In the past, blood pressure was something that grandma or grandpa took medicine for. But today, hypertension is increasingly becoming a concern in kids because of the prevalence of obesity among our youth.
One in three children in our nation is obese. Of those youngsters, 30 percent have elevated blood pressure. High blood pressure in children and adolescents poses an increased risk of hypertension as adults. Hypertension is a known risk factor for heart disease and death, and may also lead to kidney disease and stroke, which ultimately impacts quality of life and life expectancy.
Normal blood pressure in a child depends on the youngster’s age, gender and height. If the doctor determines your child’s blood pressure is high, there are different stages according to the severity that can affect the urgency for further evaluation and treatment.
Routine blood pressure measurements should be taken at every primary care visit beginning at age 3. Your doctor may choose to have your child’s blood pressure taken before then if there are other risk factors present. Abnormal readings are repeated for validity and a diagnosis is made based on persistently elevated readings. Your child’s doctor will also know how to differentiate whether the elevation in blood pressure is only present in the doctor’s office, a condition known as “White Coat Hypertension,” which is caused by your child being stressed while having a check-up.
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Hypertension may be primary or secondary if there is an underlying cause. Primary hypertension is often associated with obesity and a family history of hypertension. Secondary causes of hypertension are more common in children than in adults and include kidney disease, endocrine disorders, congenital heart disease and other conditions. Sleep-disordered breathing and sleep apnea also increase the risk for hypertension. Your doctor will take a detailed history and perform a thorough physical examination to identify possible secondary causes if your child is found to have elevated blood pressure.
Hypertension may bring other cardiovascular risk factors, including diabetes and abnormal lipid profiles, all of which are independent contributors to early heart disease. Being overweight also carries these risks. So, it is recommended that children with hypertension be screened for diabetes and evidence of abnormal cholesterol profiles.
Your pediatrician might request a work up for secondary causes of hypertension and a referral to subspecialists, as necessary. In addition, a subspecialist referral may be necessary to detect any end-organ damage related to hypertension, such as a thickened heart muscle, eye changes and kidney changes.
Depending on the severity and cause of hypertension, medications may be needed to lower the blood pressure. However, a healthy lifestyle is an integral part of the prevention and treatment of obesity and hypertension. Even with a fast-paced life, lifestyle modification must be emphasized. For example, a decrease in the body mass index (BMI) by 10 percent has shown a decrease in blood pressure.
Weight loss is the first step in the management of hypertension associated with obesity. Healthy eating, consisting of a diet rich in fruits, vegetables, fiber and non-fat dairy is recommended. Portion control, avoidance of food and drink high in sugar, decreased salt intake and regular meals, including a healthy breakfast, are also steps one should take toward healthier eating.
Physical activity is equally important, and the current recommendation is for regular aerobic activity for 30 to 60 minutes each day with limited television, computer, game console screen time to less than two hours per day. This has been shown to be beneficial in preventing obesity, hypertension and other cardiovascular risk factors.
The importance of a healthy lifestyle in preventing current and future cardiovascular disease cannot be stressed enough. The responsibility lies not only with your child, but with your whole family, our communities and our nation, to encourage a lifestyle that will ensure a healthier tomorrow. Our children represent our future and together we can make a difference in the lives of our children, to preserve the health and well-being of the next generation.
Mary Antonette Co, M.D., is a pediatric resident, and Juanita Hunter, M.D., is a pediatric cardiologist at the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.