Hypertension in children is becoming a growing healthcare concern in America. It is quite common to see reports of hypertension in children. Most cases of hypertension in children remains undiagnosed and therefore the present prevalence is an underestimation of the real scenario. Unlike adults, the normal blood pressure values in children can vary based on their age and height, and thus borderline cases of hypertension, escape diagnosis. Sedentary lifestyle and obesity are important risk factors for hypertension in children. Through proper lifestyle practices and diet, hypertension can be prevented in children. Preventing hypertension in children is important as hypertension can cause damage to organs like brain, eyes, heart and kidney. Preventing hypertension in children can help prevent commodities that can affect the child at a later stage in life.
Pathophysiology: Blood pressure is mainly affected by two variables: the cardiac output and resistance of the blood vessel. Any change in the value of these variables can affect blood pressure. Rise in cardiac output or vascular resistance or both increases blood pressure. Rise in blood pressure is called hypertension. The hypertension seen in children is often seen associated with hyperinsulinemia (metabolic syndrome) and obesity. Though the molecular mechanism that links these two conditions to hypertension is not completely understood, it is understood that there is elevation in sodium reabsorption by the kidney and elevation in sympathetic tone in children with hypertension (Riley & Bluhm, 2012). Both these factors can increase cardiac output and vascular resistance. Hypertension could also be a comorbidity of chronic kidney failure (Dionne, 2015). In a population study on 6235 children in the U.S, researchers found a progressive increase in blood pressure, with sodium intake above the mean value (Yang et al., 2012). Sodium increases urinary reabsorption of water, increases cardiac output and increases vascular resistance. The risk for sodium associated hypertension was high in overweight children when compared to children with normal weight (Yang et al., 2012).
Epidemiology: There is no recent data on the prevalence of hypertension in children. According to the available estimates, the prevalence could be somewhere between 2-5% in the United States (Riley & Bluhm, 2012). There is no much difference in the prevalence between the genders. Following puberty, adolescent boys tend to have a higher risk for hypertension when compared to girls of the same age. No noticable difference was observed between the races with respect to prevalence of this condition.
Diagnosis: The diagnosis is made based on the systolic and diastolic blood pressure values. The cut off values vary with age. Table 1 carries the age-wise maximum systolic and diastolic values that are considered while diagnosing hypertension. (Riley & Bluhm, 2012)
Management and follow up on the disorder: To begin with, physicians should make it a habit to measure and report the blood pressure of children aged 3 years and above, right from their first visit to the hospital/office. This is important in detecting prehypertensive stage, will enable early detection of the disorder, and offer time to prevent serious comorbidities that accompany hypertension. Children in whom hypertension is detected for the first time, a detail history checkup and physical examination will help identify the etiology or to rule out any underlying medical cause. (Riley & Bluhm, 2012)
During history taking, information on the child’s birth, growth and development can be recorded. History of previous renal, cardiac, endocrine, urologic, and neurologic diseases needs to be explored. Likewise, medication history and other nutritional or growth supplements taken by the child can also be hypertensive. Unhealthy dietary habits, smoking and alcohol consumption can be knowing through history check. Some children may require immediate attention to hypertension, due to emergency situations like seizures or altered mental stage. It is important to review the urgency of treating hypertension in the review. Certain drugs and endocrine disorders can also cause hypertension. This can be revealed through history check and physical examination. During physical examination, the BMI can be measured. The blood pressure is measured at both hands and legs. It is important that the blood pressure in both arms are almost equal. The blood pressure in the legs is normally higher than the blood pressure in the hands. Any variation in this normal trends suggest an underlying pathology in the child, which could be the cause of hypertension. (Riley & Bluhm, 2012)
Hypertension increases risk for cardiovascular diseases, hyperlipidemia, diabetes and organ damage. It can also harm the retina. For this reason, children with hypertension will be screened and evaluated for target organ function. Hypertension is mainly a lifestyle disease and very rarely occurs from other primary causes. Thus, lifestyle management is very important in managing hypertension. Being overweight, consuming sodium rich diet, lack of physical activity, tobacco and alcohol consumption are some of the unhealthy lifestyle habits that can lead to hypertension. For this reason, the child will be advised to a healthy lifestyle that in-cooperates healthy eating habits, regular physical activity, avoiding risky habits and maintaining a healthy body weight. If hypertension continues to persist despite life style modification and non-pharmacological measures, only then is a pharmacological agents administered to the child. Thiazide diuretics, ACE inhibitors, angiotensin II receptor, beta blocker and calcium channel blocker are found to be effective and safe for use in children. (Riley & Bluhm, 2012)
A school level initiative to reduce obesity and metabolic syndrome can be beneficial in reducing the prevalence of hypertension in this population. Hypertension in children usually occurs as an epidemic and certain common cultural practices in the population could be predisposing the children to lifestyle disorders like hypertension. (Elizondo-Montemayor et al., 2013)
References
Dionne, J. (2015). Evidence-based guidelines for the management of hypertension in children with chronic kidney disease. Pediatric Nephrology, 30(11), 1919-1927. http://dx.doi.org/10.1007/s00467-015-3077-7
Elizondo-Montemayor, L., Gutierrez, N., Moreno, D., Martínez, U., Tamargo, D., & Treviño, M. (2013). School-based individualised lifestyle intervention decreases obesity and the metabolic syndrome in Mexican children. Journal Of Human Nutrition And Dietetics, 26, 82-89. http://dx.doi.org/10.1111/jhn.12070
Riley, M. & Bluhm, B. (2012). High Blood Pressure in Children and Adolescents. Am Fam Physician, 85(7), 693-700.
Yang, Q., Zhang, Z., Kuklina, E., Fang, J., Ayala, C., & Hong, Y. et al. (2012). Sodium Intake and Blood Pressure Among US Children and Adolescents. PEDIATRICS, 130(4), 611-619. http://dx.doi.org/10.1542/peds.2011-3870
