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CNAA / Theses / 2020 / May /

Estimation of risk factors, clinical-biochemical and hemodynamic particularities in children with hypertension


Author: Mătrăgună Nelea
Degree:doctor habilitat of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2020
Scientific consultants: Mihai Popovici
doctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology
Ninel Revenco
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Medical-Sanitary Public Institution Institute of Cardiology

Status

The thesis was presented on the 28 May, 2020
Approved by NCAA on the 30 October, 2020

Abstract

Adobe PDF document – 2.09 Mb / in romanian

Thesis

CZU 616.12-008.331.1-056.52-053.2 (043.2)

Adobe PDF document 3.98 Mb / in romanian
198 pages

Keywords

hypertension, risk factors, children

Summary

Structure of the thesis: introduction, 5 chapters, synthesis of results, general conclusions and recommendations, bibliography from 323 titles, 198 text pages, 44 tables, 35 figures. The results obtained are published in 60 scientific papers.

Field of study: cardiology.

Purpose of the paper: The assessment of the clinical-biochemical and haemodynamic peculiarities, the impact of various risk factors present in hypertensive children according to body weight.

Objectives of the paper: Estimation of risk factors in the occurrence of hypertension (HT) in children; assessment of clinical-hemodynamic peculiarities of HT in children; assessment of lipid- specific, glucose spectrum specifics of chronic inflammation markers (hs, α-TNF) and adipokine (adiponectin, leptin) in hypertensive children and body weight; estimating the role of homocysteine as a marker of endothelial dysfunction; the assessment of catecholamines as markers of sympathetic nervous system involvement in pathogenic links of HT and obesity in children, as well as assessment of subclinical organ damage (assessment of microalbuminuria, left ventricular myocardium mass index, carotid artery intima thickness) in children with hypertension.

Scientific novelty and originality: A case-control study was conducted that assessed the impact of a complex block of risk factors with hypertensive determinism, including the role of hyperhomocysteinaemia and the deficiency of 25 OH vit D, a higher number of hypertensive children. The innovative intent is also to estimate the significance of microalbuminuria, the left ventricular myocardium mass index (LVMMI), the intimate-mean ratio in the common carotid artery, in their position of early markers of subclinical organ damage in hypertensive children. An unusual tentative research is testing leptin, serum adiponectin, hs, α-TNF PCR, serum catecholamines and urine to argue the role of the sympathetic nervous system, pro-inflammatory adipokines and cytokines in the pathogenetic links of HT and obesity in children. New results for science and practice obtained: The results, which determined the solution of a scientific and applicative problem, of major importance, lie in the scientific substantiation of the new visions on HT risk factors in children (traditional risk factors, hyperhomocysteinemia and difficulties in diagnosing diabetes, adipokine / cytokines, markers of endothelial dysfunction, involvement of the sympathetic nervous system and subclinical organ damage), which has contributed to a broader understanding of the pathophysiological mechanisms of achieving HT in children and confirmed the appropriateness of their use as early screening biomarkers of HT for the early application of prophylaxis and treatment measures.

Theoretical significance:
In-depth research on the risk factors, premises, and circumstances involved in the occurrence of HT in children has substantially completed the vision of a concept upon a phenomenon with multiple medical and social human implications, such as that of HT initiated at early ontogenetic stages. Program research in the defining substrate of the affect, such as chronic inflammation markers (CRP hs, α-TNF), adipokine, hipovitaminosis D - as early markers of HT, hyperhomocistin as a marker of endothelial dysfunction and catecholamines analyzed as a marker of sympathetic nervous system (SNS) involvement in the HT pathogenesis have brought new scientific arguments and have finally suggested clear principles of ordering appropriate activities and measures of effective prophylaxis, combating risk factors and hypertensive determinism disorders. Monitoring serum levels of 25 hydroxyvitamin D and correction of deficiency at the right time will further optimize cardiovascular health of the population.

Paper’s applicative value
: By revealing the morbid contribution of the risk factors that the hypertensive children behave or are exposed to, the programs of prophylactic measures that will be implemented in practice will optimize the morbidity through HT. The implementation in the pediatric routine of the testing of adipokines, proinflammatory markers and endothelial dysfunction will contribute to the recognition of HT at preclinical stages and will suggest early preventative and treatment measures. Microalbuminuria testing, LVMMI, carotid artery intimate / mean thickness assessment will complement and sublimate the appropriate (subclinical) diagnosis of subclinical organ damage.
Implementation of scientific results: The results of the study were implemented in the clinical activity of the scientific laboratory of pediatric cardiology of the PHI Institute of Cardiology, specialized services of the PHI "Valentin Ignatenco" Municipal Clinical Hospital for Children and the Institute of Endoscopy of the PHI Mother and Child Institute.