When we think of high blood pressure (hypertension) we usually think of it as an adult problem. But did you know high blood pressure can be present at any age? Elie Firzli, MD, pediatric nephrologist, talks about symptoms and treatments.
Did you know: High blood pressure happens in children. In fact, it is now recognized that hypertension in adults most likely begins during childhood.
Here we spoke with pediatric nephrologist Dr. Elie Firzli about this often-misunderstood condition.
How long have you been treating children for high blood pressure?
I have been treating children with hypertension for more than 20 years now. When I first started practicing, it was a rare occurrence to diagnose a child with primary or essential hypertension. Most of the patients we treated for hypertension had kidney problems or other primary conditions as mentioned below.
Are you finding a trend more (or younger) cases of high blood pressure? If so, what do you attribute this to?
Data from the National Health and Nutrition Examination Survey (NHANES) indicates that the prevalence of essential hypertension in children is on the rise (data since 1988). Along with this rise is a rise in overweight and obesity. The data shows that there is a relation between high blood pressure and being overweight. Further stat shows a connection between the condition and eating a diet higher in salt. The percentage of patients with primary hypertension we see is more than in previous years. Genetics do play a role, but problems with overweight, lifestyle, poor dietary habits as well as social factors remain the most recognized and accepted cause for this change.
High blood pressure occurs when the body retains more salt and water or when the blood vessels are more constricted than normal. Chronic high blood pressure can lead to serious complications such as heart disease, stroke and kidney damage.
Adults have a blood pressure target below 120/80. But for kids, there is not a single target number indicating high blood pressure. Normal blood pressure is a moving target depending on a child’s age, gender and height among their peer group. For children 13 years and above, the normal and high blood pressure values are similar to those of adults.
High blood pressure in kids often goes undetected and untreated because there usually aren’t any symptoms. Certain conditions can increase the risk of your child having high blood pressure, such as low birth weight, premature birth, congenital heart disease and certain kidney problems.
What is your approach to the care of your patients?
First, let’s discuss primary high blood pressure
Just like in adults, being overweight (a body mass index of over 25) is a risk factor for high blood pressure (primary hypertension) in children. Other risks include having high cholesterol, type 2 diabetes or a family history of high blood pressure. Eating a well-balanced and nutritious food low in salt in smaller portions and getting regular, daily exercise can help reduce high blood pressure in children, but in certain cases medications may be required. Avoidance of processed food is also advisable, as this type of food usually contains a high amount of salt.
Now let’s talk about secondary high blood pressure, which is caused by another underlying health condition and is more common in kids.
The causes include kidney diseases, heart problems, adrenal disorders, thyroid problems, certain medications and sleep disorders.
Unfortunately, many children who have high blood pressure are more likely to have high blood pressure as adults unless they begin treatment and lifestyle modifications to lower their blood pressure.
Any tips for parents in helping their children manage their high blood pressure?
If you’re unsure about normal blood pressure in kids, have your primary care physician check your child’s blood pressure. Over-the-counter machines are not recommended by the American Academy of Pediatrics (AAP). Your care provider will use an AAP-approved screening table indicating the lower values (systolic or diastolic) for gender and age. If your child’s pressure falls below these values, there is no need to worry. If the blood pressure is higher, your care provider can use more sophisticated tables published by the AAP in 2017 to evaluate if high pressure exists and how severe it is. The AAP recommends blood pressure measurements annually for healthy children age 3 years and above. High risk patients should have more frequent measurements.
If you’re concerned about your child having a risk factor for high blood pressure, such as being overweight or obese, talk to your child’s doctor. Whatever is advised by your care provider, make these changes for all family members so your child does not feel different. Also, the heath style and diet advised for hypertension is usually healthier for other members of the family.