1
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
1-8
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
ABSTRACT
The aim of this study was to assess the results of 24-hour blood pressure monitoring (ABPM) in adolescents with
autonomic dystonia syndrome. We examined 243 adolescents 12-18 years old with clinically and laboratory-
instrumental confirmed dysfunction of the autonomic nervous system - autonomic dystonia syndrome. It was revealed
that in adolescents with autonomic dystonia syndrome, as a result of ABPM, significant deviations from the standards
recommended at the moment for assessing the results of ABPM in children were found. The identified deviations may
indicate an increase in vascular tone in these children, as well as the presence of disorders associated with the
development of cardiovascular complications in adulthood.
KEYWORDS
Adolescents, autonomic disorders, 24-hour blood pressure monitoring.
INTRODUCTION
Currently, there is no doubt that its origins lie in
childhood and adolescence [1,2,7]. Epidemiological
data indicate that the prevalence of the disease in
schoolchildren ranges from 20 to 180% [3]. The
Research Article
24-HOUR BLOOD PRESSURE MONITORING IN ADOLESCENTS WITH
VEGETATIVE DYSTONIA SYNDROME
Submission Date:
December 21, 2021,
Accepted Date:
January 02, 2022,
Published Date:
January 12, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue01-01
Sh. Kurtieva
Researcher, Center for the development of professional qualifications of medical workers, Tashkent,
Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
2
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
1-8
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
variability of the data can be associated with
differences
in
geographic
and
ecological
characteristics, social status of the subjects, their diet
and lifestyle.
In half of the children, the disease is asymptomatic,
which makes it difficult to identify, and therefore, its
timely treatment. Children with higher than average
blood pressure (BP) tend to increase with age. In the
future, it remains elevated in 33-42%, and in 17-26% of
children, arterial hypertension progresses, i.e. every
third child with elevations in blood pressure may
subsequently develop hypertension (4).
For a real change in the existing situation, primary
prevention is of the greatest importance, which is
based on the concept of risk factors for cardiovascular
diseases, confirmed by numerous epidemiological and
clinical studies [5, 6].
THE MAIN RESULTS AND FINDINGS
To analyze the results of daily blood pressure
monitoring in adolescents with autonomic dystonia
syndrome.
243 adolescents of puberty with vegetative dystonia
syndrome (SVD) were assessed for 24-hour blood
pressure monitoring (ABPM), who were examined in
the Teenage Center of the city of Tashkent for the
period 2018-2020. Of these, there were 87 adolescent
boys, average age 15.0 ± 2.2 years, and adolescent girls
156, average age 15.3 ± 2.6 years. In the course of the
study, groups of adolescents with SVD were formed
depending on gender and a history of perinatal
nervous system pathology (PPNS), group 1 consisted of
53 (21.8%) adolescent boys with PPNS, group 2 - 34
(14.0% ) adolescent boys without PPNS, 3 groups
comprised 107 (44.0%) adolescent girls with PPNS and
group 4 - 49 (20.2%) adolescent girls without PPNS.
Outpatient ABPM in adolescents was performed using
the TM-2421 and TM-2430 monitors from A&D
Company Ltd., using the oscillometric method (in the
case of TM-2421, also in combination with the
auscultatory method). The study began in the time
range from 10 to 12 am, carried out according to the
standard method. The average number of blood
pressure measurements for each adolescent during
the day was 46 cases.
The results were processed as follows: calculation of
the mean, standard deviation, Mann-Whitney U-test,
correlation analysis. Programs used: Microsoft Office
Excel, Stadia.
When assessing the mean level of systolic blood
pressure (SBP) and diastolic blood pressure (DBP)
during wakefulness and nocturnal sleep, the following
results were obtained. The mean SBP values in all cases
exceeded the levels of the 75th percentile during the
waking period and during the night sleep. An excess of
the 95th percentile level for SBP was noted in
adolescents of both sexes with a history of PPNS.
