Do you know what hypertension is? It’s high blood pressure. But to understand why high blood pressure can pose an issue, let’s go into what blood pressure is. Dr. Alan Sing, pediatric cardiologist with Pediatric Heart Specialists at Children’s Health, explains that blood pressure is the pressure generated when the volume of blood pushes outward on the blood vessel walls. That volume comes from when the heart squeezes and sends out blood to the rest of the body.
Now, did you know that hypertension isn’t just an adult problem? That’s right. Kids can develop hypertension. But is it different than hypertension in adults? How can you tell if your kid has hypertension? Sing answers these questions and more.
Is there a difference between the condition when present in kids versus adults? The main difference between children and adults is the blood pressure values that are considered normal. Children 13 years and older use the same values as adults.
However, for those 12 years and younger, their normal values are based on percentiles derived from their age, height and gender.
What causes hypertension in kids? It’s important to note that not all high blood pressure readings mean a patient has hypertension.
“White-coat hypertension” is a term used to describe a patient who goes to the doctor’s office, sees a doctor wearing a white coat and gets nervous. The subsequent blood pressure reading may then be high because his adrenaline increased when he was nervous. However, when he checks his pressure at home or somewhere else where he isn’t nervous, his blood pressure is normal.
This can certainly affect children; some studies have suggested that a third, and even up to one half, of all children being evaluated for hypertension actually just have white coat hypertension.
We generally consider the risk of long-term health issues from white-coat hypertension more like patients who have normal blood pressure compared to those who have true hypertension. However, patients with white coat hypertension are also more likely to develop true sustained hypertension, so it’s still important for those folks to monitor their blood pressures.
And what about those with true hypertension? The most common cause of sustained hypertension is called primary hypertension. This is high blood pressure that’s usually caused by lifestyle choices like a poor diet, lack of exercise or being overweight.
However, the other major category is called secondary hypertension. This is high blood pressure that is caused by other medical problems, such as problems in the kidneys or the blood vessels that supply the kidneys, cardiac conditions like coarctation of the aorta, thyroid problems, endocrine problems and even some genetic problems.
It’s very important to accurately diagnose the cause of the hypertension because if there is indeed a secondary cause, effective treatment requires additionally addressing the underlying condition, as opposed to just focusing on the blood pressure.
What are the symptoms of hypertension? What should parents watch out for? Most of the time, when we think about having a health concern or a problem, there’s a symptom of some kind, like pain or a change in the way someone feels. However, there is a reason high blood pressure has been called the “silent killer.”
Many times, there are no symptoms at all. In the infrequent situation where there are symptoms, the most common ones are headaches, blurry vision or nose bleeds. Other patients will complain about just feeling “bad.” They can’t pinpoint an exact feeling, but they just know they don’t feel good.
Long term, hypertension can cause damage to various organs in the body, like the heart, kidney, eyes and brain.
It’s also one of the five classic causes (hypertension, diabetes, high cholesterol, obesity, and smoking) of atherosclerosis, or what we colloquially call “clogging of the arteries.”
In addition to clogged arteries, are there higher risks for other problems when kids have this condition? Yes, hypertension can exacerbate other medical conditions.
For instance, the aortic valve is one of the main heart valves. Its purpose is to open to allow blood to get pumped out to the rest of the body and closes to prevent blood from flowing backwards into the heart.
There is a condition called aortic valve insufficiency where the valve doesn’t close normally, and “leakiness” of the valve develops. Hypertension can sometimes make the leakiness worse because it is acting as a force that pushes the blood backwards, so adequate blood pressure control is an important management strategy in this condition.
Even within the current COVID pandemic, we have seen strong evidence that patients with uncontrolled hypertension may be more at risk of developing a severe COVID infection.
So resulting issues can be very serious. Can either primary or secondary hypertension be prevented? Secondary hypertension usually cannot be prevented in the sense that most of us don’t have control over the development of the relevant medical conditions, but primary hypertension can certainly be prevented by trying to live a healthy lifestyle.
And what would that look like? The first line of therapy is always lifestyle changes that include diet, exercise and weight loss.
For diet, we recommend the DASH diet—dietary approaches to stop hypertension. This emphasizes fruits, vegetables, low-fat dairy foods and moderate amounts of whole grains, fish, poultry and nuts.
It’s also important to limit foods that are high in saturated fat and to limit sugary beverages and sweets. Perhaps the most important component is to minimize salt intake. The average American diet has approximately 3400mg of sodium per day, and the DASH diet recommends less than 2300mg.
There is another version called the Lower Sodium DASH diet that recommends less than 1500mg.
For exercise, vigorous activity for 30–60 minutes a day for 3–5 days per week is a very important part of hypertension management. In addition, for patients who are overweight, weight loss can be an important treatment focus.
For patients who fail to meet their BP goals with lifestyle changes alone, many times we will have to initiate prescription medication therapy. While this is always a last resort, we fortunately have many very safe and effective medications that can bring blood pressures down to a more desirable level.
And for those with secondary hypertension? Treatment will be much more effective if the underlying condition is addressed as well.
Are you seeing an increase of hypertension in kids? Yes, hypertension is an increasing and important condition in the pediatric population.
It may be hard for families to see the need to monitor blood pressure in otherwise young, healthy children because many times there are no outwards symptoms. However, the goal of pediatricians is to prevent unnecessary exposure to decades of untreated high blood pressure, all in the name of preparing our children to live long, healthy and productive lives.
Image courtesy of iStock.