The number children and young people with high blood pressure has been increasing. The current lifestyle is one of the contributing factors to the disease. The most adverse is poor quality diet and excessive intake of salt. Further, the energy expenditure is lower, e.g. due lack of physical activities. Many children and young people do not have enough information about the risks of high blood pressure and its prevention. It is critical to identify groups with a risk of hypertension, i.e. children and young people with the so-called ?high normal? blood pressure. At the beginning we set four objectives: to learn the blood pressure measuring techniques suitable for children ? using digital and mercury tonometers, to find 25 ? 30 children with the ?high normal? blood pressure, to instruct nurses, particularly in the primary care, about the correct technique of blood pressure measurement in children and to compare the values of blood pressure measured with mercury and digital tonometers. The research was conducted in basic and secondary schools in České Budějovice and in a pediatric surgery. The researched group consisted of children and young people aged 13 ? 18. To achieve the first objective we measured blood pressure in 613 children with a digital tonometer and to achieve the second objective we measured blood pressure in 50 children both with mercury and digital tonometers. The results have been presented in form of tables. We found out that it was not necessary to examine more children, as we had expected, to get a sample group of 30 children with the ?high normal? blood pressure. Further, we found out that there was no significant difference between the values measured with a mercury tonometer and with a digital tonometer. The results have shown that it is essential to use the correct technique for blood pressure measurement in children. Based on our findings we have developed an educational material for nurses.

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An educational module, based on evidence-based practice (EBP) guidelines by the 8th Joint National Committee (JNC 8) and the American College of Cardiology (ACC), was created and implemented to determine if its implementation would impact the knowledge of clinic staff regarding current EBP guidelines about self-management of hypertension (HTN). The module has the potential to contribute to the resolution of patient noncompliance on HTN treatment and management by increasing nursing staff proficiency in knowledge transfer to patients on effective self-management of their health condition. The creation of the module was guided by the concept of need or asset assessment and the theory of planned behavior. The module was composed of 2 short lecture presentations on HTN, current EBP guidelines on lifestyle modifications, and proper blood pressure measurement. The module also included pre- and postlecture surveys to evaluate knowledge and practices of staff, and reiterated the current guidelines and approaches presented in the lectures. Survey data were analyzed using McNemar’s test for paired and binary data. Results showed the agreement of all the staff in recognizing the utility of the module in standardizing their knowledge of current EBP guidelines on lifestyle modifications and blood pressure measurement procedures. The results also showed the enhancement of staff proficiency which might lead to efficient education of patients on effective HTN treatment and management protocol. This pathway has the potential to bring about social change by decreasing the incidence of patient noncompliance and improving patient health.

Advancements in clinical care have led to a growing cohort of preterm-born individuals now entering adulthood. Before birth, such adults were often exposed to a suboptimal intrauterine environment, and after delivery, key developmental stages that would normally occur in utero during the third trimester had to take place under ex utero physiological conditions. Through detailed cardiovascular phenotyping, this thesis investigates the cardiovascular changes in preterm-born young adults, utilising a cohort of individuals with data collection since recruitment at birth. The detailed perinatal information was first used to design nested case-control studies to investigate the effects of early lipid and glucocorticoid exposure on long-term cardiovascular physiology in individuals born preterm. It was demonstrated that intravenous lipid administration leads to an artificial elevation of total cholesterol levels in immediate postnatal life, which is associated with long-term changes in aortic and left ventricular function proportional to the degree of cholesterol elevation. Additionally, exposure to antenatal glucocorticoids relates to a regional increase in aortic arch stiffness in young adulthood, as well as changes in glucose metabolism. It was then shown that young adults born preterm have increased left ventricular mass, out of proportion to blood pressure, and a unique three-dimensional left ventricular geometry, with reduced systolic and diastolic function compared to term-born controls. Similarly, they also show distinct differences in the right ventricle, with increased right ventricular mass and a proportion having clinically impaired right ventricular systolic function. Finally, it was demonstrated that preterm-born individuals have increased circulating levels of antiangiogenic factors in young adulthood, which relate to capillary rarefaction and blood pressure elevation. These findings are of considerable public health relevance given that nearly 10% of births are now preterm. Understanding whether modification of these variations in cardiovascular structure and function prevent the development of cardiovascular disease in this growing subgroup of the population will be of future interest.