Average DBP values in adolescents in groups II and IV
did not exceed the 75th percentile level during the
entire monitoring period. In adolescents of groups I
and III, the level of DBP during the day exceeded the
value of the 75th percentile, and at night it reached the
level of the 95th percentile and even exceeded it.
The presented table 1 shows the ABPM data in
adolescents, depending on the magnitude of the
pressure load during the day. In the examined
adolescents in group I, 28.3% of cases had a labile form
of AH (PAH), and 5.7% had stable AH (AH). In group II,
PAH was noted in 11.8%, SAG was found in 2.9% of cases.
In group III, 20.6% had PAH according to ABPM data
and 3.7% had SAH. As for group IV, PAH was registered
in 6.1% of adolescents, SAG was not recorded. In groups
3
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
1-8
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
of girls (III and IV), hypotension was significantly more
frequent compared to groups of boys (I and II) 23.4%
and 26.5% versus 7.5% and 8.8%, respectively. (Table 1.).
Table 1.
Results of ABPM in adolescents
depending on the availability of PPNS and gender
Thus, BP instability is noted in adolescents with SVD.
PAH is more common in groups of children with a
history of PPNS; in the group of adolescent girls, in
addition to PAH, a fairly high percentage of children
had low BP values compared to the norm.
Subsequently, the data for ABPM were considered in
terms of hypertensive load, i.e., depending on the
number of measurements of blood pressure,
overestimating the established limits, values of the
95th percentile, during the day. In the literature, it is
believed that in healthy adolescents this indicator
should not exceed 25%, with labile hypertension (PAH),
the percentage of excess is from 25 to 50%, and with
stable hypertension - 50% or more in the daytime and at
night. Similar approaches to data analysis are also used
in pediatrics [Table 2, Fig. 1].
Table 2.
The value of the night decrease in blood pressure (in%) in the examined adolescents and adolescents
Types
of blood
pressure
Group I, n =
53
Group II,
n = 34
Group III, n
= 107
IV
group, n = 49
SBP
12,01+5,7
13,54±6,8
12,08+5,7**
13,18+6,3
DBP
15,92±6,8*#^
17,16+7,5
16,23±6,8**
17,27+8,1
Note: * - p <0.05 differences between groups I and II.
** - p <0.001 differences between groups III and IV.
^ - p <0.001 differences between groups I and III.
# -
p <0.001 differences between groups I and IV.
4
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
I
SSUE
01
Pages:
1-8
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Figure 1. The value of the nighttime decrease in blood pressure (in%) in the examined adolescents and
adolescents.
Table 3 shows the data characterizing the value of the
nighttime decrease in blood pressure in the examined
adolescents. In groups III and IV, adolescents without
PPNS were dominated by patients with an optimal
decrease in SBP and DBP at night - dipper (SBP) - 50.0%
and 51.5%, respectively, and dipper (DBP) with
insufficient reduction in blood pressure at night - non -
dipper - 41.5% and 39.3%, respectively. In the groups of
patients with SVD and PPNS, children with insufficient
decrease in blood pressure at night prevailed - non-
dipper (SBP) 37.7% and 36.4%, respectively, - non-dipper
(DBP) - 24.5% and 29, 0% respectively. It should be noted
that the percentage of cases of insufficient decrease in
SBP and DBP in boys was higher than in girls.
5
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
1-8
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Table 3.
Types of nocturnal BP reduction in adolescents with SVD
Thus, it can be noted that in groups II and IV, during
ABPM (pressure load value less than 25%), normal
indicators of a nighttime decrease in blood pressure
were found. At the same time, the degree of nocturnal
decrease in DBP in these children and adolescents was
insufficient in comparison with the indicators given by
M. Soergel. Apparently, this indicates a dysregulation
of blood pressure in this group of children with a
tendency to increase vascular tone.
In groups I and III of children, the degree of nocturnal
decrease in SBP was more pronounced in comparison
with the data of M. Soergel, although the difference
was small. This fact may indirectly indicate a significant
proportion in this group with the "daytime" form of
labile hypertension. It should be noted that the degree
of nocturnal decrease in DBP, as in labile hypertension,
was very significantly different from the data of M.
