Современные подходы к лечению артериальной гипертензии у детей и подростков: обзор клинических рекомендаций

Учитывая рост распространенности повышенного артериального давления (АД) у детей и подростков, знакомство педиатров с современными тенденциями медикаментозной и немедикаментозной терапии артериальной гипертензии (АГ) представляется актуальным и своевременным. Цель работы — представить обзор международных и отечественных рекомендаций по лечению АГ. Проведен поиск информации в сети PubMed по ключевым словам recommendations, arterial hypertension treatment, guidelines of management, pediatric hypertension. Проанализированы обзоры, клинические рекомендации и оригинальные статьи, опубликованные c 2010 по 2020 г. Дано подробное описание дифференцированной тактики лечения АГ у детей и подростков. Подробно обсуждены подходы к немедикаментозной коррекции повышенного АД, описаны показания к антигипертензивной терапии, дана характеристика основных классов гипотензивных средств — показания, противопоказания и возможные побочные эффекты. Также описаны принципы терапии рефрактерной АГ и правила сочетания антигипертензивных средств.

1. Александров А.А., Кисляк О.А., Леонтьева И.В., Розанов В.Б. Диагностика, лечение и профилактика артериальной гипертензии у детей и подростков: российские рекомендации (второй пересмотр) // Кардиоваскулярная терапия и профилактика. — 2009. — Т. 8. — № 4 S1. — 32 с.

2. Song P, Zhang Y Yu J, et al. Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA Pediatr. 2019;173(12):1154-1163. 10.1001/jamapediatrics.2019.3310

3. Rosner B, Cook NR, Daniels S, Falkner B. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension. 2013;62(2):247-254. doi: 10.1161/HYPERTENSI0NAHA.111.00831

4. Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann NY Acad Sci. 2018;1411(1):166-183. doi: 10.1111/nyas.13602

5. Kelishadi R, Mirmoghtadaee P, Najafi H, Keikha M. Systematic review on the association of abdominal obesity in children and adolescents with risk factors. J Res Med Sci. 2015;20(3):294-307.

6. Xi B, Zhang T, Li S, et al. Can Pediatric Hypertension Criteria Be Simplified? APrediction Analysis ofSubclinical Cardiovascular Outcomes from the Bogalusa Heart Study. Hypertension. 2017;69(4):691-696. doi: 10.1161/HYPERTENSI0NAHA.116.08782

7. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. doi: 10.1542/peds.2017-1904

8. Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887-1920. doi: 10.1097/HJH.0000000000001039

9. Dionne JM, Harris KC, Benoit G, et al. Hypertension Canada Guideline Committee. Hypertension Canada's 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension. Can J Cardiol. 2017;33(5):577-585. doi: 10.1016/j.cjca.2017.03.007

10. Александров А.А., Кисляк О.А., Леонтьева И.В. Клинические рекомендации. Диагностика, лечение и профилактика артериальной гипертензии у детей и подростков // Системные гипертензии. — 2020. — Т. 17. — № 2. — С. 7-35. doi: 10.26442/2075082X.2020.2.200126

11. Khoury M, Urbina EM. Hypertension in adolescents: diagnosis, treatment, and implications. Lancet Child Adolesc Health. 2021;5(5):357-366. doi: 10.1016/S2352-4642(20)30344-8

12. Blanchette E, Flynn JT. Implications of the 2017 AAP Clinical H Practice Guidelines for Management of Hypertension in Children and Adolescents: a Review. Curr Hypertens Rep. 2017;21(5):35. doi: 10.1007/s11906-019-0943-x

13. Matossian D. Pediatric Hypertension. Pediatr Ann. 2018;47(12):e499-e503. doi: 10.3928/19382359-20181119-01

14. Salas P, Gonzalez C, Carrillo D, et al. Blood hypertension in children. Guideliness for diagnosis and treatment. Part 2 Pediatric Nephrology Branch, Chilean Pediatric Society. Rev Chil Pediatr. 2019;90(3):336-342. doi: 10.32641/rchped.v90i3.1007

15. Goel M, Pal P Agrawal A, Ashok C. Relationship of body mass index and other life style factors with hypertension in adolescents. Ann Pediatr Cardiol. 2016;9(1):29-34. doi: 10.4103/0974-2069.171393

16. Hvidt KN, Olsen MH, Ibsen H, Holm JC. Effect of changes in BMI and waist circumference on ambulatory blood pressure in obese children and adolescents. J Hypertens. 2014;32(7):1470-1477. doi: 10.1097/HJH.0000000000000188

