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Check Blood Pressure Starting at Age 3

<P>Children With High Blood Pressure Should Be Treated</P>
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WebMD Health News

May 20, 2004 (New York) -- High blood pressure -- the silent disease that leads to heart attacks, strokes, and kidney failure in adults -- is rapidly becoming a concern for the nation's children. Now the National High Blood Pressure Education Program is issuing new guidelines to deal with the problem.

The guidelines, which will be published in the July issue of the journal Pediatrics, were previewed today at the American Society of Hypertension's 19th Annual Scientific Meeting.

"The big message here is that high blood pressure in children is real, it is not a theoretical problem," says Bonita Falkner, MD, professor of medicine at Jefferson Medical School in Philadelphia. Falkner chaired the working group that drafted the new guidelines. She says regular blood pressure checks should start at age 3, but says that "even younger children can have hypertension and should be treated for it."

An adult is considered to have high blood pressure when the top number of a blood pressure reading (systolic pressure) is more than 140 mm Hg or when the lower number of a blood pressure reading is more than 90 mm Hg (diastolic pressure).

These reference numbers for diagnosing high blood pressure change in children as they age because children change, explains Falkner. So rather than fixing on specific numbers, health care providers can use charts that have percentile norms for blood pressure based on sex, age, and height, she explains.

Time to Intervene

The new guidelines recommend that children who have blood pressure readings that are in the 90th to 95th percentile for their age have "pre-hypertension, which not only means that these children are at risk for developing high blood pressure, but it also means that this is the time to intervene," Falkner tells WebMD. She says this new "pre-hypertension" category is one of the big changes in the new guidelines.

Both parents and doctors consider pre-hypertension a warning flag and immediately institute lifestyle changes. Those changes, Falkner says, mean "more exercise and a diet that is high in fresh fruits and vegetables and low in salt." Because kids, like grown-ups, are more likely to have high blood pressure if they are overweight or obese, she says that lifestyle changes also usually mean a weight-loss plan.

Children with blood pressure readings that put them in 95th or higher percentile have hypertension. For these children, lifestyle changes should be initiated, but Falkner says that it is unlikely that exercise and diet will be enough to control blood pressure in these kids. When six months of diet and exercise don't control blood pressure, the guidelines recommend that children be given high blood pressure medications used in adults to treat the condition.

She says most of these drugs -- beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) have been tested in children. But diuretics, which are among the oldest and cheapest high blood pressure drugs, have not yet been tested in children.

Falkner says that children who "are competitive athletes and children with asthma are probably not good candidates for beta blockers, which slow the heart rate." She says that ACE inhibitors and ARBs, which are the drugs commonly used to treat adults with diabetes and high blood pressure, are a good choice for children with diabetes and high blood pressure.

Children should be evaluated for damage to organs such as the heart and kidneys, Falkner says. This, too, marks a change in the guidelines and is yet another indication of the growing concern about high blood pressure in kids.

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