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Hypertension on the Rise in Children and Adolescents
High blood pressure and its complications have traditionally been considered to be adult health concerns. Unfortunately, this is no longer the case. The incidence of hypertension has increased significantly in children and teens in the past decade.
A recent study looked at this trend. It examined the increase in hospitalizations for hypertension among children and teenagers and the economic impact of this trend.
Unlike adults, in whom high blood pressure is diagnosed when one exceeds a target blood pressure reading, there is no one cut-off value for the diagnosis in children. Instead, a child’s blood pressure measurements must be viewed in the context of his or her growth. When the pressure reading is the same or higher than 95% of children who are the same sex, age and height, the child is diagnosed with hypertension.
There are two kinds of high blood pressure, essential or primary, which occurs on its own, and secondary, which is caused by an underlying medical condition such as kidney, heart, or endocrine diseases. Secondary hypertension can also be caused by some prescription and over the counter medications and some illegal drugs. In younger children, secondary hypertension is more common, but in teens hypertension is often essential.
High blood pressure in children, as in adults, often has no symptoms. But it places extra burden on the heart chambers and blood vessels as they pump and carry blood around the body. This contributes to the long term risks of high blood pressure in which include stroke, heart attack, heart failure, kidney disease, and eye disease. High blood pressure in children is treated similarly to adults with a comprehensive plan including appropriate diet, weight loss, exercise, avoidance of tobacco smoke, and possibly medications.
Researchers looked at hospital records from 1997, 2000, 2003, 2005 and found that pediatric hypertension-related hospitalizations nationwide had nearly doubled: from 12,661 admissions in 1997 to 24,602 in 2006. The charges for the inpatient care for pediatric hypertension increased by 50% over the study period: the charges generated from these pediatric hypertension-related hospitalizations equaled $3.1billion. Clearly, the economic and medical impacts of pediatric high blood pressure on the health care system have increased dramatically.
Admissions for hypertension were more common among males and African Americans. Sixty eight percent of the patients were 10-18 years old, the age group more likely to have hypertension without an identifiable medical cause.
The records reflected that obesity was the most common secondary diagnosis after hypertension. Children who are obese have three times higher risk of developing high blood pressure. Hypertension associated with obesity is considered to be primary or essential hypertension. The researchers suggest that the higher incidence of hypertension admissions in the pediatric population, particularly among teens, reflects the increased incidence of obesity in that population, further underscoring the medical and economic burden of the current epidemic of overweight and obesity in the United States.
The study was published in Hypertension. An accompanying editorial added further context to the study. It stressed that hypertension in children, rather than resolving, continues into adulthood and increases the risk for later complications. Additionally concerning, the vascular damage which is caused by hypertension gets its start during childhood. Up to 30% of children with newly diagnosed hypertension already show abnormal changes in the thickness of their heart walls and in their major arteries.
There are many take-home messages. Children’s blood pressures should be measured routinely during primary care visits and abnormal values should be followed up conscientiously. When blood pressure measurements remain abnormal over repeated checks, the children should be treated for their hypertension with lifestyle modifications and medications when appropriate rather than assuming they will “outgrow” the problem.
Overweight and obesity, as known risk factors for hypertension, should be aggressively treated and strategies of education and prevention should continue to be explored and implemented. Appropriate prevention and treatment of hypertension in childhood is a critical step in decreasing the adult burden of cardiovascular disease.
July 19, 2012