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Overview of Hypertension in Children | Endocrinology

What is hypertension in children?

Hypertension in children is a blood pressure that is equal to or greater than 95 percent of children of the same sex, age, and height as your child. There is no simple target blood pressure reading that indicates high blood pressure in all children because what is considered normal changes as children grow older.

Hypertension in children under the age of 6 is usually caused by another medical condition. Older children can develop high blood pressure for the same reasons as adults: being overweight, poor nutrition, and lack of exercise.

Lifestyle changes, such as eating a heart-healthy diet and getting more exercise, can help lower hypertension in children. But for some children, medications may be necessary.

Alternate name

  • High blood pressure

Types of hypertension in children

There are dual key types of hypertension in children: primary and secondary hypertension.

  • Primary hypertension is the most communal type of high blood pressure. For most people who have this type of blood pressure, it develops over time as you age.
  • Secondary hypertension is caused by another medical condition or the use of certain medications. It usually gets better after treating the condition or stopping the drugs that are causing it.

Causes of hypertension in children

Primary hypertension

Primary hypertension means that hypertension does not appear to be caused by some other underlying medical condition. Many doctors believe that the incidence of hypertension in children or adolescents has increased along with the obesity epidemic. Most adolescents and children older than 6 years with hypertension have a family history of hypertension and/or being overweight.

Secondary hypertension

Secondary hypertension is initiated by a known underlying healing condition. Of these, about

  • 80 percent of children have some type of kidney disease or abnormalities in the blood vessels
  • 5 percent have an endocrine disorder
  • 2 to 5 percent have heart disease

Hypertension in babies with hypertension almost always has a secondary cause. Also, premature babies have a higher incidence of hypertension.

Among children with hypertension, especially those who are very young, secondary hypertension is more common than primary hypertension. But among children older than 6 to 8 years, the ratio of primary to secondary hypertension is close to 50/50.

Risk factors

Your child’s risk factors for hypertension in children rest on health conditions, genetics, and lifestyle factors.

Primary (essential) hypertension

Primary hypertension happens on its own, without a recognizable cause. This type of high blood pressure occurs most often in older children, usually 6 years and older. Risk factors for developing primary hypertension include:

  • Being overweight or obese
  • Have a family past of high blood pressure
  • Have type 2 diabetes or high fasting blood sugar
  • Have high cholesterol
  • Eating too much salt
  • Be black or Hispanic
  • Being a man
  • Smoking or exposure to secondhand smoke
  • Be sedentary

Secondary hypertension

Secondary hypertension is caused by another condition. It is more common in young children. Other causes of high blood pressure include:

  • Chronic kidney disease
  • Polycystic kidney disease
  • Heart problems, such as severe narrowing (coarctation) of the aorta
  • Adrenal disorders
  • Hyperthyroidism
  • Pheochromocytoma, a rare tumor in the adrenal gland
  • Narrowing of the artery to the kidney (renal artery stenosis)
  • Sleep disorders, especially obstructive sleep apnea
  • Certain medications, such as decongestants, oral contraceptives, and steroids
  • Drugs, such as cocaine

Symptoms of hypertension in children

Hypertension is known as a silent killer because it usually has no signs or symptoms. Most hypertensive patients feel fine and do not know that their blood pressure is elevated.

When hypertension is very severe or advanced, symptoms can include headache, fainting, and loss of kidney function. In the late stages, seizures can occur.

Diagnosis of hypertension in children

High blood pressure usually has no symptoms. Therefore, the only way to know if you have it is to check your blood pressure regularly with your healthcare provider. Your provider will use a pressure gauge, stethoscope or electronic sensor, and a blood pressure cuff. You will take two or more readings at separate appointments before making a diagnosis.

You have high blood pressure if your impressions show that:

  • Your systolic is 140 or more
  • Your diastolic is 90 or more

Some providers may ruminate you to have high blood pressure if you have other heart risk factors:

  • Your systolic is between 130 and 139
  • Your diastolic is between 80 and 89

Blood pressure readings above 180/120 are uncertainly high and require immediate medical attention.

For children and adolescents, the healthcare provider compares the blood pressure reading with what is normal for other children of the same age, height, and sex.

