RU2306848C2 - Method for detecting the probability of developing essential arterial hypertension in teenagers - Google Patents

Abstract

FIELD: medicine, pediatrics, cardiorheumatology.

SUBSTANCE: it is necessary to detect the level of triglycerides (TG), the level of Willebrand's factor (WF), variability of systolic arterial pressure per a day (STD SAP) daily index of systolic arterial pressure (DI SAP) to calculate the probability of developing arterial hypertension by the following formula: P=e^F/(1+e^F), where P - the probability of developing essential arterial hypertension, e - ( the basis of natural logarithm)=2.718, F - the separating function which should be determined according to the following formula: F=-8.3565+(2.4617*TG)+(0.0210*WF)+(0.4824*STD SAP)+(-0.2762*DI SAP). At P being above 0.5 the probability for developing essential arterial hypertension is considered to be high, and at P being below or equal to 0.5 the probability of developing essential arterial hypertension is considered to be low. The innovation enables to efficiently diagnose essential arterial hypertension and prescribe adequate prophylactic therapy in due time.

EFFECT: higher accuracy of detection.

2 ex, 3 tbl

Description

The invention relates to medicine and can be used in pediatrics and cardiac rheumatology.

There is a method for predicting the occurrence of essential arterial hypertension [1, 2], which consists in analyzing the frequency of occurrence of markers of an unfavorable course of essential arterial hypertension in children: burdened heredity for hypertension, blood pressure in the onset of the disease, hyperuricemia, inadequate (excessive) vegetative supply with hyperdiastolic variant.

The disadvantage of this method is that it does not allow to predict the consequences of high blood pressure in adolescents and the timely use of antihypertensive therapy.

An adequate prototype was not found.

From the literature [1, 3, 4, 5,] and our observations, a group of indicators is known that reliably affect the formation of essential arterial hypertension and the occurrence of target organ damage.

The goal is to increase the sensitivity and specificity of the method.

The goal is achieved by a technical solution, which is a method for determining the likelihood of formation of essential arterial hypertension in adolescents by analyzing the most significant factors for the adverse course of essential arterial hypertension: triglycerides (TG), von Willebrand factor (VF), and systolic blood pressure variability (SBP) per day according to its standard deviation (STD), daily index (SI) of systolic blood pressure and determining the probability of ation essential hypertension by the formula

where p is the probability of the formation of essential arterial hypertension;

e - (base of the natural logarithm) = 2.718;

F is the separating function, which is determined by the formula:

F = -8.3565 + (2.4617 * TG) + (0.0210 * FV) + (0.4824 * STD GARDEN) + (- 0.2762 * SI GAD), where TG is the level of triglycerides, PV - von Willebrand factor level, STD SBP - standard deviation of systolic blood pressure per day, SI SBP - daily index of systolic blood pressure.

With p greater than 0.5, the probability of developing essential arterial hypertension is considered high, and with p less than or equal to 0.5, the likelihood of developing essential arterial hypertension is considered low.

New in the present invention is the analysis of the most significant factors affecting the occurrence of essential arterial hypertension, the determination of the likelihood of the formation of essential arterial hypertension in adolescents by the formula

and values: p more than 0.5, the likelihood of developing essential arterial hypertension is high; p less than or equal to 0.5, the likelihood of developing essential arterial hypertension is low.

Information about the prevalence of high blood pressure in children and adolescents is very contradictory and ranges from 4.8 to 14.3%, with half of the children having an asymptomatic course. Most researchers recognize the presence of the so-called tracking of blood pressure, that is, maintaining its level in subsequent years. In 33-42% of cases, blood pressure remains at the same level, and in 17-26% of cases arterial hypertension is progressive in nature. Thus, every third child with a rise in blood pressure, subsequently, the formation of hypertension is possible. These observations can serve as sufficient justification for the early diagnosis and prevention of essential arterial hypertension through early intervention.

The lack of clear diagnostic criteria to detect essential arterial hypertension in adolescents, the difficulty of differential diagnosis of neurocirculatory dystonia with hypertonic type with essential arterial hypertension, which is often associated with autonomic dysfunction, show how important it is to distinguish among those adolescents and young people with high blood pressure those whom further development of essential arterial hypertension is possible.

One of the important questions that a practitioner has is the question of the prognosis of the course of essential hypertension in adolescents and the risk of developing hypertension. First of all, this question must be answered in order to determine the need for the use of antihypertensive drugs in a particular patient. To identify a group of patients at risk of developing primary hypertension, an attempt was made to identify prognostic factors.

