. Blood pressure is measured three times, and the mean values ​​of systolic and diastolic BP (mmHg) are calculated. The normal value of mean BP (systolic and diastolic) is determined within the range of up to the 90th percentile, taking into account the height, age, and gender of the schoolchild (Clinical guidelines. Hypertension in Children (2025)).

[0009] Then, in overweight schoolchildren with normal blood pressure, perfusion (M, conventional units) is determined in the forearm skin area (in accordance with the device operating manual) using the laser Doppler flowmetry (LDF) method using the portable Lazma PF device (Russia) before and immediately after physical activity (30 squats in 1 minute) and the integral indicator, the functional reserve index of microcirculation (FRI = M (conventional units) after PE / M (conventional units) before PE), is calculated. School-age children with FRI of 0.86 conventional units or less are classified as being at high risk for developing primary hypertension, which requires a preventive measures program. With FRI above 0.86 conventional units, the risk of developing arterial hypertension is low: primary prevention is not carried out.

[0010] Examples (table).

[0011] Example 1.

[0012] Boy Z. (11 years old) with excess body weight (21.9 kg / m 2) had normal initial ambulatory blood pressure (BP) taking into account age, height, and gender - 112 / 69 mmHg. According to the results of instrumental studies (LASMA PF) of microcirculation (M, conventional units) before and immediately after PE, the initial index of the functional reserve of microcirculation (IFRM = 5.97 / 6.94) was 0.86 conventional units, i.e. the child belonged to the high-risk group for developing hypertension. The boy did not receive any non-drug recommendations for the prevention of arterial hypertension; no long-term drug therapy was administered for 1 year. After 1 year, outpatient BP was 123 / 68 mmHg (high normal systolic blood pressure (HNSBP)).

[0013] Thus, in a boy with excess body weight and initially normal blood pressure values ​​(mmHg) against the background of a low IGF value (0.86 conventional units and below), after 1 year, systolic IBP was recorded taking into account age, height and gender.

[0014] Example 2.

[0015] Girl C. (14 years old) with excess body weight (24.1 kg / m 2 ) had normal initial ambulatory blood pressure values ​​taking into account age, height, and gender - 124 / 73 mmHg. According to the results of instrumental studies (Lasma PF) of microcirculation (M, conventional units) before and immediately after PE, the initial index of the functional reserve of microcirculation (IFRM = 3.85 / 8.28) was 0.46 conventional units, i.e. the girl belonged to the high-risk group for developing hypertension. The schoolgirl did not receive any non-drug recommendations for the prevention of arterial hypertension; no long-term drug therapy was administered for 1 year. After 1 year, outpatient blood pressure was 136 / 77 mmHg (isolated systolic hypertension, stage 1). Thus, in a girl with excess body weight and initially normal blood pressure values ​​(mmHg) against the background of a low IGF-I value (0.86 conventional units and below), isolated systolic hypertension of stage 1 was recorded after 1 year, taking into account age, height and gender.

[0016] Example 3.

[0017] Boy U. (12 years old) with overweight (22.7 kg / m 2 ) had normal initial ambulatory blood pressure (BP) taking into account age, height, and gender - 116 / 71 mmHg. According to the results of instrumental studies (LASMA PF) of microcirculation (M, conventional units) before and immediately after PE, the initial index of the functional reserve of microcirculation (IFRM = 8.49 / 10.03) was 0.85 conventional units, i.e. the child belonged to the high-risk group for developing hypertension. The boy did not receive any non-drug recommendations for the prevention of arterial hypertension; no long-term drug therapy was administered for 1 year. After 1 year, outpatient BP was 125 / 72 mmHg (high normal systolic blood pressure (HNSBP)). Thus, in a boy with excess body weight and initially normal blood pressure values ​​(mmHg) against the background of a low IGF value (0.86 conventional units and below), after 1 year, systolic IBP was recorded taking into account age, height and gender.

[0018] Example 4.

[0019] Girl N. (11 years old) with excess body weight (22.8 kg / m 2 ) had normal initial ambulatory blood pressure values ​​taking into account age, height, and gender - 106 / 66 mmHg. According to the results of instrumental studies (Lazma PF) of microcirculation (M, conventional units) before and immediately after PE, the initial index of the functional reserve of microcirculation (IFRM = 3.39 / 3.88) was 0.87 conventional units, i.e. the girl did not belong to the high-risk group for developing hypertension. The schoolgirl did not receive any non-drug recommendations for the prevention of arterial hypertension; no long-term drug therapy was administered for 1 year. After 1 year, outpatient blood pressure was 114 / 67 mmHg (normal blood pressure). Thus, in a girl with excess body weight and initially normal blood pressure values ​​(mmHg) against the background of a standard value of the IGF-I (more than 0.86 conventional units), after 1 year, normal blood pressure was recorded taking into account age, height and gender.

[0020] Example 5.

