Hypertension (high blood pressure) in children, is blood pressure that is at or above the 95th percentile for children who are of the same sex, age and height. To make a diagnosis of hypertension it is necessary for blood pressure to be elevated on a persistent basis on three separate occasions. It is important to record the blood pressure appropriately before making a diagnosis of hypertension. The prevalence of hypertension is estimated to be 1% - 3% for children and adolescents. The strongest determinant of hypertension in children is Body Mass Index (BMI).
In a child with newly diagnosed hypertension, it is important to evaluate for any secondary causes of hypertension like kidney disease, heart disease and endocrine problems. A diagnosis of primary or essential hypertension is made after other secondary causes are ruled out. The risk factors for essential hypertension are obesity, lipid disorders, diabetes, smoking, alcohol addiction and sedentary lifestyle. These are the same risk factors which are responsible for cardiovascular events and they are modifiable.
Though the cardiovascular disease manifests in adults, the early changes begin in childhood. Childhood hypertension along with other risk factors like obesity is a major factor in adult cardiovascular events like heart attack and stroke. The other organs like kidney, liver and brain can be affected secondary to heart diseases.
Preventive measures to modify the cardiovascular risk factors should begin in childhood. The importance of healthy lifestyle should be taught early on in life. Diet, regular physical activity, adequate sleep, avoidance of smoking and alcohol are some of the ways to reduce the risk of early onset hypertension in children. As a result of pediatric preventive care, the adult population with a lower burden of atherosclerosis will have a lower burden of cardiovascular diseases.
Promoting heart healthy diet – Encouraging intake of dietary fiber in the form of fresh fruits, vegetables and whole grains, reduction in the intake of sugar sweetened beverages and foods, and avoiding consumption of chips, fries and packed foods (commonly called junk). The intake of protein should be optimized and consumption of saturated fat should be minimized.
Routine physical activity should be encouraged throughout childhood. The recommended minimum physical activity for children and adolescents is about 30-60 minutes every day. This can include any sport of their choice or activities like swimming, cycling, brisk walking, running and yoga. Being physically active reduces the risk of hypertension and obesity. These habits are more likely to stay with them if inculcated early in childhood.
Avoidance of smoking and alcohol should be emphasized. Children should be educated regarding the harmful effects of nicotine and the long-term consequences of nicotine exposure. Similarly, substance abuse and the health hazards of these should be explained to children and adolescents.
Finally, children should be taught about the importance of adequate sleep (8-9hours/day), reduction in screen time and management of stress.
Primordial prevention that is early intervention to prevent the onset of cardiovascular risk factors specially hypertension and obesity is paramount to make the society healthy as a whole and prevent cardiovascular events.
(Author: Dr. Kavya Mallikarjun - Consultant - Paediatric Cardiology, Manipal Hospital Old Airport Road)