17. Bondyra-Wisniewska B, Myszkowska-Ryciak J, Harton A. Impact of Lifestyle Intervention Programs for Children and Adolescents with Overweight or Obesity on Body Weight and Selected Cardiometabolic Factors-A Systematic Review. Int J Environ Res Public Health. 2021;18(4):2061. doi: 10.3390/ijerph18042061

18. Zhang T, Zhang H, Li S, et al. Impact of adiposity on incident hypertension is modified by insulin resistance in adults: longitudinal observation from the Bogalusa Heart Study. Hypertension. 2016;67(1):56-62. doi: 10.1161/HYPERTENSIONAHA.115.06509

19. Barnes TL, Crandell JL, Bell RA, et al. Change in DASH diet score and cardiovascular risk factors in youth with type 1 and type 2 diabetes mellitus: The SEARCH for Diabetes in Youth Study. Nutr Diabetes. 2013;3(10):e91. doi: 10.1038/nutd.2013.32

20. Juonala M, Viikari JS, Kahonen M, et al. Life-time risk factors and progression of carotid atherosclerosis in young adults: the Cardiovascular Risk in Young Finns study. Eur Heart J. 2010;31(14):1745-1751. doi: 10.1093/eurheartj/ehq141

21. Yuan WL, Kakinami L, Gray-Donald K, et al. Influence of dairy product consumption on children's blood pressure: results from the QUALITY cohort. J Acad Nutr Diet. 2013;113(7):936-941. doi: 10.1016/j.jand.2013.03.010

22. Buendia JR, Bradlee ML, Daniels SR, et al. Longitudinal effects of dietary sodium and potassium on blood pressure in adolescent girls. JAMA Pediatr. 2015;169(6):560-568. doi: 10.1001/jamapediatrics.2015.0411

23. Saneei P, Hashemipour M, Kelishadi R, et al. Effects of recommendations to follow the Dietary Approaches to Stop Hypertension (DASH) diet vs. usual dietary advice on childhood metabolic syndrome: a randomised cross-over clinical trial. Br J Nutr. 2013;110(12):2250-2259. doi: 10.1017/S0007114513001724

24. Niinikoski H, Jula A, Viikari J, et al. Blood pressure is lower in children and adolescents with a lowsaturated-fat diet since infancy: the special Turku coronary risk factor intervention project. Hypertension. 2009;53(6):918-924. doi: 10.1161/HYPERTENSI0NAHA.109.130146

25. Davis JN, Ventura EE, Cook LT, et al. LA Sprouts: a gardening, nutrition, and cooking intervention for Latino youth improves diet and reduces obesity. J Am Diet Assoc. 2011;111(8):1224-1230. doi: 10.1016/j.jada.2011.05.009

26. Yang Q, Zhang Z, Kuklina EV, et al. Sodium intake and blood pressure among US children and adolescents. Pediatrics. 2012;130(4):611-619. doi: 10.1542/peds.2011-3870

27. Boegehold MA. The effect of high salt intake on endothelial function:reduced vascular nitric oxide in the absence of hypertension. J Vasc Res. 2013;50(6):458-467. doi: 10.1159/000355270

28. Machado IBS, Tofanelli MR, Saldanha da Silva AA, Simoes E Silva AC. Factors Associated with Primary Hypertension in Pediatric Patients: An Up-to-Date. Curr Pediatr Rev. 2021;17(1):15-37. doi: 10.2174/1573396317999210111200222.

29. Farpour-Lambert NJ, Aggoun Y, Marchand LM, et al. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in prepubertal obese children. J Am Coll Cardiol. 2009;54(25):2396-2406. doi: 10.1016/j.jacc.2009.08.030

30. Garcia-Hermoso A, Saavedra JM, Escalante Y. Effects of exercise on resting blood pressure in obese children: a meta-analysis of randomized controlled trials. Obes Rev. 2013;14(11):919-928. doi: 10.1111/obr.12054

31. Fridolfsson J, Buck C, Hunsberger M, et al. Family consortium. High-intensity activity is more strongly associated with metabolic health in children compared to sedentary time: a cross-sectional study of the I.Family cohort. IntJ BehavNutrPhys Act. 2021;18(1):90. doi: 10.1186/s12966-021-01156-1

32. WHO. Physical activity. 26 November 2020. World Health Organization. Available online: https://www.who.int/news-room/fact-sheets/detail/physical-activity. Accessed on October 6, 2021.

