USE OF INDICATORS OF THE STATE OF MICROCIRCULATION IN THE DIAGNOSTICS OF ARTERIAL HYPERTENSION IN SCHOOLCHILDREN

Abstract

Objective . Arterial hypertension is a disease characterized by a periodic or persistent increase of blood pressure that occurs on the background of excessive activity of the sympathoadrenal or renin-angiotensin-systems. The prevalence of hypertension in children is from 1% to 14%, among schoolchildren - 12-18%. The diagnosis of hypertension is established in children in the case when primary arterial hypertension persists for 1 year or more or earlier (in the presence of target organ damage). Purpose of the study. To evaluate and use indicators of the state of microcirculation in the diagnosis of arterial hypertension in schoolchildren. Materials and methods. 80 children of school age from the countryside and the city of Chernivtsi were examined. The average age of the children was 14.2 ± 0.11 years. The main group (40 persons) included children with high blood pressure, and the control group consisted of 40 clinically healthy children. Blood pressure was measured with an automatic blood pressure monitor with interchangeable cuffs, three times with an interval of 2 minutes. The evaluation of the state of peripheral microcirculation was carried out using computer capillaroscopy (quantitative and qualitative parameters were estimated). Results. In 26 children (65.0%) of the main group, the level of blood pressure was within the range of 90-95%, which is estimated as arterial prehypertension; in 14 children (35.0%) - exceeded the 95th percentile, which is regarded as grade 1 arterial hypertension. In all children of the control group, the level of blood pressure was within the range of 25-75 percentile corridor, which corresponds to the normal level of blood pressure. During biomicroscopy of the nail bed capillaries in the main group, 4 children (10%) showed a change in the shape of the capillaries, and there was a decrease in their number per unit area, in 9 children (22.5%) the phenomenon of "sladge" and slowing of blood flow with local spasm of capillaries was observed. In the control group, there were no such changes. When assessing the perivascular zone, linear density and capillary length, there were no differences in these indicators between the groups. A significant difference was observed in children of the main group among the following indicators:  average capillary width, distance between capillaries, average number of anastomoses, which is explained by the presence of local capillary spasm due to reduced oxygenation and slowed blood flow in children with arterial hypertension. Conclusions . In children with arterial hypertension, symptoms of microcirculation disturbance are more often manifested wiyh: a decrease in the width of the capillary, the presence of the phenomenon of "sladge", local spasm and a slowdown in blood flow, a change in the shape of the capillary, which can be explained by vegetative dysregulation, which in turn is accompanied by a violation of hemodynamics at all levels, including capillary.