Imagine your family doctor telling you that your 4-year-old has hypertension - more commonly referred to as high blood pressure. Unusual as it sounds, it is becoming more common. Children can have high blood pressure, too.

Although high blood pressure is not as common in children as it is in adults, it can still have life-threatening consequences if left untreated. Because high blood pressure has few symptoms, the key is to be sure that your child's doctor is following his or her blood pressure. Incorporating a few simple lifestyle changes can keep blood pressure from getting out of control.

New Guidelines on Childhood Hypertension

A recent study funded by the National Heart, Lung and Blood Institute (NHLBI) has shown that blood pressure levels for children and teenagers have risen dramatically since 1988. The study results are so serious that the NHLBI working group on pediatric hypertension plans to release new clinical practice guidelines on high blood pressure in children and adolescents later this summer.

With blood pressure levels rising in children, the NHLBI released a summary of new guidelines in May to help physicians better diagnose and treat new cases of high blood pressure. The new guidelines will appear in this month's issue of the journal Pediatrics.

The new guidelines urge physicians to screen all children for high blood pressure at age 3 during routine well-child visits.

They have now defined 4 classifications of blood pressure based on the child's gender, age and height: normal, pre-hypertension, stage 1 and stage 2 hypertension.

The normative data were derived from measurements taken in more than 70,000 children nationwide. Normal blood pressure values are much lower in children than adults and gradually increase with age and size.

"The increase in blood pressure among American children is a serious public health issue that should be prevented at all costs. For the first time, using newer diagnostic tools, we have documented that end-organ damage from hypertension occurs even during childhood," says Dr. Ronald Portman, professor of pediatrics and director of the pediatric nephrology division at The University of Texas Medical School at Houston. "For children in particular, prevention is the best medicine."

Portman, who is president of the International Pediatric Hypertension Association, is a member of the NHLBI working group and co-author of the soon-to-be-released guidelines.

Time and Pressure, Bad Mix

Hypertension is blood pressure that is persistently above the normal range. It can damage the heart, brain, kidney and eyes if left untreated. It often puts children at greater risk for heart disease during adulthood. Approximately 5 percent of American children have high blood pressure - a figure much higher than noted in previous years.

Most younger children have hypertension related to an underlying kidney disease. However, older children and adolescents often develop the same type of hypertension as adults. Researchers aren't sure why some children have higher blood pressure than others. But several factors are certain to put a child at risk for hypertension:

• children who are overweight
• children with a family history of high blood pressure
• children of African-American or Mexican-American heritage

An Ounce of Prevention is Worth.

Portman stresses the importance of prevention in helping children live a long, healthy life. As a practicing pediatric hypertension specialist, he always asks himself five questions pertaining to his young patients at risk for high blood pressure:

• Does the child really have high blood pressure?
• Why does the child have high blood pressure?
• Does the child have other heart disease risk factors such as obesity, diabetes, high cholesterol, tobacco smoking or physical inactivity?
• What has high blood pressure already done to the child's body?
• What should we do about it?

"While many adult studies show modest improvement in outcomes with treatment of hypertension, the goal of medical research must be to prevent high blood pressure from ever occurring and give your child a healthy start in life," Portman says.

Portman recommends some lifestyle changes to help keep your child's blood pressure controlled:

• Don't smoke. Pre-teens and teens who smoke should quit to reduce their risk for high blood pressure, heart disease and stroke. Parents who smoke can set a good example by quitting and teaching their children about the dangers of tobacco.
• Eat right and exercise. We've heard it over and over again. But a balanced diet and physical activity is the best remedy to help lower blood pressure. Feed your child fruits, vegetables, low-fat dairy foods and low-salt foods.
• Maintain weight. Help your child get the weight off and keep it off.
• Have your child's blood pressure checked often. Portman suggests getting your child's blood pressure checked starting at age 3, unless they already have a high-risk condition.
• Follow doctor's orders. Sometimes, physicians will need to prescribe blood pressure medication if a special diet and exercise don't bring the blood pressure to a normal level, if hypertensive damage is present, or a specific disease causing the hypertension is found. Recent studies of antihypertensive medications performed under new guidelines by the Food and Drug Administration have led to an increase in knowledge about their safety and efficacy in children.

For the tables from the new clinical practice guidelines on hypertension in children and adolescents, go to www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.htm

For a guide on lowering high blood pressure, log on at http://www.nhlbi.nih.gov/hbp/index.html

http://www.nhlbi.nih.gov/health/public/heart/hbp/hbp_low/hbp_low.pdf

For general information about pediatric hypertension, go to www.pediatrichypertension.org

Top Textbook on Hypertension in Children Pediatric Hypertension , co-authored by Ronald Portman, M.D., John Sorof, M.D. and Julie Ingelfinger, M.D., is the only textbook focusing on high blood pressure in children.

UPDATED: 8-05-2004

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