Hypertension in Children: What Parents Need to Know

Children and hypertension
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Children can develop hypertension, too.

Children can develop hypertension, so it’s important for them to have regular check-ups. All children over the age of three years old should have their blood pressure checked annually. At each annual well-child check up, blood pressure is measured and compared against the blood pressures of other children in their age group. If it’s a high number, the doctor’s office will check it again after two more days to determine if it is hypertension or simply a single elevated blood pressure.

Know the numbers.

Blood pressure has two numbers. The top number is the systolic blood pressure, or pressure in the arteries when the heart is contracting. The bottom number is the diastolic blood pressure or the pressure in the arteries during the heart’s relaxation phase. A child is considered to have normal blood pressure if both numbers are less than the 90th percentile for their age group. That means that 90 of every 100 children in that age group have a lower blood pressure.

Pre-hypertension in children and adolescents

Children who have systolic and/or diastolic blood pressure greater than or equal to the 90th percentile for their age group, but less than the 95th percentile, are considered to have pre-hypertension. Any adolescent with blood pressure greater than 120/80 mm Hg is also considered to have prehypertension. Children with pre-hypertension should modify any factors that are contributing to their condition, just as adults are advised to do.

Hypertension: how it's diagnosed in children and adolescents

Children with a blood pressure greater than or equal to the 95th percentile for their age group have hypertension. Adolescents with blood pressure greater than 140/90 mm Hg also have hypertension. Caffeine, nicotine, and some medications can elevate blood pressure, so be certain to let your doctor know if this is a possible factor in your child’s blood pressure measurement.

 Adult blood pressure cuffs should not be used to measure a child’s blood pressure as it may give a falsely low reading. A cuff that is too small may give a falsely elevated blood pressure measurement.

What to expect if your child has high blood pressure

Hypertension in children may be the result of another medical condition, such as kidney disease. Some families also have an inherited tendency to develop high blood pressure. When a child is diagnosed with hypertension, the physician will always look for an underlying problem that can be treated before prescribing blood pressure medication. This workup may include blood tests and imaging studies, like ultrasound examination of the heart or kidneys. The initial step in treating hypertension is lifestyle change.

Lifestyle changes are often necessary.

Lifestyle changes that children with high blood pressure or pre-hypertension can make to improve their numbers include regular exercise and reducing the amount of salt in the diet. Children who are overweight may be advised to work with a nutritionist to find healthy eating patterns that will both safely lead to weight loss and reduce dietary salt.

Adults should not smoke in the home or car, as second-hand smoke contains over 7,000 chemicals, and many of those chemicals contribute to health problems in children.

Processed foods should be avoided.

Processed foods are often convenient for parents and children, particularly when running from one activity to the next. Unfortunately, they are loaded with salt, to improve their taste. This has a significant effect on blood pressure in children and adults. Processed foods often contain high-calorie additives that are low in nutritional value, which contributes to obesity, hypertension, and diabetes.

Aerobic exercise is very important.​ 

Aerobic exercise is another important part of a healthy lifestyle, and studies have demonstrated the benefits of exercise on hypertension. Children who spend too much time in front of a television or playing computer games are at greater health risk than children who regularly exercise 20 or thirty minutes each day. Aerobic exercises include running, walking, biking, and swimming. Exercise classes that elevate the heart rate, like Zumba or spin classes, are sometimes fun for adolescents.

Your child may need medication for hypertension.

If lifestyle changes don’t return the child’s blood pressure to the normal range, the doctor will probably prescribe medication. It’s very important to be compliant with both lifestyle changes and prescribed medications. Hypertension is “the Silent Killer,” because there are no symptoms and individuals sometimes decide on their own to stop their medicine. Although high blood pressure usually doesn’t cause symptoms, over time it results in damage to organs like the kidneys and the heart. Children with very high blood pressure may have seizures or heart failure. Heart failure occurs when the heart is no longer able to pump normally. Children with high blood pressure are also at greater risk of having hypertension as an adult, which can lead to strokes and heart attacks.

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