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 child population in order to prevent bad habits (alcohol, drugs, smoking) and promote a healthy lifestyle. The preventive program should be oriented not only to the school, but also to the family. It is important to disseminate knowledge about lifestyle and health, to provide the necessary social support to motivate action in the desired direction. Children should be taught a healthy lifestyle in the same way as they are taught to read, write, and count.

Proper nutrition

The daily diet of children should contain all the necessary essential and replaceable nutritional factors in quantities corresponding to the physiological needs of children and adolescents for essential nutrients and energy. Preference should be given to milk and dairy products with a low fat content, which allows for the replenishment of protein and calcium needs, while avoiding excessive caloric content. The diet should include a variety of vegetables and fruits, which are sources of vitamins, minerals, starchy carbohydrates, organic acids and dietary fiber. Vegetable consumption should exceed fruit consumption by approximately two times. High intake of antioxidants from vegetables and fruits helps protect the body from the damaging effects of free radicals. Legumes, peanuts, bread, green vegetables such as spinach, Brussels sprouts and broccoli are sources of folic acid. Sources of iron are leafy greens of the cabbage family (broccoli, spinach).

Reducing the consumption of table salt

Children with arterial hypertension should limit their consumption of table salt to 70 mmol sodium per day. It is recommended to use iodized salt and increase the amount of potassium- and magnesium-rich foods in the diet. The largest amount of potassium (more than 0.5 g per 100 g of product) is found in dried apricots, beans, peas, seaweed, prunes, raisins, and jacket potatoes.

Reducing excess body weight

Elimination of excess body weight not only reduces blood pressure, but also reduces sensitivity to salt, and reduces manifestations of dyslipidemia and insulin resistance. In children with obesity, the daily caloric content of food should be more strictly limited, fat consumption should be reduced (up to 30% of daily caloric content). Consumption of sugars is limited: sweets, confectionery, sweet drinks (replace sweet soft drinks with mineral water, freshly squeezed juices).

Physical activity

Physical activity is an important aspect of hypertension prevention. Physical inactivity in children ranks first among other risk factors for cardiovascular diseases. This risk factor is most unfavorable in children during puberty. Regular physical training increases the level of blood oxygenation in children, increases the adaptive capacity of the cardiovascular system, and has a greater positive effect than in adults, promoting favorable development of the cardiovascular system. Physical activity is one of the most effective means of combating excess body weight and hypertension. Physical training helps increase the content of cholesterol in high-density lipoproteins (antiatherogenic fraction). According to the guidelines "Hygienic norm of physical activity for children and adolescents aged 5-18 years", the norm of organized physical activity should be 4-9 hours per week for girls and 7-12 hours for boys. Daily aerobic exercise lasting 30 to 60 minutes is recommended. Dynamic types of physical activity are preferable: walking, swimming, rhythmic gymnastics, cycling, skating, skiing, dancing. At the same time, static loads are contraindicated for children with arterial hypertension: lifting weights, various types of wrestling.

Energy expenditure during different types of physical activity

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

Prevention of lipid metabolism disorders

Prevention of lipid metabolism disorders should also be included in the complex of measures for arterial hypertension. Deviations in lipid metabolism indicators are most often detected in children with a combination of arterial hypertension and obesity, with elevated triglyceride levels and low levels of high-density lipoprotein cholesterol most often detected. To correct hypertriglyceridemia (more than 1.7 mmol/l), it is advisable to correct excess body weight and limit easily digestible carbohydrates.

To correct hypercholesterolemia (more than 6.0 mmol/l) in school-age children who are at high risk, a diet is prescribed that includes limiting fats to less than 20-30% of total calories; maintaining a 1:1 ratio of saturated and unsaturated fatty acids; limiting cholesterol intake from 200 to 300 mg% per day.

The principle of dispensary observation

Medical examination is a method of active dynamic monitoring of the health of the population, including children and adolescents. All children and adolescents with a hereditary burden of hypertension, high normal blood pressure, hypertension and hypertension are subject to medical examination.

The medical examination includes the following activities:

• registration of all children and adolescents with a family history of hypertension, high normal blood pressure, hypertension and arterial hypertension;
• periodic medical examination of these individuals in order to prevent the progression of arterial hypertension;
• implementation of a range of health and therapeutic measures aimed at normalizing blood pressure;
• conducting medical and professional consultations and career guidance for children and adolescents with arterial hypertension and hypertension, taking into account their gender and age.

A pediatrician must examine children and adolescents with a family history of hypertension and high normal blood pressure once every 6 months (the examination is limited to anthropometry and three-time blood pressure measurements). This group must be included in dispensary group I.

If the diagnosis of arterial hypertension (essential or symptomatic) or hypertension is confirmed, the pediatrician observes the child or adolescent once every 3-4 months. To determine the scope of diagnostic measures, develop non-drug and drug treatment tactics and on issues of combating risk factors for hypertension, the child should be consulted by a cardiologist (for arterial hypertension - once every 6 months, for hypertension - once every 3 months). According to indications, the child or adolescent can be consulted by a nephrologist, ophthalmologist and neurologist. Mandatory examinations are carried out at least once a year, additional - according to indications.

Children and adolescents with arterial hypertension should be included in the II dispensary registration group, and those with hypertension - in the III.

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

Indications for inpatient examination of children and adolescents with arterial hypertension are persistent increase in blood pressure, presence of vascular crises, insufficient effectiveness of outpatient treatment, and unclear genesis of arterial hypertension.

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