[0021] Boy V. (15 years old) with excess body weight (25.2 kg / m 2 ) had normal initial ambulatory blood pressure (BP) taking into account age, height, and gender - 118 / 68 mmHg. According to the results of instrumental studies (LASMA PF) of microcirculation (M, conventional units) before and immediately after PE, the initial index of the functional reserve of microcirculation (IFRM = 4.93 / 5.37) was 0.92 conventional units, i.e. the child did not belong to the high-risk group for developing hypertension. The boy did not receive any non-drug recommendations for the prevention of arterial hypertension; no long-term drug therapy was administered for 1 year. After 1 year, outpatient BP was 123 / 72 mmHg (normal blood pressure). Thus, in a boy with excess body weight and initially normal blood pressure values ​​(mmHg) against the background of a standard value of the IGF-I (more than 0.86 conventional units), after 1 year, normal blood pressure was recorded taking into account age, height and gender.

[0022] Example 6.

[0023] Girl T. (16 years old) with excess body weight (28.1 kg / m 2 ) had normal initial ambulatory blood pressure, taking into account age, height, and gender - 121 / 72 mmHg. According to the results of instrumental studies (Lasma PF) of microcirculation (M, conventional units) before and immediately after PE, the initial index of the functional reserve of microcirculation (IFRM = 14.24 / 10.76) was 1.32 conventional units, i.e. the girl did not belong to the high-risk group for developing hypertension. The schoolgirl did not receive non-drug recommendations for the prevention of arterial hypertension, and no long-term drug therapy was carried out for 1 year. After 1 year, outpatient blood pressure was 122 / 74 mmHg (normal blood pressure). Thus, in a girl with excess body weight and initially normal blood pressure values ​​(mmHg) against the background of a standard value of the IGF-I (more than 0.86 conventional units), after 1 year, normal blood pressure was recorded taking into account age, height and gender.

[0024] Example 7.

[0025] Girl K. (14 years old) with excess body weight (23.9 kg / m 2 ) had normal initial ambulatory blood pressure values ​​taking into account age, height, and gender - 117 / 70 mmHg. According to the results of instrumental studies (Lasma PF) of microcirculation (M, conventional units) before and immediately after PE, the initial index of the functional reserve of microcirculation (IFRM = 3.75 / 5.98) was 0.63 conventional units, i.e. the girl belonged to the high-risk group for developing hypertension. The schoolgirl did not receive any non-drug recommendations for the prevention of arterial hypertension; no long-term drug therapy was administered for 1 year. After 1 year, outpatient blood pressure was 133 / 76 mmHg (isolated systolic hypertension, stage 1). Thus, in a girl with excess body weight and initially normal blood pressure values ​​(mmHg) against the background of a low IGF-I value (0.86 conventional units and below), isolated systolic hypertension of stage 1 was recorded after 1 year, taking into account age, height and gender.

[0026] Further dynamic outpatient blood pressure measurements were conducted (after 1 year) in 12 school-age children with a baseline IGFMI value of 0.86 conventional units or less and in 20 children with a baseline IGFMI value greater than 0.86 conventional units. School-age children (11-17 years old) were randomly selected for the dynamic study. No significant differences in gender or age were determined between the groups. The schoolchildren did not receive any non-drug recommendations for the prevention of arterial hypertension, and no long-term drug therapy affecting blood pressure levels was carried out.

[0027] It was revealed that after 1 year, in school-age children with an initial IFM value of 0.86 conventional units or less (n=12), normal BP, taking into account the child's age, height, and gender, was not determined; high normal systolic blood pressure (HNSBP) was recorded in 7 school-age children; isolated systolic hypertension of the 1st degree - in 5 schoolchildren. Accordingly, in dynamics (after 1 year), a significant increase in the average values ​​of systolic BP (BP syst.) was recorded in schoolchildren in this group. исх. показатель = 117.6±4.8 mmHg; syst. BP. через 1 год = 130.4±5.5 mmHg; p<0.05).

[0028] In the dynamics (after 1 year) of school-age children (n=20) with an initial systolic blood pressure index value of more than 0.86 conventional units, it was revealed that only 1 of the twenty examined (5.0%) had high normal systolic blood pressure (p>0.05) taking into account the child’s age, height, and gender; the remaining 19 schoolchildren (95.0%) maintained normal blood pressure after 1 year, taking into account age, height, and gender.

[0029] The conducted conjugate statistical analysis between the two specified groups depending on the initial value of the IGFRM using the chi-square criterion confirmed the relationship between the factorial (IGFRM is equal to or less than 0.86 conventional units) and the resultant (diagnosis of high blood pressure after 1 year - HBP or AG) signs (χ 2 =28.06, significance level p<0.001).

[0030]

[0031]

[0032]

[0033] Thus, the proposed method for determining the high-risk group for developing primary arterial hypertension in overweight schoolchildren is effective.

[0034] The advantages of the proposed method are that:

[0035] 1. Quantitative assessment of the MFRI (microcirculation functional reserve index) allows us to determine the personalized risk of developing primary hypertension in school-age children with excess body weight and normal blood pressure values ​​(high-risk group);

[0036] 2. Establishing a high-risk group allows for timely primary prevention (non-drug recommendations for optimizing nutrition and physical activity, psychological correction) in schoolchildren, thereby avoiding the development of cardiovascular risks in later years of their lives.

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