| Abstract [eng] |
Background. Arterial hypertension in young age has been shown to track into adulthood, increasing the risk of premature cardiovascular mortality. With the rising global prevalence of pediatric hypertension, timely correct diagnosis and appropriate treatment are essential. As adherence to diagnostic and treatment recommendations remains underexplored in real-life settings, this work aimed to assess the diagnostic and treatment practices of pediatric arterial hypertension in Lithuania and to provide recommendations to parents, the public, and healthcare professionals. Methods. Master thesis was conducted in two parts, the first involved two anonymous online cross-sectional surveys of Lithuanian adolescents aged 14–17 years and parents with children under 18 years, using developed original questionnaires. The second part comprised a cross-sectional analysis of reimbursed antihypertensive medications prescribed to children aged 0–17 years, categorized by disease aetiology and patient age. Results. In the first part, 1504 parents and 448 adolescents were surveyed. Median age of the surveyed parents‘ children and adolescents was 6 years, 50.2% were female. Blood pressure was measured only in 55% of all children aged 3 years or older, it was observed that the rates of measurements increased with age and exceeded 80% from the age of 14 years. Only 3.3% of respondents reported that their blood pressure was measured correctly. Common errors included single measurements (81.4%), incorrect positioning (40.7%), miscuffing (39.2%) and insufficient rest time before measurement (27.9%). Lack of feedback was observed in 60.2% of cases. The second part analysis found that 46.3% of primary and 51.7% of secondary hypertension patients received pharmacological treatment. Most (80.3%) received monotherapy. Irrespective of age or disease aetiology, angiotensin-converting enzyme inhibitors were the most popular drugs among all children. Beta-adrenoceptor blockers came second and calcium channel blockers third. The lowest proportion of primary hypertension patients were treated with diuretics and ‘‘other‘‘ class of drugs, while those with secondary hypertension - with a combination of drugs. Conclusions. The first part of the study revealed that blood pressure screening in Lithuanian primary care remains insufficient, with frequent technical errors. The second part of the study showed that not all children with secondary hypertension receive treatment, beta-adrenoceptor blockers were overused, while angiotensin II receptor blockers and diuretics were underused. Most children received monotherapy, predominantly with angiotensin-converting enzyme inhibitors, irrespective of age or hypertension type. |
