High Blood Pressure in Children
When you need to see your child's pediatrician.
High Blood Pressure (HBP) or Hypertension (HTN) is no longer considered an adult disease only. Over the past couple decades; the prevalence of obesity has dramatically increased, which increases the prevalence of HTN as well.
Blood pressure (BP) readings in children are different from adults’. As children grow, BP increases gradually. Normal BP values or readings are based on age, gender and height. We have BP tables for every age, height and gender that shows the normal ranges as well as HTN ranges. BP can be categorized into 3 categories : normal , HTN and if the BP reading falls between normal and HTN values, then, the patient would be considered as having pre-hypertension. This category is very important because it helps physicians intervene in order to avoid patients from developing true HTN.
When a patient is found to have high BP, unless it is severe or the patient has symptoms, the BP should be repeated in 3 separate occasions.
Some children have high BP at the clinic and normal BP at home, this is named “white coat HTN”, in this case, we perform 24 hour BP monitoring at home with a special machine that is provided by our office to confirm the diagnosis. We usually do not prescribe medications if it is only “white coat HTN”.
The majority of children with HTN do not manifest any symptoms. HTN is mostly identified on a routine school physical, and that’s why it is important for primary care physicians to measure BP and categorize it according to the BP tables as being normal, HTN or pre-HTN. Other patients may experience symptoms such as headache, dizziness, chest pain, fatigue … In such cases, BP should be checked.
The causes of HTN are divided into primary or secondary.
Primary HTN is on the rise, it is related to obesity, unhealthy diet poor in fruits and vegetables and high in salt, sedentary lifestyle, and some inherited genes.
Secondary HTN is considered to be secondary to an underlying disease, the most common one being kidney diseases, other diseases include and not limited to: vascular diseases, thyroid disorder, and certain tumors …
When we have a patient with HTN, the work up includes complete history and physical exam, blood and urine tests as well as imaging studies.
Why do we care about HTN in children? We care because of the concern about target organ damage. HTN can cause damage to the kidneys, heart, blood vessels and eyes.
How do we manage HTN?
Once a patient is diagnosed with pre-HTN, management includes counseling about diet, physical activity, weight loss.. Physicians should re-check BP in 6 months.
However patients with true HTN, treatment would be lifestyle changes and anti-hypertension drugs. Drugs are indicated if patients have severe HTN, symptoms of HTN, diabetes, target organ damage, persistent HTN despite lifestyle changes, and treat the underlying conditions if HTN is secondary.
Management of HTN of a child does not end with prescribing drugs, however, close ongoing monitoring of BP, monitoring of drugs side effects and ongoing counseling about weight, diet and exercise are crucial for better outcome.
Finally, HTN remains a serious medical concern, WHO (the world health organization) reports that high BP in adults that is not well controlled remains a major risk factor for death in the world, risk for stroke, heart disease, kidney disease and dialysis. The prevalence of HTN in children is increasing, early detection and management are important to prevent and/or monitor long-term complications. For more information about OU Physicians – Tulsa or to make an appointment with Dr. Razzouk call 918-619-4323.
