Some Kids Under 3 Need Blood Pressure Checked

High Blood Pressure in Childhood Increasingly Common

From the WebMD Archives

July 28, 2004 -- With childhood obesity sprouting an epidemic of health problems, doctors are being asked to check for and treat high blood pressure even in kids under 3.

New guidelines reiterate earlier recommendations that doctors routinely test blood pressure in all children starting at age 3. But now, an expert panel suggests that some children should be checked even earlier and provides more specific advice for treating high blood pressure in youngsters.

It's estimated that 1% to 3% of American toddlers and school-age children already have high blood pressure. That's at least 750,000 kids.

High blood pressure is called the "silent killer" because it usually causes no symptoms but can eventually lead to very serious consequences such as heart attack and stroke.

High Blood Pressure: Not Just for Obese Kids

"The obesity epidemic in childhood is making this more of an issue," says Bonita Falkner, MD, who led the expert panel drafting the new guidelines. "But even normal-weight children can have high blood pressure."

Falkner, professor of medicine and pediatrics at Jefferson Medical College in Philadelphia, tells WebMD that the new guidelines -- unveiled in May at the American Society of Hypertension annual meeting and to be published as a special supplement to the August issue of Pediatrics -- provide more information on how doctors should evaluate and treat high blood pressure in their youngest patients and urges them to keep a closer eye for other problems that can result from it.

"Before we advised doctors to screen children for high blood pressure starting at age 3 and keep an eye out for it, but there was little specifically addressing how to evaluate and treat it," she says.

Different Set of Numbers

In adults, high blood pressure is diagnosed when the top (systolic) number of a blood pressure reading is more than 140, or when the lower (diastolic) number is more than 90.

"But for young children, there is no one number that defines high blood pressure because there is a normal rise in blood pressure with growth and development," she tells WebMD.

Instead, doctors will use charts similar to "growth tables" that place children into groups for their height and weight. These charts will have blood pressure norms based on the child's age, sex, and height.

In addition to taking blood pressure readings of all children beginning at age 3, the guidelines recommend that blood pressure be routinely measured in younger children with certain conditions, including those born prematurely or at a low birth weight, those who had a prolonged hospital stay after delivery, those with heart disease, and those taking medications that can raise blood pressure.

Kids and a Change of Life

Under the guidelines, children in the 90th or above percentiles for their age have "prehypertension," suggesting the need for lifestyle changes. Those children, as well as some with mild high blood pressure, would typically be first treated with lifestyle medication similar to adults with either condition.

"That means increasing physical activity in children who are sedentary, making dietary changes, and for those who are already overweight, taking measures to control weight," says Falkner.

Weight loss should be the No. 1 treatment for high blood pressure due to obesity, according to the guidelines. Both regular physical activity and a reduced-calorie diet should be part of the weight loss plan.

Physical activity should include some activity that the child enjoys for 30 to 60 minutes at least four days a week. Sedentary activities, such as watching TV, using a computer, or playing video games, should be limited to less than two hours a day to help prevent obesity, high blood pressure, and high cholesterol.

Diet should include limited salt as well as a diet rich in fresh fruits and vegetables. Reducing salt can also help bring blood pressure down. The experts also suggest getting the whole family involved because that improves weight loss success in children.

Blood Pressure Drugs for Kids

If those efforts fail after six months or children already have more severe high blood pressure, they would be treated with high blood pressure medications used in adults. Most have already been tested in children, but diuretics, among the least expensive and most widely used, have not.

"There are also certain indications to take further steps," says Falkner. "Children with more severe hypertension should have their (cholesterol) levels checked, evaluated for sleep apnea, and be tested for pre-diabetes." These conditions are associated with high blood pressure, and some children might even be tested for organ damage, especially to the kidneys.

"The major message for parents is that hypertension is a cardiovascular risk factor and it begins in the young -- this is not a problem only limited to adults," says Joseph Flynn, MD, director of the Pediatric Hypertension Program at The Children's Hospital at Montefiore and another panel member.

"Clearly, high blood pressure starts in childhood," he tells WebMD. "It's to the benefit of the child to have something done about it early, before they become cardiac cripples at age 40. This is taking a more preventative approach."

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SOURCES: The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, Supplement to Pediatrics, August 2004; vol 114: pp 555-575. Bonita Falkner, MD, professor of medicine and pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia. Joseph Flynn, MD, director, Pediatric Hypertension Program; associate professor of clinical pediatrics, The Children's Hospital, Montefiore, N.Y.
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