High blood pressure, also called hypertension, affects millions of adults in the United States and is directly linked to the development of heart disease and stroke. Unfortunately, high blood pressure in children and adolescents is a growing health problem, especially with the surge in obesity and excessive salt in kids’ diets.
Children with high blood pressure are likely to have this problem into adulthood. Hypertension in most children can be due to an underlying problem of the kidneys, heart or hormones. Depending on the reason for the high blood pressure, a variety of treatments are available to prevent ongoing damage to the body.
Blood pressure is determined by the force of blood pushing against the walls of the arteries when the heart beats (systolic blood pressure) compared to when the heart relaxes (diastolic blood pressure). Normal blood pressure in adults is less than 120/80, while hypertension is defined as more than 140/90. In children, however, normal blood pressure depends on age, gender and height. It naturally increases with age, ranging from 70/40 in a newborn to 120/80 in an adolescent.
High blood pressure stresses the walls of arteries, causing damage to the organs that they supply, especially the eyes, kidneys, brain and heart. In each of these organs, the arteries become weak and are at risk of rupture and bleeding. With time there is a decrease in blood and oxygen delivery that causes irreversible damage and scarring. This can result in vision loss, stroke, and kidney and heart failure.
Since the consequences of untreated high blood pressure are serious, it is important to identify children early. It is currently recommended that children 3 years and older have their blood pressure measured at each routine doctor’s visit, typically once a year. Certain groups of children are at higher risk for developing high blood pressure and should be checked regularly before age 3. These high risk groups include:
▪ History of preterm birth or low birthweight (less than 5 pounds)
▪ Congenital heart disease
▪ Recurrent urinary tract infections
▪ Kidney and urinary tract congenital malformations
▪ Blood or protein in the urine
▪ Family history of hypertension or any chronic kidney disease
If your child is found to have high blood pressure on three separate doctor’s visits, further evaluation is needed. This may include 24-hour blood pressure monitoring with a blood pressure cuff that records many readings during the day and night at home. Pediatricians at UHealth have used this technique for more than 10 years with great results in distinguishing children with true or false hypertension. False high blood pressure readings are possible when children are anxious at the doctor’s office, known as “white coat hypertension.” This type of hypertension is temporary and thought to have limited long-term consequences.
Once your pediatrician detects high blood pressure, he or she may consider referring your child to an expert physician in the field of hypertension, usually a kidney or heart specialist. When meeting the specialist, it is important that the doctor know if your child has any of the following symptoms that can be associated with high blood pressure:
▪ Heat or cold intolerance
▪ Shortness of breath
▪ Body swelling
▪ Decreased urination
High blood pressure in older children who are overweight or obese may be linked to high cholesterol and pre-diabetes similar to that found in adults. In these children, treatment is directed toward weight loss, diet modification, increasing exercise and decreasing salt intake. This is most effective when the family as a whole incorporates these changes into their daily life. In addition, caffeinated drinks such as energy sodas and coffee should be avoided.
Depending on the cause of high blood pressure, a medication may be recommended for your child. Several medications for hypertension are safely used in children, usually under the care of a specialist. The length of treatment is individualized to each child and the goal is to protect from the long-term complications mentioned above.
Pediatric high blood pressure can be successfully evaluated and managed, but it is important to follow up with your child’s doctor if hypertension is suspected. For a comprehensive evaluation and recommendations, call pediatric hypertension experts at UHealth at (305) 585-6726.
Marissa DeFreitas, M.D., is a pediatrician in the Pediatric Nephrology Division at UHealth – the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.