Hypertension In Children: Signs, Symptoms, Causes & Treatment

The occurrence of high blood pressure in kids may be low, but considering that it is a chronic condition, it is crucial to know about it. Hypertension or high blood pressure (HBP) is predominantly seen in adults. But, as per the American Academy of Pediatrics (AAP), nearly 3.5 percent of children in the US develop it.

Hypertension should be detected early as it can damage vital organs such as the heart, the eyes, the brain. Therefore, regular monitoring of a child’s blood pressure (BP) and taking prompt measures to keep it within the healthy range is imperative.

This post gives information on high blood pressure, its signs, diagnosis, treatment, and prevention.

What Is High Blood Pressure?

Blood pressure refers to the force of blood that pushes against the walls of the arteries as the heart pumps blood. The arteries are the blood vessels that carry the blood from the heart to the entire body. When the blood passes through the arteries at a higher pressure than normal, it’s known as high blood pressure (HBP).

High blood pressure can damage the arterial walls and cause several health issues, including organ damage. Hence, monitoring a child’s blood pressure is vital.

Blood Pressure Classification For Children

A reference range for normal, elevated, and high blood pressure values exists for adults. However, for children, there are no set ranges. Instead, percentile values are used to compare a child’s blood pressure to their peer’s based on different factors, such as height, weight, and age. The table below shows the blood pressure classification for children:

Source: American Academy Of Family Physicians (AAFP)

For children aged above 13 years, the normal BP range is the same as for adults.

According to the new ACA/AHA guidelines, a person is said to have high BP if their BP is at 130/80mm Hg.

Sign And Symptoms Of High Blood Pressure In Children

Typically, children with prehypertension and stage-1 hypertension may not show any evident signs and symptoms. It is only when a child enters stage-2 hypertension that they may exhibit one or more of the following signs.

• Frequent headaches
• Vomiting
• Abdominal pain
• Double vision or blurred vision
• Vision loss
• Chest pain
• Rapid heartbeat (palpitation)
• Breathing problems, such as shortness of breath
• Seizures

If a child shows any of these signs and symptoms, consult a pediatrician promptly. The doctor will evaluate the child to locate the possible causes and chart out a treatment plan.

Causes Of High Blood Pressure In Children

Depending on the cause, HBP in children and teens is categorized as primary (essential) and secondary.

1. Primary hypertension: Primary or essential hypertension is when the cause of high BP is unidentifiable. Experts believe that the common reason for primary hypertension is inheritance. Most children above six years with high blood pressure have a family history of the condition.

According to the American Academy Of Family Physicians (AAFP), primary hypertension accounts for most cases of childhood hypertension. Some of the risk factors associated with primary hypertension are

• • Overweight or obesity
  • Sedentary lifestyle
  • Consistently high fasting blood sugar levels or type-2 diabetes
  • High blood cholesterol levels (hypercholesterolemia)
  • Exposure to passive smoking
  • Excessive salt consumption

Besides these, the ethnicity of the child is also a risk factor for primary hypertension. For instance, the incidence of HBP is high in African-American children above the age of 12 years.

2. Secondary hypertension: Unlike primary hypertension, secondary hypertension is associated with identifiable underlying causes, including

• Congenital heart defects, such as coarctation.
• Kidney issues, such as chronic kidney disease or polycystic kidney disease.
• Endocrine disorders, such as overactive thyroid (hyperthyroidism).
• Brain injury.
• Rare adrenal gland tumors.
• Overuse or long-term use of prescription drugs (steroids, methamphetamine, oral contraceptive).

Besides these, obesity, inactivity, and illicit drug (cocaine) use can also cause hypertension in teens and children. Secondary hypertension is more common in young children, and primary and secondary hypertensions have an almost equal incidence for children above six to eight years.

“Beware of a phenomenon called white coat hypertension. It is an elevated blood pressure reading that occurs due to the anxiety that comes for some children with a doctor’s visit. Readings are normal when the child is relaxed, and this is not true hypertension,” says Dr. David Shafran, a pediatrician at Cleveland Clinic and head of Pediatrics at K Health. Whitecoat hypertension is considered a risk factor for HBP, especially when a child’s BP continually rises when anxious.

How To Diagnose High Blood Pressure?

