More children and teens are likely to be categorized as having abnormal blood pressure during their annual wellness visits, based on new recommendations released Monday by the American Academy of Pediatrics.
High blood pressure is mostly a “silent” condition, with no visible symptoms. Yet it can have long-term health consequences, including cardiovascular disease. The new guidelines, aimed at prevention, were published Monday in the journal Pediatrics. They include new diagnosis tables based on normal-weight children.
The Academy convened a 20-person committee to update the previous guidelines, issued in 2004, and develop new evidence-based recommendations. As part of its work, the committee reviewed nearly 15,000 articles focused on diagnosis, evaluation and early management of abnormally high blood pressure in children and teens.
An estimated 3.5% of all children and teens in the United States have hypertension, according to the guidelines.
“The prevalence of 3.5% is based on fairly recent large-scale screening studies,” said Dr. Joseph T. Flynn, lead author of the guidelines and a professor of pediatrics at University of Washington. In the past, the percentage of children diagnosed with high blood pressure was lower, he said: “based on previous studies, maybe 1% to 2%.”
The cause of hypertension depends on the age group.
“In infants and very young children, we worry about an underlying cause like kidney disease,” Flynn said. With older school-age children and teenagers, the cause is more likely to be primary hypertension, sometimes called essential hypertension, “where there’s no specific problem,” he said. “This is like adults.”
“Obesity does contribute to higher blood pressure,” he said. Yet the physiological mechanisms causing high blood pressure are very complicated, and not all kids who are overweight or obese are hypertensive, while some normal-weight kids may be.
“If, for example, a child is known to have kidney disease or heart disease, then they would be at higher risk for hypertension. Another group would be kids whose parents have hypertension,” Flynn said.
The guidelines include updated blood pressure tables based on normal-weight children for more precise classifications of hypertension. As a result, more children will be categorized as needing treatment.
“Untreated, we believe that high blood pressure in a child will lead to high blood pressure when that child becomes an adult, so that would potentially lead to an increased risk of cardiovascular disease later in life,” Flynn said, adding that untreated hypertension can also cause heart and kidney damage.
The new guidelines are aligned with those for adults according to Flynn.
“The blood pressure levels that are concerning in adults would also be concerning in an older teenager,” meaning those age 13 and older. “It simplifies things for doctors,” he said.
The major thing parents need to know is that their children should have their blood pressure checked when they see a doctor, Flynn said. Also, know that hypertension can be managed with lifestyle change: for example, more exercise or changing the diet. Sometimes, though, the condition requires medication.
Another change in the new guidelines is an emphasis on confirmation of the diagnosis.