Hypertension (High Blood Pressure)

We usually think of high blood pressure, or hypertension, as a problem that affects adults. But, in fact, this condition can be present at any age, even in infancy. About five of every hundred children have higher than normal blood pressure, although fewer than one in a hundred has medically significant hypertension.

How blood pressure is measured

The term blood pressure actually refers to two separate measurements:

  • systolic blood pressure is the highest pressure reached in the arteries as the heart pumps blood out for circulation through the body
  • diastolic blood pressure is the much lower pressure that occurs in the arteries when the heart relaxes to take blood in between beats

If either or both of these measurements are above the range found in healthy individuals of similar age and sex, it’s called hypertension.

Who gets high blood pressure

  • Hypertension is more common among individuals of color than whites. It also seems to be more prevalent in some parts of the world; for example, it’s very rare among Alaskan Inuit, but affects as many as forty of every hundred adults in northern Japan.
  • In many cases hypertension seems to develop with age. As a result, your child may show no signs of high blood pressure as an infant, but may develop the condition as she grows.
  • Youngsters who are overweight are also more prone to have hypertension (and other chronic diseases). Thus good eating habits (without overeating and without emphasizing high-fat foods) and plenty of physical activity are important throughout the early years of childhood (and for the rest of her life).

Causes

In most instances of high blood pressure, no known cause can be identified. However, when hypertension becomes severe in children, it’s usually a symptom of another serious problem, such as kidney disease or abnormalities of the heart or of the nervous or endocrine (gland) system.

Detection is key

Fortunately, high blood pressure alone rarely causes serious problems in children, and can be controlled through dietary changes, medication, or a combination of the two. However, if hypertension is allowed to continue or become worse over many years, the prolonged extra pressure can lead to heart failure. In addition, the stress on blood vessels in the brain can cause them to burst, producing a stroke. Also, long-term hypertension causes changes in blood vessel walls that may result in damage to the kidneys, eyes, and other organs. For these reasons it’s important for children found to have hypertension to have their blood pressure checked regularly by their pediatrician, and for you to follow the doctor’s advice carefully.

Signs and symptoms

In most routine physical examinations, your child's blood pressure will be measured. This is how hypertension is usually discovered. Most often this condition causes no noticeable discomfort, but any of the following may indicate high blood pressure:

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

Diagnosis

If your child is found to have high blood pressure, your pediatrician will order tests to see if there is an underlying medical problem causing it. These tests include studies of the urine and blood. Sometimes special X rays are used to examine the blood supply to the kidneys. If, as in most cases, no causative medical problem can be found, the diagnosis of essential hypertension will be made. (In medical terms, the word essential refers only to the fact that no cause could be found.)

Managing your child's high blood pressure

  • The first step toward reducing your child’s blood pressure is to limit the salt in her diet. Giving up the use of table salt and restricting salty foods can reverse mild hypertension and will help lower more serious blood pressure elevations. You’ll also have to be cautious when shopping for packaged foods; most canned and processed foods contain a great deal of salt, so check labels carefully to make sure the items have little or no salt added.
  • The pediatrician also may suggest that your child get more exercise. Physical activity seems to help regulate blood pressure and thus can reduce mild hypertension. Weight reduction in the obese individual also may serve to lower blood pressure; in addition, the avoidance of excessive weight provides other health benefits.

Medication

Once the pediatrician knows your child has high blood pressure, he’ll want to check it frequently to make sure the hypertension is not becoming more severe. Depending on how high the blood pressure is, the pediatrician may refer the child to a child hypertension specialist, usually a kidney expert. If it does become worse, it may be treated with medication as well as diet and exercise.

Many types of medications are available, which work through different parts of the body. At first the pediatrician may prescribe a diuretic, a medicine that increases urine output of salt (sodium), before trying stronger drugs. Alternatively, or if this doesn’t return your child’s blood pressure to normal, an antihypertensive drug will be prescribed. Initially the doctor will prescribe a single drug, adding others only if the blood pressure is difficult to control.

Follow your pediatrician's instructions

When your child’s blood pressure is brought under control with diet or medication, you may be tempted to let her increase her salt intake or stop taking her medicine because the problem seems to be gone. However, doing this will only bring back the hypertension, so be sure to follow your pediatrician’s instructions exactly.

Early detection is key

It’s very important to detect hypertension early. It is now recommended that all children have their blood pressure checked beginning at age three, sooner for those at high risk (infants that were preterm, had a low birth weight, and who had a difficult or prolonged hospital stay, as well as in children who have congenital heart disease, who are receiving medications that might increase blood pressure, or who have any other condition that might lead to high blood pressure).

Prevention

Because overweight children are more likely to develop hypertension (as well as other health problems), watch your child’s caloric intake and make sure she gets plenty of exercise.

It’s also wise to keep excess salt out of your child’s diet, even if she doesn’t have high blood pressure. There’s no clear evidence that salt causes this problem, but your child doesn’t need extra salt, and once she develops a taste for it, she’ll have more difficulty decreasing salt intake if she develops blood pressure problems later in life.

Published online: 6/07

Source: Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2004 American Academy of Pediatrics, Updated 5/05)
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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


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