To identify significant factors for the adverse course of essential arterial hypertension during non-drug therapy, we used the method of step-by-step logistic regression, which allowed us to identify factors associated with the unfavorable course of essential arterial hypertension and calculate the ratio of steps for each of these factors. Initially, to create the model, a group of indicators was taken, which according to our observations and literature data significantly affect the course of essential arterial hypertension and the occurrence of damage to target organs.

We have selected the following indicators:

1. Hereditary burden of hypertension in the proband family.

2. Variability of systolic blood pressure.

3. Morning rise in systolic blood pressure.

4. The daily index of systolic blood pressure.

5. Left ventricular myocardial mass and left ventricular myocardial mass index.

6. The level of cortisol in serum.

7. The level of uric acid in the blood serum.

8. Indicators of the lipid spectrum: the level of total cholesterol and triglycerides.

9. Type of hemodynamics.

10. Catecholamines of urine.

11. The von Willebrand factor.

12. Tolerance to physical activity

During dynamic observation during therapy without the use of antihypertensive drugs, patients were divided into groups. As a separation criterion, a sign of a regressive or progressive course of the disease was used.

The training sample is presented:

Group 1 - adolescents with an unfavorable, progressive course of neurocirculatory dystonia of the hypertonic type, who after 6 months of using non-drug methods developed essential arterial hypertension (27 people).

Group 2 - individuals with normalization of blood pressure on the background of six-month non-drug therapy (26 people).

Group 2 is selected as reference.

The results of the logistic regression are presented in table 1.

Table 1 Logistic Regression Results Options DF (number of degrees of freedom) χ ² p Triglycerides one 8.2127 0.0042 Von Willebrand factor one 5.0618 0,0245 STD systolic blood pressure one 4.1744 0.0410 SI systolic blood pressure one 3.9050 0,0481

As a result of the analysis, the separating function was determined. It included 4 indicators: the level of triglycerides, von Willebrand factor, the variability of systolic blood pressure per day, which was determined by the standard deviation, and the value of the daily index of systolic blood pressure. The parameters of the separating function are presented in table 2.

table 2 Separator Function Parameters Parameter DF (number of degrees of freedom) Coefficient Standard error χ ² p Constant one -8.3565 2.8837 8.3973 0.0038 Triglycerides one 2.4617 1,1503 4,5799 0,0323 Willebrand factor one 0.0210 0,0100 4.3927 0,0361 Standard deviation of systolic blood pressure per day one 0.4824 0.2206 4.7812 0.0288 Daily systolic blood pressure index one -0.2762 0.1133 5.9399 0.0148

Table 2.1

Model characteristic (classification on the initial sample) Match rate 85.9 Somers'd 0.718 Odds ratio Table 2.2 Parameter Coefficient Triglycerides 11,725 Von Willebrand factor 1,021 Standard deviation of systolic blood pressure per day 1,620 Daily systolic blood pressure index 0.759

With an increase in the level of triglycerides by 1 mmol / L, the risk of developing essential arterial hypertension increases by 11.7 times (Tables 2.1 and 2.2). An increase in the content of von Willebrand factor by 1% entails an increase in the risk of developing essential hypertension by 2%, given the wide range of this factor (50-100%), an increase of even 10% increases the risk of the disease by 20%. Increased systolic blood pressure variability is an independent risk factor for target organ damage. According to our model, an increase in the variability of systolic blood pressure per day by 1 mmHg. Art. increases the risk of an adverse course of essential arterial hypertension by 62%. In turn, a 1% decrease in the daily systolic blood pressure index results in a 76% increase in risk. To predict the formation of the disease, taking into account all risk factors, an attempt was made to build a model for predicting the course of essential arterial hypertension in adolescents using only non-drug correction methods.

Formula

F = -8.3565 + (2.4617 * TG) + (0.0210 * PV) + (0.4824 * STD GARDEN) + (- 0.2762 * SI GARDEN)

Then the probability of the formation of essential arterial hypertension against the background of non-drug correction methods will be equal

that is, if p is greater than 0.5, the probability of developing essential arterial hypertension is high, and vice versa, if p is less than or equal to 0.5, the likelihood of developing essential arterial hypertension is small, and essential arterial hypertension will probably be regressive.

The sensitivity of the method was 92.3% and the specificity of 82.3%.

The claimed essential features in the aggregate showed new properties that are not obvious to a specialist and not arising explicitly from the prior art in this field.

