Misiura O. Medico-psychological care of adolescents with primary arterial hypertension

The purpose of the study was based on the study of psycho-emotional, behavioral and personality characteristics and adherence to the treatment of adolescents with primary arterial hypertension (AH) to develop an algorithm for their medico-psychological care. The research is based on the results comprehensive survey of 143 adolescents, including 95 adolescents with primary AH and anonymous questionnaires of 279 adolescents in Kyiv. It is proved that high reactive anxiety in adolescents is independent, and in combination with overweight, an additional factor stabilizing blood pressure at a high level. It has been established that adolescents with primary AH have a reduced quality of life, especially physical role-functioning, most of them suffer from insomnia. In almost all cases there is a tendency to computer dependence, the level of which correlates with the level of average daily pulse blood pressure, and vice versa with the level of physical functioning. It has been established that adolescents with primary AH have a reduced quality of life, especially physical role-functioning; 77.8% of them suffer from insomnia; moreover, in 30.8% of patients insomnia was observed almost every night. Manifestations of insomnia were significantly inversely correlated with quality of life indicators such as physical functioning (r = -0.55; P <0.01) and general health (r = -0.48; P <0.05). Type D personality according to the DS-14 test was detected in 35.3% of patients (71.4% of girls and 22.2% of boys). The values of the “Negative arousal” and “Social depression” scales of this test were inversely correlated with the indicators of the “Viability” and “Emotional Functioning” scales of the SF-36 test. The adherence to the recommendations for pharmacotherapy was found only in 7.7% of adolescents with primary AH. The role of distress personality features in reducing the quality of life and adherence to treatment has been established. Based on the revealed patterns, an algorithm and program for medico-psychological care of adolescents with primary AH was developed. Psychosocial correction included motivational interviews and cognitive-behavioral therapy. The motivational interview was aimed at understanding the patient's problems (high blood pressure, the risk of complications, body overweight, anxiety, computer dependence, etc.) and increased adherence to therapy. Particular attention was paid to the importance of self-monitoring of blood pressure and body weight, "screen time", compliance with the diet and sufficient physical activity, and the elimination of bad habits. The application of the algorithm was effective in 85% of patients, on the average, twice the adherence to treatment was increased and the quality of life in patients was improved.