High Blood Pressure (“Hypertension”) in Children
Basics of High Blood Pressure
High blood pressure (also called “hypertension”) is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure and other health problems. “Blood pressure” is the force of blood pushing against the walls of the arteries as the heart pumps blood and is measured systolic and diastolic pressures. “Systolic” refers to when the heart contracts and pumps blood through the body, and “diastolic” refers blood pressure when the heart is at rest between beats.
- If the pressure is high during the pumping phase (systole), then the first number (systolic pressure) recorded during a blood pressure reading will be high.
- If the pressure is high during the relaxation phase (diastole), then the second number recorded (diastolic pressure) will be high.
Causes of High Blood Pressure
Blood pressure may be classified as "primary" (without a definite cause) or "secondary" (related to an illness or behavior).
Factors that may contribute to primary hypertension in adults (and possibly children) include:
- High blood cholesterol levels
- Being overweight
Secondary causes of hypertension in children include:
- Illnesses. The kidneys play an important role in regulating blood pressure, and are often less able to perform this vital task when diseased. A congenital (present at birth) heart defect called coarctation of the aorta may also cause high blood pressure. Head injury may raise the pressure inside the brain, which affects the body's ability to regulate blood pressure normally.
- Immobility (perhaps due to a chronic illness)
- Severe pain (the type associated with cancer or burns)
Health Problems Associated with High Blood Pressure
High blood pressure (or “hypertension”) increases the risk of coronary heart disease (heart attack) and stroke (brain attack). With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate blood.
Heart attack and stroke related to high blood pressure are rare in children and adolescents. Yet studies of young adults with high blood pressure find many had high blood pressure as a child. Children and adolescents who have high blood pressure (or even mild hypertension) begin to suffer harmful effects on the heart and blood vessels even in their 20s.
Tests, Procedures and Diagnosis of High Blood Pressure
A child's doctor may note an elevated blood pressure reading during a routine office visit. Obtaining calm, resting blood pressures on several different occasions (days, weeks or months apart) provides better information about whether blood pressure elevation is consistent or due to fear or stress.
To diagnose hypertension, a child's doctor obtains a medical history (information about a child's diet, exercise level, home and school activities, and possible stressors) and may perform a physical examination.
Diagnostic tests may help determine if a child's high blood pressure is related to an illness, or is "essential" or "primary" hypertension, meaning it has no known cause. Diagnostic procedures may include:
- Blood tests (including cholesterol levels and kidney function)
- Other tests to evaluate the health of other organs (such as the heart or kidneys) that may contribute to hypertension
Treatment of High Blood Pressure
A physician determines a treatment plan for high blood pressure based on:
- A child's age, overall health and medical history
- Severity of the condition
- A child's tolerance to specific medications, procedures or treatments
- Expectations for the course of the condition
- Parents’ opinions or preferences
If a secondary cause for high blood pressure is found (such as kidney disease), the underlying disease is treated. If no cause is determined, the first treatment approach is lifestyle therapy, including:
- Weight reduction
- Increasing physical activity
- Healthy diet
These interventions can lower systolic and diastolic blood pressure, improve heart strength and lower blood cholesterol. These are all important steps in preventing heart disease as an adult. Medications to control high blood pressure are only needed in about 1 percent of children with the disorder. A child's doctor should be consulted for more information.