An identical set of features was not found in the study of the prior art in patent and medical literature.

The present invention can be widely used in medical practice.

Based on the foregoing, the claimed technical solution should be considered relevant criteria: "Novelty", "Inventive step", "Industrial applicability".

The invention will be clear from the following description of examples:

Example No. 1

Patient L. Artem, 17 years old, was admitted with complaints of periodic rises in blood pressure, headaches against a background of physical exertion.

After a comprehensive examination, the diagnosis was made:

Neurocirculatory asthenia Labile arterial hypertension.

TG - 1.26 mmol / l

PV - 144%

STD GARDEN 12.1 mmHg Art.

SI GARDEN 10.6%

Predicting the course of the disease

F = -8.3565 + (2.4617 * 1.26) + (0.0210 * 144) + (0.4824 * 12.1) + (- 0.2762 * 10.6) = 0.6785

P = 0.66 - the likelihood of developing essential hypertension is high.

After 6 months of non-drug therapy, a comprehensive examination of the patient, including daily monitoring of blood pressure, was diagnosed with essential arterial hypertension and antihypertensive therapy was prescribed.

Example No. 2

Patient T. Stas., 13 years old, was admitted with complaints of periodic rises in blood pressure, accompanied by weakness, dizziness. After a comprehensive examination, the diagnosis was made:

Neurocirculatory asthenia. Labile arterial hypertension.

TG - 1.3 mmol / l

PV - 62%

STD GARDEN 13.1 mmHg Art.

SI GARDEN 12.1%

Prediction of the course of the disease:

F = -8.3565 + (2.4617 * 1.3) + (0.0210 * 62) + (0.4824 * 13.1) + (- 0.2762 * 12.1) = - 0.6844

P = 0.33 - the likelihood of developing essential arterial hypertension is low.

After 6 months of non-drug therapy with a comprehensive examination of the patient, including daily monitoring of blood pressure, a decrease in the average figures of blood pressure during the day and a decrease in systolic blood pressure to acceptable values (less than 25%) were noted. The patient was continued non-drug therapy.

The proposed method was tested on 30 patients not previously included in the study.

The relationship between the results of the prognostic test and the real progressive or regressive development of hypertension is shown in Table 3.

Table 3 Model Check (n = 30) The real development of events Development forecast according to the model Normalization of blood pressure The development of essential hypertension Normalization of blood pressure 12 one The development of essential hypertension 3 fourteen

Thus, the sensitivity of the method was 92.3%, and the specificity of 82.3%.

The proposed method allows to increase the accuracy of the diagnosis of essential arterial hypertension and timely prescribe adequate preventive therapy.

Bibliography

1. Rovda Yu.I. Risk factors and their significance in the development of arterial hypertension in children: Abstract. diss .... dr. honey. sciences. - Kemerovo, 1995 .-- 48 p.

2. Rovda Yu.I. Risk factors and their significance in the development of arterial hypertension in adolescents (follow-up observation) / Siberian Medical Journal. - 2005. - T.20. - No. 4. - S. 61-67.

3. Leontiev I.V. The current state of the problems of diagnosis, treatment and prevention of arterial hypertension in children and adolescents // Russian Bulletin of Perinatology and Pediatrics. - 2002. - No. 1. - S. 38-45.

4. Belsha C.W. Ambulatory blood pressure monitoring and hypertensive targetorgan damage in children // Blood Pressure Monitoring, 1999. - No. 4 - P.161-164.

5. Daniels S.R. Hypertension- induced cardiac damage in children and adolescents // Blood Pressure Monitoring, 1999. - No. 4 - P.165-170.

Claims (1)

A method for determining the likelihood of formation of essential arterial hypertension in adolescents, characterized in that they determine the level of triglycerides (TG), the level of von Willebrand factor (VF), the variability of systolic blood pressure per day (STD GARDEN), the daily systolic blood pressure index (SI GARDEN) and calculate the probability of arterial hypertension formation according to the formula

where p is the probability of the formation of essential arterial hypertension, e is (the base of the natural logarithm) = 2.718, F is the dividing function, which is determined by the formula F = -8.3565 + (2.4617 · TG) + (0.0210 · PV) + (0.4824 · STD GARDEN) + (- 0.2762 · SI GAD) and with p greater than 0.5, the probability of developing essential arterial hypertension is considered high, and with p less than or equal to 0.5, the probability of developing essential arterial hypertension is considered low .