The role of pulmonary hemodynamics and endothelial dysfunction in the development of arterial hypertension in children with chronic bronchopulmonary diseases
In 280 children aged from 10 to 17 years with chronic bronchopulmonary diseases 24h monitoring of systemic arterial pressure (AP) was performed, pulmonary hemodynamics was evaluated and the functional state of the endothelium was determined. Increased systemic AP was recorded almost in 1/4 of children with pulmonary hypertension, its correlation with the level of average pressure in the pulmonary artery (r from +0.35 to +0.54 depending on the time of day) and total pulmonary resistance (r from +0.31 to +0.57 depending on the time of day) was revealed. Impaired variability of systemic AP was found in almost 1/3 of these patients and it progressed with worsening of pulmonary hemodynamics. A decrease of maximal endothelium-dependent vasodilation to 8.51 ± 0.39% in patients with pulmonary hypertension as compared with 12.36 ± 0.31% in healthy children and of total endothelium-dependent vasodilation to 572.01 ± 17.49% in patients with pulmonary hypertension as compared with 1058.47 ± 27.15%_in healthy children was detected. An interrelation was established between the indicators of endothelial dysfunction (maximal and total endothelium-dependent vasodilation, endothelin-1 level) and values of 24h monitoring of AP in children with chronic bronchopulmonary diseases, which might point to an important role of endothelial dysfunction in pathogenetic mechanisms of development of arterial hypertension in children with chronic bronchopulmonary diseases.