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Childhood Hypertension

Can children have high blood pressure (hypertension)?

Yes.

Hypertension is becoming increasingly common in children and adolescents. An estimated 3-5% of kids have high blood pressure. Children who have high blood pressure tend to be hypertensive as adults.

What is blood pressure?

Blood pressure is the pressure the blood exerts against the blood vessel walls as the heart pumps. The pressure increases when the heart contracts and pushes blood into the vessels (systolic) and lowers when the heart relaxes (diastolic).

Blood pressures vary depending on the age, height and gender. Generally, blood pressure is low in infancy, and rises slowly as the child ages. Boys’ blood pressure is slightly higher than girls’ are, and taller people generally have higher blood pressure than short people.

How is blood pressure measured?

Blood pressure (BP) is expressed in millimeters of mercury (mmHg). The top pressure number refers to systolic pressure. The bottom number refers to diastolic pressure. BP is measured either manually by a device known as sphygmomanometer or by an automatic device. Special attention needs to be paid in the selection of an appropriate cuff size in relation to the child’s upper arm.

High blood pressure (Hypertension) – What is it?

High blood pressure (hypertension) means the pressure in your arteries is higher than it should be. High blood pressure in children is blood pressure that is the same as or higher than 95 percent of children who are the same sex, age and height as your child on at least 3 separate occasions.

It’s easy for adults to tell if they have high blood pressure simply by having blood pressure checks and comparing the numbers to a simple chart. Children have the BP checks; however interpreting the numbers is trickier. Your child’s doctor will use charts based on your child’s sex, height, and blood pressure numbers to determine whether or not your child has high blood pressure.

Does my child need further tests?

When hypertension is diagnosed, further testing is recommended to help determine the cause of hypertension. The evaluation generally includes a medical history and physical examination, measurements of blood pressure, laboratory tests and ultrasound.

What are the causes of hypertension in children?

  1. Primary hypertension (Essential hypertension)Primary hypertension means that the hypertension does not seem to be caused by some other underlying medical condition. The incidence of childhood or adolescent primary hypertension has been rising along with the obesity epidemic. The majorities of teens with primary hypertension have a family history of hypertension and/or are overweight.
  2. Secondary hypertensionSecondary hypertension is hypertension caused by a known underlying medical condition. The table below shows the causes of hypertension in children;
    Causes of secondary hypertension Percentage
    Kidney disease
    75%
    Blood vessel abnormalities
    15%
    Endocrinological disorder
    5%
    Others
    5%

What are common symptoms of hypertension?

Often, kids and teens have no symptoms, though some children may experience headaches. In rare severe cases, your child might have serious signs and symptoms that indicate medical emergency, such as loss of vision, double vision, confusion, seizure, chest pain, abdominal pain and difficulty in breathing.

If there are no high blood pressure symptoms, why is it important to treat hypertension?

High blood pressure adds to the workload of the heart and arteries. Though a person may not have any symptoms, it doesn’t mean that the high blood pressure isn’t affecting the body.

These effects include:

  • Heart and Blood vessels – coronary artery disease, heart failure, hardening of the arteries (Atherosclerosis).
  • Kidneys – if the blood vessels in the kidneys are damaged, they may stop removing waste and extra fluid from the body and result in kidney failure. This extra fluid can raise blood pressure even more.
  • Other organs – hypertension makes it harder for blood to reach many different parts of the body, including the eyes and the brain, and can lead to blindness and strokes.

The effects of hypertension can begin during childhood.

How is hypertension treated?

Your child’s treatment plan may depend on:

  • Whether the hypertension is primary or secondary (if secondary, treating the underlying condition may help resolve the hypertension).
  • How high is the blood pressure.

Mild to moderate hypertension with minimum symptoms may be controlled by non-pharmacological measures. This is otherwise known as Lifestyle modification.

Lifestyle – Diet and exercise modification to lower high blood pressure

  1. Weight
    Aim to keep your weight at a healthy level or reduce your weight if you are overweight.
  2. Exercise
    Aim to exercise for 20-30 minutes per day most days of the week. Aerobic exercise includes walking, swimming and biking.
  3. Eat a healthy diet and reduce salt intake
    Eat a diet rich in fresh, fruits, fresh vegetables and whole grains, and limited in salt, fat and sugar-sweetened beverages.

Medications

In children and adolescents, medications may be recommended in cases of moderate to severe hypertension.

  • Medications may include: Diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers, and calcium channel blockers.

How long is medication needed for?

Depending on the causes of hypertension and control of hypertension, the duration of drug treatment differs. The ability to reverse any underlying medication problems and the success of lifestyle modification will allow medications to be stopped.

Know what your blood pressure should be and work to keep it at that level.

For more information:

Clinical Practice Guidelines Management of Hypertension
(Ministry of Health Malaysia, Academy of Medicine of Malaysia, Malaysia Society of Hypertension)

Last Reviewed : 19 June 2014
Writer : Dr. Yap Yok Chin
Accreditor : Dr. Lim Yam Ngo
Reviewer : Dr. Aina Mariana bt. Abdul Manaf