Soergel in the direction of insufficient decrease.The
latter may indicate that in the children we examined
with hypertension, significant disturbances in the
circadian rhythm of blood pressure were observed,
mainly associated with an increase in peripheral
vascular resistance.
Noteworthy is the significant proportion of
adolescents with over-dipper type nighttime BP
reduction and insufficient BP reduction (non-dipper) in
children with labile AH. It should be noted that among
people with normal blood pressure (according to
ABPM data), more often than in the group of
confirmed hypertension, there were children who did
not give an adequate decrease in blood pressure at
night.
In the literature there are indications that in patients
with hypertension during outpatient monitoring of
blood pressure, an increased variability of blood
pressure is recorded [6,7], that increased variability of
blood pressure, as well as the degree of nocturnal
decrease in blood pressure, has a high prognostic value
in terms of the occurrence of cardiovascular
complications in adult patients [2,4].
6
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
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01
Pages:
1-8
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
We also analyzed the variability of blood pressure per
day, the period of wakefulness and night sleep in the
examined adolescents.The data are presented in Table
4.
Table 4.
Variability of blood pressure in groups of adolescents with varying degrees of pressure load.
BP
variability
Group I, n
= 53
Group
II, n = 34
Group
III, n = 107
IV group, n
= 49
SBP per day
12,1+3,5*
11,6+3,2
12,3+3,5
11,2+2,2
DBP per day
11,2+2,8*
9,2+2,9
10,8+1,5^
8,9+4,1
SBP in the
afternoon
13,2+3,4*
12,4+4,3
13,6+5,2^
11,9+2,7
DBP in the
afternoon
7,9+2,6
6,5+6,1
7,3+5,4
6,7+1,9
SBP at night
10,5+4,3*#
8,4+2,7
9,6+3,1^
7,9+2,5
DBP at night
8,1+3,5*#
6,3+2,1
7,8+1,5
6,8+2,1
Note * - p <0.005 - reliability of differences between groups I and II. ^ p <0.005 - III - IV groups. # - p <0.005 -
between groups I and III.
From the above data, it follows that the variability of
SBP and DBP in adolescents in groups I and III is
significantly greater in comparison with the variability
in blood pressure in groups II and IV of adolescents.
The results obtained can be formulated as follows:
When studying the circadian rhythm of blood pressure,
it was found that the degree of nocturnal decrease in
DBP in the examined adolescents with PPNS was
significantly less than in adolescents without PPNS
examined by M. Soergel. This fact may indicate that an
insufficient decrease in vascular tone at night indicates
a violation of the pressor and depressor mechanisms in
the group of children with PPNS. The study of blood
pressure variability showed a significant increase in this
indicator depending on the degree of hypertensive
load.
Thus, in adolescents with PPNS, as a result of ABPM,
significant
deviations
from
the
standards
recommended at the moment for assessing the results
of ABPM in children were found. The identified
deviations may indicate an increase in vascular tone in
these children, as well as the presence of disorders in
them, associated with
the development of
cardiovascular complications in the adult state. These
deviations were noted not only in adolescents with
SVD with PPNS, but also in the group of patients with
SVD without PPNS.
7
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
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01
Pages:
1-8
SJIF
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(2020:
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(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
CONCLUSION
In conclusion, it should be noted that as a result of
using the ABPM method, labile hypertension can be
detected. This fact, from our point of view, may rather
indicate the high diagnostic value of the traditional
method for determining blood pressure and once
again emphasizes the importance of accurate
adherence to the method for measuring blood
pressure in the usual way.
As an additional method of examination in children and
adolescents with SVD, ABPM can be useful in terms of
assessing the severity of the disease, and will also help
identify groups of children with various types and
forms of impairments in blood pressure regulation.
Comparison of the results obtained during the ABPM,
with the history data, the state of health at the time of
the examination and the data of other instrumental
studies will contribute to the formation of a
differentiated approach to the treatment and
dispensary observation of children and adolescents
with SVD.
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Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
I
SSUE
01
Pages:
1-8
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
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