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Thursday, June 21, 2012

Hypertension in Kids

By Roy Benaroch, MD

Child Checking His Heartbeat

Hypertension, or an elevated blood pressure, is far more common in adults than children. Still, it can occur at any age. And the younger the child, the more likely an elevated blood pressure could be from an important medical issue that needs to be addressed quickly.

A “normal” blood pressure in a child isn’t a single number. It depends on the child’s age, sex, and height, and it’s best to refer to a specific table to see what a healthy BP is for a specific child.

In children, the most common cause of an elevated BP is incorrect measuring technique. If a BP cuff is used that’s too small, the measured value will be artificially high. A muscular 14-year-old almost certainly needs an adult cuff, or even an “adult large” cuff. Assuming that the right cuff is used, it’s important to see if the BP is elevated in different circumstances by having the family check it at home or a fire station or drug store a few times. Keep in mind, though, that an elevated BP does need to be addressed one way or the other—its not something that ought to wait until next year’s check up.

Causes of a truly elevated BP in a child could include:

* Medications (including decongestants, ADD medicines, steroids, birth control pills, and others)

* Kidney disease

* Heart disease

* Obesity

* Sleep apnea

* Chronic pain or illness

The workup for a child with a consistently elevated BP usually includes a urinalysis and blood tests (to look for kidney disease and metabolic problems) and a kidney ultrasound. Sometimes a cardiac workup is also good idea. The younger the child, the more likely these tests are to reveal a specific underlying cause of elevated BP that needs to be addressed, and the more quick and aggressive the workup needs to be.

In adults, most hypertension is called “essential hypertension” or “primary hypertension”—that is, an elevated blood pressure that doesn’t really have a specific cause. This kind of hypertension leads to long-term issues with heart disease, stroke, and eye and kidney disease. We used to think this was only a disease of adults, but it’s clear that some teenagers already have this kind of chronic hypertension and ought to be treated the same way as adults to reduce their long-term health risks. Children and adults with primary hypertension should also be evaluated for other health risks that often go hand-in-hand with hypertension: obesity, diabetes, and elevated cholesterol. The “first line” therapy should include healthy eating and exercise habits, followed by medicines to lower blood pressure if necessary.

Parents of teens often think they grow up so fast—and in today’s world, that sometimes means that diseases of adults can start young. Blood pressure should be checked at least once a year in all kids down to age 3, and even in children below three with special risk factors. Too young? Maybe. But it won’t help to not look.

Photo: iStockphoto

Posted by: Roy Benaroch, MD, FAAP at 6:30 am

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