By Aaron Allen
The Seattle Medium
Hypertension, or high blood pressure, is a persistent elevation in blood pressure diagnosed when repeated measurements over time exceed normal values. While it is often discussed in the context of adults, childhood hypertension is a serious condition that parents should be aware of, even though it is rarely talked about. In children and adolescents, blood pressure typically increases with age and height, meaning that normal blood pressure values change yearly, much like height and weight. According to medical experts, hypertension in children can be detected as early as three years old.
A child or adolescent is diagnosed with hypertension when their average blood pressure is at or above the 95th percentile for their age, sex and height, measured multiple times over three or more visits.
Dr. Susan Halbach, director of the Hypertension Program at Seattle Children’s Hospital and a pediatric nephrologist, says that parents should pay attention to their child’s blood pressure just as much as their own.
“Pediatric hypertension is on the rise,” says Halbach. “Hypertension is particularly important. Here in our field, we’ve nicknamed hypertension as the silent killer because most children who have high blood pressure do not have any symptoms; they don’t feel sick. So, in most cases, parents are not going to seek out care.”
To detect hypertension, Dr. Halbach advises that children should have their blood pressure measured at least once yearly, ideally at each healthcare encounter. If a child’s blood pressure is at or above the 90th percentile, it should be tested three times, ideally using a stethoscope and a hand-inflated blood pressure cuff. If the average of these three measurements is at or above the 95th percentile, follow-up visits are necessary to confirm high blood pressure.
Children with an average blood pressure between the 90th and 95th percentiles, or those with readings of 120/80 or higher, are considered prehypertensive and should have their blood pressure rechecked in six months. Consistently high readings will indicate hypertension.
“The majority of children and adults with hypertension are diagnosed because they’re screened for it,” Halbach emphasizes. “As pediatricians, most of us are interested in prevention. So, we believe that it’s quite important to screen for hypertension even starting in childhood.”
The increase in pediatric hypertension is not entirely clear, but it is often attributed to the obesity epidemic. Since 1980, the prevalence of obesity among children and adolescents has almost tripled, with 32 percent of children in the United States now being overweight or obese. Among this group, 20 percent to 47 percent are estimated to have hypertension.
Research from Johns Hopkins suggests that children who are overweight or obese are more likely to be hypertensive, often due to lifestyle factors. Overweight children are also more likely to have other risk factors for heart disease, such as high cholesterol, diabetes and left ventricular hypertrophy (abnormal thickening of the heart).
“Hypertension is primarily lifestyle-driven,” Halbach says. “The things that we know contribute to a healthy lifestyle in terms of disease prevention are not accessible to people in equal ways, like food deserts and environmental factors.”
“I take care of patients who live in places where convenience foods are really all that’s available or affordable for them. They may know what they need to do, but accessing it is difficult,” continued Green. “Green spaces and safe areas to exercise are also contributing factors.”
Studies show that African American and children from underrepresented communities face a greater risk of having high blood pressure compared to their White counterparts.
A medical essay by Dr. Halbach and Dr. Joseph Flynn highlights that social determinants of health (SDOH) are significant contributors to disease burden and adverse health outcomes in the U.S. population. The essay discusses a study by Nagata et al., which found significant predictors of hypertensive-range blood pressure among early adolescents, including male sex, Black race, household income and parent education level.
“The association between household income level and hypertensive-range BP is not surprising given the well-known lifestyle factors contributing to the development of hypertension such as poor nutrition and lack of regular physical activity. Engaging in health-promoting lifestyle behaviors is the foundation for the prevention and nonpharmacologic treatment of primary hypertension in both children and adults,” the essay notes.
Household income and race play a major role in the disparities, as Black families compared to White families continue to experience higher risks even among high-income earners. The essay concludes that “within lower-income households, there was no significant association between race and hypertensive-range BP, but among higher-income households, Black race was associated with more than threefold higher odds of hypertensive-range BP compared to White race.”
“There is quite a bit of evidence that there is a lot of disparity in cardiovascular disease occurrence and outcomes in the United States,” says Halbach. “Specifically in adults when you’re talking about things like heart attacks or strokes. But then even among children, the incidence and prevalence of hypertension show disparities, with nonWhite groups having higher rates of hypertension.”
To treat hypertension in children, it is suggested that parents and families focus on the underlying cause and adopt heart-healthy lifestyles. This includes:
• Weight loss if overweight
• Daily aerobic exercise: aim for 60 minutes or more of moderate to vigorous activity every day
• Limit activities such as computer/video/tablet games and TV watching to less than two hours per day
• Regular daily intake of fresh vegetables, fruits and low-fat dairy
• Eliminate empty calorie drinks like juice, soda and sweet tea. Increase water intake
• Avoid foods high in salt
• Limit cholesterol intake to less than 300 mg each day
• Stop smoking
Halbach advises that some children may require medication, especially those identified with a secondary cause of hypertension, those who are symptomatic, those with diabetes or evidence of organ damage, and those who continue to have hypertension after six months of lifestyle changes.
This article was originally published by The Seattle Medium.
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