33. Black HR, Sica D, Ferdinand K, et al. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 6: Hypertension: A Scientific Statement from the American Heart Association and the American College of Cardiology. Circulation. 2015;132(22):e298-e302. doi: 10.1161/CIR.0000000000000242

34. Baker-Smith CM, Pietris N, Jinadu L. Recommendations for exercise and screening for safe athletic participation in hypertensive youth. Pediatr Nephrol. 2020;35(5):743-752. doi: 10.1007/s00467-019-04258-y

35. Cai L, Wu Y, Wilson RF, et al. Effect of childhood obesity prevention programs on blood pressure: a systematic review and meta-analysis. Circulation. 2014;129(18):1832-1839. doi: 10.1161/CIRCULATIONAHA.113.005666

36. Zhu L, Liu J, Yu Y, Tian Z. Effect of high-intensity interval training on cardiometabolic risk factors in childhood obesity: a meta-analysis. J Sports Med Phys Fitness. 2021;61(5):743-752. doi: 10.23736/S0022-4707.20.11329-X

37. Gregoski MJ, Barnes VA, Tingen MS, et al. Breathing awareness meditation and Life Skills Training programs influence upon ambulatory blood pressure and sodium excretion among African American adolescents. J Adolesc Health. 2011;48(1):59-64. doi: 10.1016/j.jadohealth.2010.05.019

38. Barnes VA, Kapuku GK, Treiber FA. Impact of transcendental meditation on left ventricular mass in African American adolescents. Evid Based Complement Alternat Med. 2012;2012:923153. doi: 10.1155/2012/923153

39. Sieverdes JC, Mueller M, Gregoski MJ, et al. Effects of Hatha yoga on blood pressure, salivary а-amylase, and cortisol function among normotensive and prehypertensive youth. J Altern Complement Med. 2014;20(4):241-250. doi: 10.1089/acm.2013.0139

40. Luehrs RE, Zhang D, Pierce GL, et al. Cigarette Smoking and Longitudinal Associations With Blood Pressure: The CARDIA Study. J Am Heart Assoc. 2021;10(9):e019566. doi: 10.1161/JAHA.120.019566

41. Чазова И.Е., Жернакова Ю.В. Клинические рекомендации. Диагностика и лечение артериальной гипертонии // Системные гипертензии. — 2019. — Т. 16. — № 1. — С. 6-31. doi: 10.26442/2075082X.2019.1.190179

42. Nowak D, Jasionowski A. Analysis of the Consumption of Caffeinated Energy Drinks among Polish Adolescents. Int J Environ Res Public Health. 2015;12(7):7910-7921. doi: 10.3390/ijerph120707910

43. Kaelber DC, Liu W, Ross M, et al. Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study. Pediatrics. 2016;138(6):e20162195. doi: 10.1542/peds.2016-2195

44. Tirosh A, Afek A, Rudich A, et al. Progression of normotensive adolescents to hypertensive adults: a study of 26,980 teenagers. Hypertension. 2010;56(2):203-209. doi: 10.1161/HYPERTENSIONAHA.109.146415

45. Sladowska-Kozfowska J, Litwin M, Niemirska A, et al. Change in left ventricular geometry during antihypertensive treatment in children with primary hypertension. Pediatr Nephrol. 2011;26(12):2201-2209. doi: 10.1007/s00467-011-1916-8

46. Wuhl E, Trivelli A, Picca S, et al. for the ESCAPE Trial Group. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361(17):1639-1650. doi: 10.1056/NEJMoa0902066

47. Seeman T, Dusek J, Vondrak K, et al. Ramipril in the treatment of hypertension and proteinuria in children with chronic kidney diseases. Am J Hypertens. 2004;17(5 Pt 1):415-420. doi: 10.1016/j.amjhyper.2004.01.008

48. Chaturvedi S, Lipszyc DH, Licht C, et al. Pharmacological interventions for hypertension in children. Evid Based Child Health. 2014;9(3):498-580. doi: 10.1002/14651858.CD008117.pub2

49. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs-overview and meta-analyses. J Hypertens. 2015;33:195-211. doi: 10.1097/HJH.0000000000000447

50. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 5. Head-to-head comparisons of various classes of anti hypertensive drugs — overview and meta-analyses. J Hypertens. 2015;33(7):1321-1341. doi: 10.1097/HJH.0000000000000614

51. Gilbert N, Hage A. Treatment of arterial hypertension in children and adolescents. Update of therapeutic options. Med Monatsschr Pharm. 2015;38(4):120-131. quiz 133-134.

