Vitamin D - Dependent Risk Factors of Formation of Essential Arterial Hypertension at School Children of Tashkent City

Аннотация

The study of vitamin D - dependent risk factors for the formation of essential arterial hypertension (EAH) based on the assessment of serum levels of calcidiol (25 (OH) D), calcium and vasoconstrictor factor endothelin-1-21 in 132 students aged 13 to 16 years (average age 14.64 ± 0.19 years) with normal, high normal blood pressure and essential arterial hypertension (EAH) established the priority effect of vitamin D supply on the level of diastolic blood pressure in the group of children with labile arterial hypertension and in the group of children with stable on the parameters of systolic blood pressure. In the mechanism of EAH formation in children, an interdependence between vitamin D deficiency and the severity of endothelial dysfunction by the level of endothelin -1-21 was revealed. The following vitamin D were determined by diagnostic efficiency - dependent risk factors for the formation of EAH in children in decreasing importance: endothein-1-21> 0.41fmol / ml; vitamin D <20ng / ml; Ca <2.22 mmol / L. Keywords--- Essential Arterial Hypertension, School Children, Blood Pressure, Vitamin D (25 (OH) D), Endothelin-1-21. I. INTRODUCTION Essential arterial hypertension (EAH) is one of the leading problems of modern medicine, being a significant cause of early disability and death in people of working age, the origins of which lie in childhood [1, 2]. In the structure of all registered diseases of the circulatory system in the Republic of Uzbekistan, the leading role belongs to diseases characterized by elevated levels of pressure (33.6-37, 8% in the country) [3]. It is generally recognized that the cardiovascular system is the leading effector system in the process of postnatal adaptation, through which the reactions of many regulatory systems of the body are mediated. The prevalence of EAH in childhood and adolescence is significant - from 2.4% to 20% or more [4, 5]. In recent years, there has been a tendency toward an increase in the frequency of EAH among schoolchildren, which is the result of an increase in the proportion of children with obesity and a behavioral stereotype that is far from a healthy lifestyle [6]. In children with blood pressure (BP) exceeding the norm, the tendency to its further increase increases with age and remains increased in 33-42% of them, and in 17-26% of children arterial hypertension (AH) progresses. In 50% of children, hypertension is asymptomatic, which makes it difficult to identify and, accordingly, timely treatment. Often, already in childhood, Akhmedova Firuza Mirzakirovna, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan. Agzamova Shoira Abdusalamovna, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan. Akhmedova Dilorom Ilxamovna, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan. Tashpulatova Fatima Kudratovna, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan. DOI: 10.37200/IJPR/V24I5/PR2020213 Received: 12 Mar 2020 | Revised: 28 Mar 2020 | Accepted: 06 Apr 2020 5055 International Journal of Psychosocial Rehabilitation, Vol. 24, Issue 05, 2020 ISSN: 1475-7192 target organ damage occurs: left ventricular hypertrophy, detected in 38-41% of children with hypertension [7, 8]. In this regard, the problem of prevention of modifiable risk factors in children and adolescents is a priority in pediatrics and pediatric cardiology. To date, it has been irrefutably proven that vitamin D, as a hormone with the formation of its “hormone-like axis: calcidiol-calcitriol-VDR (vitamin D receptor),” is closely interconnected not only with parathyroid hormone and calcitonin, but also with the biological effects of insulin, estrogen, neurotrophic factors and cytokines [9, 10]. In this regard, it is possible to imagine the consequences of insufficient levels of vitamin D in the human body, ranging from growth retardation to a wide range of chronic diseases that take hundreds of millions of adults' lives [11, 12]. Evidence of the beneficial effects of vitamin D has stimulated the development and adoption of nationwide recommendations to address its deficiency in Poland (2009, 2013) [13, 14], Hungary (2012) [15], Germany, Austria and Switzerland (2012) [ 16], Russian Federation (2018) [17], USA (2011) [18]. In 2012, the European Food Safety Authority issued revised vitamin D levels (upper limits) for all relevant populations [19]. The level of calcidiol - 25 (OH) D in serum is accepted as a standard biomarker of vitamin D supply for the body. This metabolite is quite stable (half-life is 2-3 weeks), reflects the intensity of vitamin D synthesis in the skin and food intake [17, 20]. A meta-analysis of 11 placebo-controlled studies (5660 patients aged 6 months to 75 years) confirmed the protective effect of vitamin D intake against respiratory tract infections (influenza, pneumonia, acute respiratory infections) [17, 24]. Higher serum vitamin D levels correlated with improved lung function in patients with cystic fibrosis [25], with a 43% reduction in