Treatment of hypertension in children

Researchers are still trying to determine the most effective way to treat high blood pressure in children. In general, treating hypertension in children is not that different from treating it in adults. Work closely with your child’s doctor to find which treatment plan will work best for your child. Here are some general guidelines:

  • Follow the DASH eating plan. The Dietary Approaches to Stop Hypertension (DASH) diet plan includes eating less fat and saturated fat, as well as more fresh fruits and vegetables, and whole foods. Limiting your salt intake can also help lower a child’s blood pressure. A dietitian can help you and your child find ways to meet these goals without giving up your favorite foods or their great taste.
  • Watch your child’s weight. Being overweight increases the risk of developing high blood pressure. Following the DASH eating plan and exercising regularly can help your child lose weight. Ask your child’s doctor to help you set weight loss goals. Your child’s doctor can also refer her to other health professionals to help her establish a weight loss plan.
  • Avoid tobacco smoke. Tobacco smoke can increase blood pressure; it can also directly damage your child’s heart and blood vessels. Protect your child from tobacco smoke, even secondhand smoke.
  • Taking medicines. If your child’s high blood pressure is severe or does not respond to lifestyle changes, your doctor may prescribe medication. It may take a while to find a combination of medications that works best to control high blood pressure with the fewest side effects. Medications used to treat high blood pressure include:
  • Diuretics reduce the amount of fluid in the blood by helping the body rid itself of extra sodium.
  • ACE inhibitors, alpha-blockers, and calcium channel blockers help keep the blood vessels from tightening up.
  • Beta-blockers: Prevent the body from making the hormone adrenaline. Adrenaline is a stress hormone. It makes the heart beat harder and faster. It also makes blood vessels tighten. All of this makes blood pressure higher.

Treating the underlying cause of high blood pressure if one can be determined. including hormonal abnormalities, coarctation of the aorta, sleep apnea, or other sleep disorders.

Complications

While children with hypertension are unlikely to have heart attacks and strokes, they still have significant risks. Hypertension causes changes in the structures of the blood vessels and the heart. Since hypertension in children has historically been little studied, there is not much data on what exactly these changes mean. But we do know that in adults, hypertension increases the chance of complications in the heart, blood vessels, and kidneys. There is also compelling evidence that some of these changes are seen in children with high blood pressure.

These changes affect:

Blood vessels: High blood pressure can damage blood vessels throughout the body, making it difficult for organs to function efficiently.

Kidneys: If the blood vessels in the kidneys are damaged, they can stop removing waste and excess fluid from the body. This extra fluid can raise your blood pressure even more.

Other Organs: If left untreated, hypertension in children makes it difficult for blood to reach many different parts of the body, including the eyes and brain, and can lead to blindness and stroke.

Prevention

If you have risk factors for hypertension in children, you can take steps now to reduce your risk for the condition and its complications.

Add healthy foods to your diet

Work slowly until you eat more servings of heart-healthy plants. Try to eat more than seven servings of fruits and vegetables a day. Then try adding one more serving per day for two weeks. After those two weeks, try adding one more serving. The goal is to consume ten servings of fruits and vegetables a day.

Adjust your opinion on the average plate of food

Instead of having meat and three sides, create a dish that uses meat as a seasoning. In other words, instead of having a steak with salad, eat a larger salad and top it with a smaller portion of steak.

Cut the sugar

Try to incorporate less sugar-sweetened foods, including yogurts, cereals, and flavored sodas. Packaged foods hide unnecessary sugar, so be sure to read the labels.

Set weight loss goals

Instead of an arbitrary “lose weight” goal, talk to your doctor about a healthy weight for you. The trusted source for the Centers for Disease Control and Prevention (CDC) recommends a weight loss goal of one to two pounds per week. That means starting to eat 500 fewer calories per day than you normally eat. Then decide what physical activity you can start to reach that goal. If exercising five nights a week is too difficult to fit into your schedule, try one more night than you are doing now. When that fits comfortably into your schedule, add another night.

Check your blood pressure regularly

The best way to prevent complications and avoid problems is to detect hypertension in children early. You can go to your doctor’s office to take a blood pressure reading, or your doctor may ask you to buy a blood pressure cuff and take the readings at home.

Keep a record of your blood pressure readings and bring them to your regular medical appointments. This can help your doctor detect potential problems before the condition progresses.