Hypertension in Children

Hypertension, or abnormally high blood pressure, is a serious medical problem in children. Children who are overweight are at increased risk for hypertension. Hypertension must be treated to avoid permanent health problems. Weight reduction, physical activity, and [Page 379]dietary changes are often used as first-line treatments that can be supplemented with antihypertensive pharmacological agents as needed.

Hypertension can be classified as primary (also known as essential) or secondary. Essential hypertension is a diagnosis of exclusion (i.e., there is no clear underlying medical cause) that is associated with several risk factors, including obesity. Secondary hypertension is the direct result of another condition, most often renal, endocrine, or cardiovascular disease. The subcategories of pediatric hypertension include prehypertension, stage 1 hypertension, and stage 2 hypertension; the percentile cutoff of blood pressure for each category is based on the child's sex, age, and height. The prevalence of pediatric hypertension is approximately 1 to 5 percent. On average, blood pressure appears to be rising; from approximately 1990 to 2000, blood pressure in children increased 1.4 mmHg in systolic measurement and 3.3 mmHg in diastolic measurement.

In children under age 10, the majority of cases of hypertension are secondary to an underlying condition such as renal parenchymal disease or renal vascular disease. Other causes include endocrine abnormalities, coarctation of the aorta, and the use of certain medications. In adolescents, most cases of hypertension are primary, rather than secondary. Risk factors in adolescents for primary hypertension include family history of cardiovascular disease and high body mass index.

Hypertension often presents with no visible symptoms. If present, symptoms can be vague and may include irritability, headaches, and sleeping difficulties. The American Heart Association recommends that all children aged 3 and older have yearly blood pressure measurements. For a proper diagnosis, it is important that the child avoid intake of stimulant (such as caffeine) before the measurement. When the measurement is taken, the child should be calm, with a steady pulse in the normal range. A blood pressure cuff of appropriate size must be used to obtain an accurate measurement. If hypertension is suspected, the measurement should be repeated twice during that visit, and on at least one other visit for confirmation.

Childhood hypertension contributes to early development of cardiovascular disease. Long-term complications from hypertension include stroke, heart failure, renal failure, and retinopathy. Maintaining a healthy weight, eating a low-fat and low-sodium diet, and engaging in regular physical activity may help to prevent pediatric hypertension. The first line of treatment for primary hypertension is lifestyle change, which can include weight reduction, dietary modification, and physical activity. Antihypertensive medications are suggested for patients who do not respond to lifestyle changes, have evidence of end-organ damage, or have stage 2 hypertension. There are a variety of medications approved for use in children, including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, calcium channel blockers, and angiotensin-receptor blockers. Secondary hypertension may resolve simultaneously if the disease causing it is treated. 

As the rate of childhood obesity increases, so too does the incidence of obesity-related illnesses like hypertension.