52. Ferguson MA, Flynn JT. Rational use of anthypertensive medications in children. Pediatr Nephrol. 2013;29(6):979-988. doi: 10.1007/s00467-013-2510-z

53. Maahs DM, Daniels SR, de Ferranti SD, et al. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the American Heart Association. Circulation. 2014;130:1532-1558. doi: 10.1161/CIR.0000000000000094

54. Kupferman JC, Aronson Friedman L, Cox C, et al. BP control and left ventricular hypertrophy regression in children with CKD. J Am Soc Nephrol. 2014;25(1):167-174. doi: 10.1681/ASN.2012121197

55. Niebauer J, Borjesson M, Carre F, et al. Recommendations for participation in competitive sports of athletes with arterial hypertension: a position statement from the sports cardiology section of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2018;39(40):3664-3671. doi: 10.1093/eurheartj/ehy511

56. Lu YT, Fan P, Zhang D, et al. Overview of Monogenic Forms of Hypertension Combined With Hypokalemia. Front Pediatr. 2021;8:543309. doi: 10.3389/fped.2020.543309

57. Gartlehner G, Vander Schaaf EB, Orr C, et al. Screening for Hypertension in Children and Adolescents: Systematic Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Nov. (Evidence Synthesis, No. 193.) Available online: https://www.ncbi.nlm.nih.gov/books/NBK564973. Accessed on October 7, 2021.

58. Erratum Flynn JT, Kaelber DC, Baker-Smith CM, et al. SUBCOMMITTEE ON SCREENING AND MANAGEMENT OF HIGH BLOOD PRESSURE IN CHILDREN. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904. Pediatrics. 2017;140(6):e20173035. doi: 10.1542/peds.2017-3035

59. Misurac J, Nichols KR, Wilson AC. Pharmacologic Management of Pediatric Hypertension. Paediatr Drugs. 2016;18(1):31-43. doi: 10.1007/s40272-015-0151-3

60. Sorof JM, Cargo P, Graepel J, et al. Beta-blocker/thiazide combination for treatment of hypertensive children: a randomised doubleblind, placebo-controlled trial. Pediatr Nephrol. 2002;17(5):345-350. doi: 10.1007/s00467-002-0851-0

61. Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547-1559. doi: 10.1056/NEJMoa0801317

62. Parving HH, Brenner BM, McMurray JJ, et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med. 2012;367(23):2204-2213. doi: 10.1056/NEJMoa1208799

63. Fried LF, Emanuele N, Zhang JH, et al. Combined angio- tensin inhibition for the treatment of diabetic nephropathy. N Engl J Med. 2013;369(20):1892-1903. doi: 10.1056/NEJMoa1303154

64. Lubrano R, Soscia F, Elli M, et al. Renal and cardiovascular effects of angiotensin-converting enzyme inhibitor plus angiotensin II receptor antagonist therapy in children with proteinuria. Pediatrics. 2006;118:e833-e838. doi: 10.1542/peds.2005-2053

65. Snauwaert E, Vande Walle J, De Bruyne P Therapeutic efficacy and safety of ACE inhibitors in the hypertensive paediatric population: a review. Arch Dis Child. 2017;102(1):63-71. doi: 10.1136/archdischild-2016-310582

66. Schaefer F, van de Walle J, Zurowska A, et al. Candesartan in Children with Hypertension Investigators. Efficacy, safety and pharmacokinetics of candesartan cilexetil in hypertensive children from 1 to less than 6 years of age. J Hypertens. 2010;28:1083-1090. doi: 10.1097/HJH.0b013e328336b86b

67. Flynn JT, Meyers KE, Neto JP, et al. Efficacy and safety of the angiotensin receptor blocker valsartan in children with hypertension aged 1 to 5 years. Hypertension. 2008;52(2):222-228. doi: 10.1161/HYPERTENSIONAHA.108.111054

68. Siddiqi N, Shatat IF. Antihypertensive agents: a long way to safe drug prescribing in children. Pediatr Nephrol. 2020;35(11):2049-2065. doi: 10.1007/s00467-019-04314-7

69. Sahney S. A review of calcium channel antagonists in the treatment of pediatric hypertension. Paediatr Drugs. 2006;8(6):357-373. doi: 10.2165/00148581-200608060-00004

70. Poirier L, Lacourciere Y. The evolving role of p-adrenergic receptor blockers in managing hypertension. Can J Cardiol. 2012;28(3):334-340. doi: 10.1016/j.cjca.2012.04.001

71. Vachek J. The use of moxonidine in the treatment of arterial hypertension. Vnitr Lek. 2021;67(3):170-172.

72. Леонтьева И.В., Балыкова Л.А., Кудашова А.В. Лечение неотложных состояний (гипертонического криза) у детей с артериальной гипертензией // Российский вестник перинатологии и педиатрии. — 2020. — Т. 65. — № 3. — С. 147-152. doi: 10.21508/1027-4065-2020-65-3-147-152