“Because of the risk of early cardiovascular disease associated with persistently elevated blood pressure, hypertension is extremely important to identify and treat early in children,” notes Dr. Shafran. Further, the Centers For Disease Control And Prevention (CDC) recommends doctors evaluate a child’s blood pressure at every visit starting from three years of age.

During a regular check-up, the doctor or healthcare professional will do a physical examination, enquire about your child’s family and medical history, and gather information about their diet and activities. Besides, they will also perform the following.

1. Check the blood pressure. The doctor or clinician will ask the child to sit in a comfortable, resting position in a quiet environment. Then, the doctor will place the blood pressure cuff in the right position and take the BP reading. To ascertain that the reading is accurate, ensure that the size of the cuff that the doctor is using is the right size for the child.

Once the reading is taken, the doctor will plot it on the BP chart to deduce a percentile. Depending on the percentile, the doctor will suggest whether the child has hypertension.

A doctor may check the child’s BP two or three times the same day to confirm the diagnosis. If the results are inconclusive or the doctor suspects white coat hypertension, they might use ambulatory BP monitoring to confirm hypertension. In ambulatory blood pressure monitoring, the child temporarily wears a device that measures their blood pressure throughout the day, even while sleeping.

2. Blood and urine test: Once a child is diagnosed with HBP, the next step is to determine the cause. The doctor would recommend additional tests, such as blood tests and urinalysis. The blood test helps assess cholesterol, triglyceride levels (lipids), and electrolytes in the blood. On the other hand, a urinalysis helps determine kidney function. Both these tests when done in combination help trace the most likely cause for hypertension in a child or teen.

3. Imaging tests: In addition to blood test and urinalysis, the doctor may also recommend more tests, such as ECHO or ECG. An ECHO test helps detect any abnormality in the heart anatomy and narrowing of the arteries, while ECG helps evaluate improper heart rhythm, indicating an underlying problem. Additionally, the doctor may also order a renal ultrasound to ascertain that the kidneys are working fine.

Depending on the severity of BP, the doctor may refer the child to a specialist, such as a kidney specialist (nephrologist) or heart specialist (cardiologist). These specialists may order more tests based on their understanding of the case and plan a suitable treatment plan for the child based on the results of those test reports.

Treatment For High Blood Pressure

The treatment options in most pediatric hypertension cases are as follows.

1. Dietary changes: The doctor will refer the child to a pediatric nutritionist, who will plan a personalized diet for the child.

“Weight loss is a primary treatment for obese children with high blood pressure. It is achieved by promoting a healthy diet and exercise.  A healthy diet example is a DASH (Dietary Approach to Stop Hypertension) diet. The DASH diet is a low-sodium, low-sugar, and low-fat diet. It also emphasizes fresh fruits and vegetables and limits processed foods and animal fat,” says California-based pediatrician and health advocate Dr. Psierrette Mimi Poinsett.

2. Physical activity: The doctor will encourage your child to indulge in age-appropriate exercises or sports to maintain an optimal blood pressure level. The child could do physical activities such as dancing indoors or running or playing football outdoors.

3. Lifestyle changes: Lifestyle changes include motivating the child to have a proper sleep, limiting screen time, and creating a stress-free, happy environment. Additionally, parents should instruct the child to stay away from illicit drugs, smoking, and alcohol, as consuming these can cause BP problems later in life.

4. Medications: If dietary and lifestyle changes do not help much, the doctor may prescribe anti-hypertensive medicines, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, calcium channel blockers, and diuretics.

• • ACE inhibitors, calcium channel blockers, and angiotensin II receptor blockers relax the blood vessels and smoothen the blood flow.
  • Diuretics (water pills) increase urination, helping expel excess sodium from the body.

The doctor will suggest which medicine the child needs and in what dosage and for how long. The decision is taken based on the child’s age, cause of HBP, its severity, and other medical conditions that the child may have.

Note: Irrespective of whether the child has primary or secondary hypertension, eating a healthy diet and maintaining an active lifestyle helps regulate BP and keeps BP-related complications at bay.

Possible Complications Of High Blood Pressure

HBP exerts stress on the heart, which over time may lead to the enlargement and thickening of the left heart chamber (left ventricle). The left heart chamber is from where oxygenated blood transfers to the entire body. This anatomical change marks the beginning of HBP complications.

