- Management of health care in primary hypertensive students in Zaporizhzhia State Medical University
Management of health care in primary hypertensive students in Zaporizhzhia State Medical University
SOVREMENNAYA PEDIATRIYA.2018.3(91):12-17; doi 10.15574/SP.2018.91.12
Ivanko O. G., Tovma A. V., Patsera M. V., Volokh N. H.
Zaporizhzhia State Medical University, Ukraine
Timely diagnosis and treatment of primary arterial hypertension (AH) in young people is of paramount importance for preventing complications of the disease and premature death in adulthood.
Objective: to discuss the efficacy of evaluation, prevention and treatment of primary AH in students, created on the basis of annual preventive medical examinations, and follow-up monitoring with the participation of medical staff of paediatric and therapeutic departments of the university.
Material and methods. During the annual preventive medical examination, provided in the medical university for the first-year students, the arterial blood pressure (BP) is measured. The value of BP equal or higher then 120/80 mm Hg is considered as a basis for further medical evaluation. The diagnosis of primary AH is established by daily BP monitoring with complex clinical, laboratory and instrumental examination. Taking into account that subjective complaints in adolescents with primary AH are poorly informative for diagnosis and prognosis, the SF-36 questionnaire was used to determine the general health perceptions.
Considering that the left ventricular hypertrophy (LVH) is the most unfavourable cardiovascular event in young hypertensive people, the evaluation of LVH predictors by echocardioscopy (Echo-CS), electrocardiography (ECG) and genes polymorphism of the NFATC family was performed.
Results. The diagnosis of primary AH is established every year in 19% of first-year students. Among them there are 16.7% of individuals with «high normal BP levels», 48.8% of adolescents — with labile AH, 23.8% — with stable AH, 8.3% of students with «white coat» hypertension and 4.8% — with the masked hypertension (detected only by ambulatory BP monitoring). It was found that 29.8% of adolescents with newly diagnosed AH had an ECG Sokolov-Lyon index positive for LVH and the further examination within 6–12 months revealed its development. In the same time the detected association between the CG genotype SNP rs2229309 of the NFATC4 gene and development of LVH has given evidence that listed signs as prognostically unfavourable can be useful to provide timely pharmacological treatment.
Conclusions. To organize medical care for students with newly diagnosed primary hypertension, it is necessary to implement medical screening of elevated BP and clinical examination with the study of prognostic predictors of unfavourable course of the disease.
Key words: adolescents, hypertension, diagnosis, risk factors, left ventricular hypertrophy, single nucleotide polymorphisms of NFATC.
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