We generally think of high blood pressure (hypertension) as a problem that only affects adults. But the reality is that it can occur at any age.
In some cases, doctors don't know exactly what causes childhood hypertension. However, there are factors that can increase a child's likelihood of having it. These include having a family history of high blood pressure, for example, or obesity.
High blood pressure can cause a child to have serious health problems in the future, such as heart disease. As more research is done on young people, harmful effects of high blood pressure on the heart, blood vessels and even learning have been found. That's why it's important to keep it under control.
Primary hypertension, meaning there is no other cause than the association with obesity (in many cases), is more frequent in the United States than secondary hypertension. With secondary hypertension, a cause is found — usually a kidney problem or disease. Other causes of secondary hypertension may include abnormalities in blood vessels that carry blood to the kidneys, thyroid diseases of the thyroid or adrenal glands and taking certain medications.
High blood pressure in children can be prevented, in many cases, with a healthy lifestyle. This includes maintaining a healthy weight, eating healthy and getting enough physical activity and sleep. In other words, controlling one disease can help prevent the other.
Jorge, a 10-year-old boy, came to my office with his mother because he had high blood pressure that was detected at his annual preventive health visit. Jorge didn't have any symptoms, but he seemed a little nervous, like most children who see a doctor for the first time. Jorge was overweight by about 22 pounds, in addition to being sedentary, playing a lot of video games and having a family history of high blood pressure.
After waiting for Jorge to calm down and get comfortable, I took his blood pressure. It was high, above the maximum normal values for his age, height and sex. Blood pressure can stay elevated for a little while when someone gets nervous. So, I decided to confirm Jorge's blood pressure with an out-of-office test called ambulatory blood pressure monitoring. For 24 hours, a portable monitor records the child's blood pressure at home, at school and even while they're sleeping. This type of monitoring, recommended by the American Academy of Pediatrics, showed that Jorge had high blood pressure even outside the office for much of the day and night.
For kids with hypertension associated with obesity, the first recommendation is to lose weight. This is best achieved by eating foods low in calories and sodium (salt) and getting more physical activity and exercise. Pediatricians may also connect families with a dietitian or nutritionist who can offer guidance. If your child's blood pressure doesn't improve with weight loss and exercise, medications can be used to control their blood pressure.
My initial recommendation for Jorge was to lose weight, improve his diet and get more exercise. I also had to prescribe medication to control his blood pressure. For several years, Jorge was unable to lose weight, and we had to keep controlling his blood pressure with medication. When he turned 16, Jorge set out to lose weight, started eating healthier, cut out sugary drinks and started exercising.
Today, Jorge is 18 years old. He managed to drop his weight from 254 pounds the previous year to a current weight of 187 pounds. Jorge's blood pressure, controlled since childhood with medication, improved significantly. Little by little we lowered the dose of his medication until finally, we were able to stop it. Jorge proved to himself that it is possible to control his weight and normalize his blood pressure, a difficult but possible achievement.
Talk to your pediatrician or primary care provider if your child has a family history of hypertension or if something worries you. Your doctor should measure your child's blood pressure as part of your regular health checkups.
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ABOUT THE WRITER
Dr. Juan C. Kupferman received his medical degree from the University of Buenos Aires School of Medicine in Argentina and his Master's degree in Public Health from Columbia University in New York. He is board-certified in general pediatrics and pediatric nephrology and is a professor of pediatrics at Albert Einstein College of Medicine. Dr. Kupferman is also the co-editor of the Spanish versions of the AAP publications, “Caring for Your Baby and Toddler, Third Edition” and Second Edition of “Your Baby's First Year.” For more information, go to HealthyChildren.org, the website for parents from the AAP.
