Pediatric Hypertension (High Blood Pressure)

Blood pressure is the force of blood exerted against the walls of the arteries as the blood travels to all parts of the body. Blood pressure is generated by the heart's pumping action.

A certain amount of blood pressure is needed to get the blood to flow properly. Blood pressure varies throughout the day. It starts out lowest in the morning and as the day goes on, it gradually increases. Anxiety, excitement and strenuous exercise can also affect normal blood pressure by increasing it.

There are two numbers to a blood pressure reading. The top number is known as the systolic blood pressure. This refers to how hard the blood is hitting against the artery wall while the heart is contracting.

The bottom number, called the diastolic blood pressure, measures how hard the blood is hitting against the artery wall while the heart is relaxing between the beats. Both numbers are important and can be elevated.

Taking a Blood Pressure Reading

To evaluate blood pressure, a cuff is first placed around the arm. It is important for the cuff to fit the arm correctly. The nurse or doctor pumps up the cuff with air so that it tightens on the arm.

When the air is let out, the cuff relaxes slowly and the nurse or doctor listens with a stethoscope for the pulsations. There is a series of sounds that can be heard as the blood pushes back through the arteries.

The very first sound heard is the systolic blood pressure. When the sounds disappear, this is called the diastolic blood pressure.

Some blood pressure machines can detect these measurements automatically without needing a doctor or nurse to listen with a stethoscope.

It is important to measure blood pressure on at least a couple of occasions to establish a diagnosis of hypertension, since blood pressure can be influenced by anxiety in the doctor's office, time of day and other everyday factors.

The diagnosis of hypertension is usually not made from one reading. However, if the blood pressure is severely high, the diagnosis may be made.

Normal Blood Pressure for a Child

Normal blood pressure for a child is based on three factors: age, gender and weight. At age 18, norms used are the same as for an adult.

High blood pressure is characterized by an excessive force of blood flow against the walls of the blood vessels. "Hypertension" means high blood pressure, or a blood pressure greater than the 95 percent for age, weight and height.

All children with blood pressure over 120 / 80 should be monitored closely as they are at risk for developing hypertension (also known as prehypertension).

The guidelines published by the government in 2004 included the recognition of the risk for end organ damage and consequently recommended obtaining an echocardiogram on all children prior to drug treatment.

The most common reason for high blood pressure is the inherited (genetic) form known as primary hypertension. This kind of hypertension is often seen in children and adolescents who are overweight. This accounts for the majority of cases with hypertension in both adults and children.

The cause of primary hypertension is unknown. The remaining cases with high blood pressure are due to an underlying cause, such as a kidney abnormality, narrowing of the arteries to the kidneys, a congenital defect of the heart such as coarctation of the aorta, or rare tumors of the adrenal gland. These forms of hypertension are called secondary hypertension because an underlying cause can be identified.

High blood pressure increases the workload of the heart, since it must squeeze blood through the blood vessels against high pressure. When the heart must pump harder, the pumping chamber (left ventricle) of the heart may become enlarged and thickened.

If high blood pressure continues to go unnoticed or untreated, the left side of the heart can become progressively larger or thicker. This is called left ventricular hypertrophy and is one of the risk factors for developing coronary artery disease and possibly a heart attack.

If high blood pressure is left untreated, it can also damage the arteries in the kidneys causing them to narrow and decrease the blood supply to the kidneys. The kidneys cannot function normally and this may result in kidney failure.

Uncontrolled high blood pressure over time can also harm the arteries that bring blood to the brain. Prolonged high blood pressure can cause the vessel walls to weaken and even possibly burst, causing bleeding in the brain. This is called a stroke.

Also, the opening of the artery may narrow or become blocked completely. In this case, blood is unable to get to the brain. This is another kind of stroke.

Uncontrolled high blood pressure can also damage the eye by causing the arteries to narrow and twist, thus cutting off the blood supply. Eventually this process may cause vision to be hindered.

It is important to remember that heart attacks, kidney failure and strokes are uncommon as a result of hypertension in children and adolescents.

However, the processes that lead to these problems probably do begin in childhood. This is why children and adolescents should have their blood pressure measured with routine healthcare visits.

Hypertension is known as the silent killer because it usually has no signs and symptoms. When hypertension is very severe or advanced, symptoms may include headache, fainting and loss of kidney function.

In late stages, convulsions may occur. Most patients with hypertension feel fine and do not know that their blood pressure is elevated.

If blood pressure is found to be high, measuring it again is important. If the blood pressure elevation is persistent, lifestyle changes are recommended such as:

  1. Achieving the proper weight through diet and exercise for patients who are overweight
  2. Cutting down on salt in the diet

Sodium and salt content are listed in a variety of ways, but on the nutrition label, sodium content is reported in milligrams (mg).

Americans typically take in 5,000 to 8,000 mg of sodium per day. If blood pressure is high, it is best to reduce sodium intake to 2,000-3,000 mg / day. A teaspoon of salt has 2,196 mg of sodium. The major sources of sodium in your diet are:

  • Salt added to food during cooking and at the table
  • Sodium added to food during processing. This is sometimes called hidden salt.
  • Sodium which naturally occurs in food and water

To reduce sodium in your diet, remove the salt shaker from the table and avoid adding it during meal preparation. Herbs and spices can be a tasty alternative. In addition, limit the amount of processed foods your family eats.

Processed luncheon meats, bacon, sausage, cheese, convenience foods and most canned foods are high in sodium. Many snack foods, including crackers, chips and baked goods, are also high in sodium.

Some sodium occurs naturally in foods, such as meats, poultry, seafood and dairy products, as well as minimal amounts in fresh vegetables and fruits. These do not need to be limited.

Look at the labels! Try to balance out the sodium in your family's meals and snacks. When eating out, avoid sauces and ask the server to prepare your meal without salt.

Certain types of restaurants, including Asian and Mexican cuisine, are particularly high in sodium, but will usually adapt your entrees to meet your needs.

Avoiding smoking, excessive caffeine and a lot of alcohol are other lifestyle changes that may help decrease blood pressure. When all else fails or if blood pressure is moderate to severe, then antihypertensive medication may be used.

Children do not usually suffer the life-threatening cardiovascular effects of high blood pressure. The ill effects of hypertension usually develop over many years. Finding it early allows us to find the appropriate ways to address it and lower the blood pressure.

Last Updated 05/2015

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