Baltimore's Child Baltimore's Child
Think only adults have to worry about high blood pressure? Think again. Although the condition is not as common, pediatric hypertension or high blood pressure is about to be diagnosed more often than in prior years, due to new updates in blood pressure guidelines for children.
The efforts to revamp the standards were lead in part by Dr. Carissa Baker-Smith. Dr. Baker-Smith is an assistant professor of pediatrics at the University of Maryland School of Medicine and a pediatric cardiologist at the University of Maryland Children’s Hospital. She is a lead author of “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.”
Here is a breakdown of what concerned parents should know:
Who made the changes?
Dr. Baker-Smith sat on an expert panel gathered by the American Academy of Pediatrics (AAP) to forge the changes. The writing committee included 17 representatives from various pediatric groups and a parent member to lend a family’s perspective. Updates were based on review of nearly 15,000 published references presenting new evidence and data over the past 13 years. The resulting guidelines were endorsed by the American Heart Association and by the American College of Cardiology.
Why have things changed?
The previous blood pressure table values were established in 2004, and included measurements from children who are overweight or obese, and more likely to have increased blood pressure. Those higher numbers were skewing the guidelines too high and risked leaving some children with high blood pressure undetected. The new tables are based on children with heathy weights, therefore the targeted values are lower and allow more precise classification according to body size.
How do the new standards affect detection?
There will be an increase in the number of children determined to have elevated blood pressure, because the cut-offs for normal blood pressure are now lower than they used to be. Detection of true hypertension will be more accurate as a result of the revised guideline.
Which children are most at risk for high blood pressure?
Only about three to four out of 100 children have high blood pressure, but for children with certain risk factors that figure can jump to 1 in 4. Higher risk groups include children with unhealthy weight (BMI between 85-95th percentile) or obesity (BMI >95th percentile), history of prematurity (<37 weeks), family history of hypertension, heart defects, children with chronic kidney disease and children taking certain medications (e.g., steroids). Children with a high salt diet are also more at risk.
How do I know if my child has high blood pressure?
Children with high blood pressure typically do not have symptoms associated with it. The “silent” nature of hypertension makes it easy to miss. But, if left unrecognized and unmanaged, it can put stress on a child’s heart over time, causing the heart muscle to thicken. It can also contribute to heart failure, stroke and other complications later in life. Uncontrolled long-standing hypertension can also have damaging effects on the kidneys and brain. Routine monitoring is important.
Could my child require blood pressure medication?
Lifestyle management should be the first line of defense, as long as a child’s blood pressure is not too high. Dr. Baker-Smith advises parents: “Pay attention when the pediatrician says that your child’s weight-for-height is increasing in an unhealthy way. Heed the recommendation for your child to cut back on extra calories and exercise more, because unhealthy weight is a major risk factor for high blood pressure. Our eye’s ability to assess whether or not a child is of an unhealthy weight is not very good. Healthy lifestyle and a healthy weight may be all that is required to control a child’s blood pressure.” If lifestyle interventions fail, or are not effectively enforced, medication may be required.
How does sleep factor into blood pressure?
It is normal for blood pressure to fall when asleep, but children with abnormal sleep (sleep-disordered breathing or obstructive sleep apnea) may not experience a normal decline in blood pressure during the night. This too can contribute to the development of abnormal changes in the heart muscle and a higher daytime blood pressure.
What should I expect at my child’s pediatrician visit?
During a routine pediatric visit, expect your child to have a full vitals assessment, including blood pressure screening. Your provider will also need to know the child’s birth history and family history to establish risk level. In revising the guidelines, the committee created 30 key action statements and 27 additional recommendations so pediatricians will now be better prepared than ever to diagnose, manage and treat high blood pressure in children starting at age 3 years (or younger for certain children with a higher risk for developing hypertension) and continuing until the child transitions to an adult provider.
What is the bottom line?
Parents need to be aware that high blood pressure can and does happen in children, and a child with high blood pressure is more vulnerable to future health problems. “If we hope to have healthy adults, we have to start with healthy kids,” said Dr. Baker-Smith. “In general, about 3 percent of children have high blood pressure, but a quarter or more of children who are of an unhealthy weight have high blood pressure. And the unhealthier the weight, the higher the blood pressure is likely to be.”
As in so many health issues, prevention and early detection play critical roles. These new guidelines for blood pressure in children help define a plan, but the important task is now getting everyone informed enough to follow through.