If the ventricular thickening and enlargement go undetected or untreated, the risk of coronary artery disease and heart attack increases. Also, the arteries can start weakening and even burst. When an artery bursts, it completely cuts off the blood supply to the vital organs, eventually resulting in

• • Kidney failure.
  • Strokes, such as brain stroke.
  • Vision problems, such as blurred vision or vision loss.

Here, it’s vital to note that stroke, heart attack, and kidney failure due to HBP are uncommon in children and teens. However, the physiological changes that cause these adverse effects start from childhood. Therefore, it’s important to regularly monitor your child’s BP and take the necessary steps to prevent HBP.

Tips To Prevent High Blood Pressure In Children

Preventing blood pressure isn’t possible when it’s caused by underlying issues, such as congenital heart defect or kidney disease. However, leading a healthy lifestyle from a tender age can help prevent HBP caused by obesity and an unhealthy lifestyle.

Here are some simple steps to prevent high blood pressure and minimize its adverse effects if your child or teen already has HBP.

1. Help your child maintain a healthy weight. Encourage the child to eat a healthy, well-balanced diet containing various foods from different food groups. This helps maintain one’s calorie intake, which plays a pivotal role in maintaining a healthy weight and keeping chronic health issues, such as HBP, at bay. So,

• • Feed your child whole grains, fresh fruits, vegetables, low-fat dairy, and lean meat.
  • Teach them to avoid or lower their intake of high fat, high sugar, and processed foods such as fries, cookies, cakes, and donuts.

To ensure your child follows these diet tips, be their role model and practice healthy eating as a family.

2. Limit your child’s sodium intake. This is vital as high sodium consumption with low potassium intake can cause HBP, raising heart disease and stroke risk. According to the American Heart Association (AHA), 81 percent of children’s sodium intake comes from grocery and restaurant food. So, limit the child’s intake of foods such as cheese, bread, cured meats, soups, and savory snacks.  Here’s the daily salt recommendation for children based on their age.

Source: NHS

3. Regulate your child’s caffeine intake. Coffee, soft drinks, energy drinks, and chocolates are common caffeinated beverages and foods that can load a child’s system with caffeine. Besides, these foods are often high in sugar, contributing to a child’s weight gain. Hence, it’s vital to avoid or limit these foods and drinks to maintain a healthy weight and control BP, especially if the child already has HBP. According to AAP, children under five years should avoid consuming caffeine.

4. Encourage your child to remain physically active. As per CDC, children between three and five years should remain active throughout the day. On the other hand, children between six and 17 years should indulge in an hour of moderate-to-vigorous intensity physical activity every day. These activities could include bone strengthening and muscle-strengthening activities, such as running, jumping, push-ups, and climbing.

5. Monitor your child’s blood pressure from as early as three years of age. It’s particularly important if the child has a family history of high blood pressure or heart disease. It’s also vital if the child is overweight or obese. And for those who were born preterm, had low birth weight, or longer NICU stay, BP screening before the baby turns three is recommended.

So, ensure that the doctor takes your child’s blood pressure reading during regular check-ups. If the doctor suspects any abnormalities, they will monitor the child’s BP for several weeks or months before confirming the diagnosis. Annual BP check is recommended for otherwise healthy children.

6. Ensure the child takes medicines on time and adheres to the medical recommendations to maintain an optimal blood pressure level.

7. Teach the child to read the nutrition facts labels. For children and teens with hypertension, this practice will help them make healthier choices. Hence, instruct your child to pick packaged foods only sparingly. If they do, they should look for low-fat, low-sodium, low-sugar options that contain healthy ingredients such as whole grains and low-fat dairy. This is also one of the best ways to prevent HBP in healthy children.

References

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Reviewer

Dr. Supriya MahajanDNB, PDCC

   

Dr. Supriya Mahajan is a pediatrician and pediatric hepatologist with 16 years of experience. She completed her MBBS from Shyam Shah Medical College and diploma from the National Board of Education, New Delhi. She went on to gain specialization in the gut and liver-related diseases in children from the Institute of Liver and Biliary Sciences and MRCPCH 1, 2 from the Royal College of Pediatrics and Child Health (RCPCH), UK.

Read full bio of Dr. Supriya Mahajan