Hypertension in Children

Despite popular belief, teens, children and even babies can have high blood pressure, also called HBP or hypertension. It's not just a disease for the middle-aged and elderly. As with adults, early diagnosis and treatment can reduce or prevent the harmful consequences of this disease.

The American Heart Association recommends that all children have yearly blood pressure measurements. Detecting high blood pressure early will improve a child's health. When it comes to blood pressure in children, normal is relative.

It depends on three factors:

• Gender
• Age
• Height

Your child's doctor can tell you what's right for your child, because normal is a complicated calculation based on these factors.

There are no obvious symptoms of high blood pressure in children. However, some may notice:

• Headache
• Dizziness
• Shortness of breath
• Visual disturbances
• Fatigue

The causes of high blood pressure in children may vary depending on its type.

Secondary causes are the most common in infants and young children.

• Newborns with umbilical artery catheters can have renal artery thrombosis and hence high chances of HTN
• Early childhood diseases like renal diseases, coarctation, endocrine, medications
• Adolescents have a high prevalence of essential hypertension

Renal and renovascular hypertension:

• Majority of cases due to urinary tract infection (secondary to obstructive lesion)
• Acute glomerulonephritis
• Henoch-Schonlein Purpura (HSP) with nephritis
• Hemolytic-uremic syndrome
• Acute tubular necrosis
• Renal trauma
• Leukemic infiltrates
• Mass lesions
• Renal artery stenosis

Essential hypertension:

• It is more common in adults and adolescents
• Usually have a positive family history
• Multifactorial causes like obesity, genetic and physiological changes

Making a diagnosis of high blood pressure in children is done by performing several tests.

Screening tests available are:

• CBC
• Urine analysis
• Urine culture
• Electrolytes
• Glucose
• BUN
• Creatinine
• Calcium
• Uric acid
• Lipid panel for patients with positive family history and essential hypertension
• Echocardiogram for chronicity (left ventricular hypertrophy)
• Renal ultrasound scan
• Angiography to see plasma rennin activity in renal veins and inferior vena cava
• Peripheral plasma rennin activity is a useful screening tool for renovascular and renal disorders

Several treatment methods are used for high blood pressure in children.

For obese patients, following recommendations are made:

• Weight control
• Aerobic exercise
• No added salt diet
• Monitor blood pressure

Pharmacological treatment in secondary hypertension and selective cases of primary hypertension:

• Often first choice in essential hypertension of a young child is diuretic or beta blocker
• If not sufficient, calcium channel blocker can be added to diuretic
• ACE inhibitors are good in high rennin hypertension secondary to renovascular or renal disease and also for high renin essential hypertension which may replace beta blocker
• Adolescents with significant hypertension should consider initial treatment with ACE inhibitor and calcium channel blocker
• Neonates with partial renal vascular occlusion should use captopril because of high angiotensin in their blood
• In patients with neural crest tumors with circulating catecholamines, use of alpha blocker (phentolamine, phenoxybenzamine) and beta-blocker to control heart rate, or agent with dual action like labetalol is suggested

These tips are good for all children to prevent high blood pressure, especially those who have or are at risk for it:

• Give your child healthy home cooked food
• Use less canned or pre-prepared food
• Encourage physical activity
• If your child smokes or chews tobacco, talk with his or her doctor about how to help your child quit
• Make sure that your child takes his or her blood pressure medicine, if prescribed.
• You and your family can keep a healthy weight

Eating for healthy blood pressure means eating:

• Less salt and packaged foods that are high in sodium, and
• More fruits and vegetables

A few alternative and homeopathic remedies exist for high blood pressure in children.

Lifestyle factors are critical determinants of blood pressure levels operating against a background of genetic susceptibility.

Excess body fat is a predominant cause of hypertension with additive effects of dietary salt, alcohol, and physical inactivity. Controlled trials in hypertensives show blood pressure lowering effects of supplemental potassium, fiber, n-3 fatty acids, and diets rich in fruit and vegetables and low in saturated fats.

Some population studies show an inverse relationship between dietary protein and blood pressure levels. Regular coffee drinking raises blood pressure in hypertensives.

The role of “stress” remains enigmatic. Key points include:

1. Control your child’s weight
2. Give your child healthy food
3. Decrease salt intake
4. Ensure regular physical activity

There are several risks and complications associated with high blood pressure in children, which include:

• Heart attacks
• Strokes
• Left ventricular hypertrophy