Overview
High blood pressure, or hypertension, in children refers to blood pressure that is at or above the 95th percentile for children of the same sex, age, and height. In teenagers, high blood pressure is defined as a blood pressure reading greater than or equal to 130/80 millimeters of mercury (mm Hg). High blood pressure in younger children is often related to other health conditions, such as heart defects, kidney disease, genetic conditions, or hormonal disorders. In older children, particularly those who are overweight, the risk of high blood pressure increases due to primary hypertension, which occurs on its own without an underlying condition. Elevated blood pressure is a preliminary stage, and if not managed, it can lead to hypertension. Lifestyle changes, including a heart-healthy diet and regular exercise, can help reduce high blood pressure in children. However, medications may be necessary in some cases. If your child has any signs or symptoms of a high blood pressure emergency or if you're concerned about their risk factors, consult their doctor.
Understanding the disease
Symptoms
Symptoms of high blood pressure in children are generally not specific to hypertension and may be associated with other health conditions. However, signs and symptoms of a high blood pressure emergency (hypertensive crisis) include:
- Severe headache
- Nausea and vomiting
- Blurred vision
- Chest pain or discomfort
- Breathing difficulties
- Confusion or dizziness
- Seizures If your child experiences any of these symptoms, seek emergency medical care immediately. It's important to note that high blood pressure usually doesn't cause symptoms, so regular check-ups are essential for early detection and management.
Risk Factors
The risk factors for developing high blood pressure in children include:
- Being overweight or having obesity
- Having a family history of high blood pressure
- Having type 2 diabetes or high fasting blood sugar levels
- Having high cholesterol
- Eating too much salt
- Being Black or Hispanic
- Being male
- Smoking or exposure to secondhand smoke
- Being sedentary
- Primary (essential) hypertension (occurring on its own without an identifiable cause, more common in children aged 6 and older) In younger children, high blood pressure is often related to other health conditions, such as heart defects, kidney disease, genetic conditions, or hormonal disorders. In older children, primary hypertension is more likely to occur due to lifestyle habits such as an unhealthy diet and lack of exercise.
Development
High blood pressure in children can develop due to a variety of factors, including underlying health conditions, genetics, and lifestyle habits. Younger children are more likely to have high blood pressure caused by specific medical conditions such as heart defects, kidney disease, genetic conditions, or hormonal disorders. These conditions can lead to increased blood pressure within the blood vessels. In older children, especially those who are overweight, primary hypertension (essential hypertension) is more common. This type of high blood pressure occurs on its own, without an underlying medical condition. The risk factors for developing primary hypertension in children include certain chronic conditions, such as kidney disease, diabetes, and sleep apnea; pregnancy; and unhealthy lifestyle habits, such as an unhealthy diet and lack of exercise. It is important to note that high blood pressure in children may be asymptomatic, and early detection through routine well-check appointments is crucial in managing and treating the condition.
Assessment and Diagnosis
Triage
If you suspect high blood pressure in your child, it is important to consult a doctor. Children's blood pressure should be checked during routine well-check appointments starting at age 3, and at every appointment if your child is found to have high blood pressure. If your child has a condition that can increase the risk of high blood pressure or if you're concerned about your child having a risk factor for high blood pressure, you should talk to your child's doctor. If your child experiences symptoms such as headaches, shortness of breath, or nosebleeds, it is also recommended to seek medical attention, especially if these symptoms are severe or persistent.
Diagnosis
To diagnose high blood pressure in children, the doctor will perform a physical exam, ask questions about the child's medical history and family history, and measure the child's blood pressure using the correct cuff size and proper technique. The blood pressure measurements will be taken during multiple visits to the doctor for accuracy. A diagnosis of high blood pressure requires elevated readings on at least three separate visits. If high blood pressure is diagnosed, the doctor may perform additional tests to determine if it is primary or secondary hypertension. These tests may include ambulatory monitoring, blood tests, and imaging tests like echocardiogram or renal ultrasound.
Management and Treatment
Complications
Uncontrolled high blood pressure in children can lead to complications, including:
- Heart attack or stroke: Hardening and thickening of the arteries due to high blood pressure or other factors can lead to a heart attack or stroke.
- Kidney problems: High blood pressure can damage blood vessels in the kidneys, impairing their function and leading to kidney disease.
- Eye damage: High blood pressure can cause damage to the blood vessels in the eyes, potentially leading to vision loss.
- Growth and development issues: Uncontrolled high blood pressure can impact growth and development in children, potentially stunting their growth and causing other developmental problems. It's essential to monitor and manage high blood pressure in children to prevent or minimize these complications. Regular check-ups and addressing any underlying health conditions or lifestyle factors can help maintain healthy blood pressure levels.
Prevention
High blood pressure in children can be prevented through lifestyle changes, such as maintaining a healthy diet low in salt, regular exercise, and managing any underlying health conditions. Encouraging healthy habits from an early age can help reduce the risk of developing high blood pressure later in childhood or adolescence.
Treatment
Treatments for high blood pressure in children may include lifestyle changes and, in some cases, medications. Lifestyle modifications such as adopting a heart-healthy diet low in salt, engaging in regular physical activity, maintaining a healthy weight, and limiting alcohol use can help reduce high blood pressure. Eating plenty of fruits, vegetables, and whole grains, and quitting smoking if applicable, can also be beneficial. Medications may be necessary for some children, particularly if their high blood pressure is caused by an underlying health condition. It's important to follow the guidance of your child's doctor regarding any treatments or medications prescribed.
Preparing for medical consultation
To prepare for an appointment for high blood pressure in children, you should:
- Make a list of your child's symptoms, including when they began, as high blood pressure rarely causes symptoms.
- Discuss your child's medical history, family history of high blood pressure, and their nutrition and activity level with the doctor.
- Ensure that your child's blood pressure is measured using the correct cuff size and technique during the appointment.
- Be aware of any pre-appointment restrictions, such as dietary restrictions, and follow them before the appointment.
- Prepare to discuss your child's daily routine, stress levels, sleep patterns, and any other relevant information that can help the doctor assess their overall health.
- Be ready to ask questions and discuss concerns you may have about your child's high blood pressure or recommended treatments. Remember that early detection and appropriate management can help reduce the risk of complications associated with high blood pressure in children.