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Medical Article

Hypertension in children

Hypertension in children and adolescents is defined as having an average systolic or diastolic blood pressure that is matched with the patient’s gender, age and height. The blood pressure more than 140 mm of Hg and a diastolic blood pressure of more than 90 mm of Hg is defined as hypertension.  Hypertension in child is decided when the systolic and diastolic blood pressure is more than or equal to 95th percentile of the children of same age, sex and height for more than 3 consecutive readings. A value of more than 120/80 mm of Hg is usually considered significant.

In prehypertension, the blood pressure values are between 90th percentile and 95th percentile.  In stage I hypertension the reading between the 95th and 99th percentile plus 5 mm of Hg. If the reading is above the 99th percentile plus 5 mm Hg, the condition is considered as stage II hypertension.

Common View

The prevalence of hypertension in childhood is about 45%, and slightly more common in the male child. The South India related study reveals that the prevalence of prehypertension and hypertension was similar in urban and rural school children in the age group of 10 to 16 years.

Causes of Pediatric Hypertension

In general, the causes of hypertension are classified as primary and secondary. There are no underlying causes for primary hypertension, while secondary hypertension has some causes.  

The secondary hypertension is more common in the paediatric age group.  Reports indicate that the childhood atherosclerosis (hardening of arteries) may be associated with childhood hypertension.

The common causes of secondary hypertension are like this, kidney-related condition like renal artery stenosis, thrombosis and congenital anomalies.  Coarctation of aorta, renal vein thrombosis, renal artery stenosis, renal tumor, drug abuse, genetic causes, sleep apnea.

The signs and Symptoms of Hypertension in Children

Hypertension doesn’t show any signs or symptoms at early age, so it is termed as the ‘silent killer’.

In advanced stage, the symptoms start to develop. Headache, dizziness, shortness of breath, visual disturbances, fatigue, and nose bleeds. Usually the children doesn’t complaint about it, if they feel complication then immediate medical attention is required. 

The children with history of prematuarity, very low birth weight, congenital heart disease or family history of congenital kidney disorders, cancer, following organ transplant, urological disease with blood or protein in urine, recurrent urinary tract infections, tuberous sclerosis and ambiguous genitalia should need particular attention.

Diagnosis of Pediatric Hypertension

While physical examination the doctors take an authentic history of the family and looks out for the signs and symptoms of hypertension. The blood pressure should be immediately measured in children with symptoms like headache, dizziness, confusion, irritability or seizures. Eye examination will help to rule out damage to the eyes due to hypertension. 

An instrument called sphygmomanometer is used to measure blood pressure. The blood pressure should be measured in the sitting or lying down position after the child has rested for 5- 10 minutes. The pressure may have to be measured in all four limbs to detect coarctation of aorta. Continuously measuring the blood pressure over 12 -24 hours ambulatory blood pressure monitoring is done. It used to rule out a situation called white coat hypertension, the condition in which blood pressure increase with seeing a doctor and also used to monitor response to treatment.  The abnormality shown in ambulatory monitoring should be cross-checked using a sphygmomanometer. 

Blood test is necessary for a hypertension child. To rule out anemia the blood count will take. Test of basis metabolic profile and electrolyte levels, takes urea and creatinine levels, fasting lipid profile and glucose will take to find out any existing metabolic problems like diabetes and high cholesterol. 

To determine renal causes of hypertension urine analysis is done and avoid kidney-related and endocrine causes of hypertension 24 hours urine protein test will be collected and tested. 

Abdominal ultrasound tests help to visualize the kidneys and identify the kidneys’ cause of hypertension. Chest x ray, electrocardiography (ECG), and endocardiography (Echo), computed tomography (CT scan) of head should be taken to identify the problem. 

Treatment for Pediatric Hypertension

Along with medication lifestyle modifications are necessary for pre-hypertension and hypertension.  Healthy diet and increased physical activity will reduce weight. Cycling, swimming, running and playing are suggested physical activities for children. Law salt intake and 1-1.5 gm of sodium is recommended. Regular follow-up to measure blood pressure is necessary for these children.  For a healthy heart intake of fried foods and sweet snacks should be avoided, instead encourage intake of fresh vegetables and fruits. 

Antihypertensive medication is useful for treatment. Medication needed for children with symptoms, end organ damage, secondary hypertension and those blood pressure is not controlled by lifestyle change. 

Fosinopril, enalapril and lisinopril like drug is used to act through multiple mechanisms, drug like amlodipine help to relax blood vessels and reduce the work of the heart, Cetral alpha agonistes like clonidine which relax blood vessels and drugs like hydralazine and minoxidil are also useful.

Prevention of Hypertension in Children

Hypertension in children may be prevented by early identification of the risks like family history of hypertension, low birth weight, overweight and sedentary lifestyle.  Annual blood pressure measurement in children more than 3 years is recommended. The children between 9-11 years are now recommended to detect abnormal lipid and cholesterol levels. Ensure children get adequate sleep.  Control over children’s use of Internet, video games and mass media. Increase the physical activities of the children. 

Health tips

Early identification of risk factors and secondary causes of hypertension in children is very important.  The children under the risk for developing hypertension should follow low intake of salt. The symptoms like irritability, headache and blurring of vision to be taken seriously.  In the first step of the treatment lifestyle and diet modification is very important.