Blood pressure screenings urged for children

Once considered a disease of middle age and later years, high blood pressure actually has its roots in early childhood. Those roots are now present in an increasing number of children and teens.

“What we’re finding is that with the current epidemic of overweight and couch-potato children, a higher percentage than ever before are in the hypertensive range,” said Dr. Julie R. Ingelfinger, a pediatrics professor at Harvard Medical School.

In light of that trend, she and other members of a government committee on blood pressure in children and adolescents recently updated guidelines for screening and treatment. They reiterated a 1996 recommendation that routine medical appointments include blood pressure checks starting at age 3. But the new guidelines of the committee, overseen by the National Institutes of Health, now instruct doctors to treat even mild elevations of blood pressure.

The revisions also say doctors should screen infants and toddlers who were born prematurely or have other diseases.

The recommendations reflect new knowledge about how aggressive screening and treatment in young people can potentially slow or stop hypertension before it has a chance to damage the heart and blood vessels.

An estimated 1% to 3% of children and teens have seriously elevated blood pressure, although some experts say the figure is probably higher. Treatment can often be as simple as increasing physical activity and watching weight. But some children may need to take prescription medications to get readings back to normal levels.

Dr. Carl M. Grushkin, head of nephrology at Childrens Hospital Los Angeles, says he would prefer to see every child screened from the earliest age. Kidney problems account for the vast majority of hypertension in kids younger than 10.

At least a couple of times each year, he said, the hospital’s emergency room treats children younger than 3 suffering from significant symptoms of hypertension, which can include headaches, nosebleeds, dizziness or palpitations. “That could have been picked up if the blood pressure measurement was taken.”

For any child whose blood pressure is higher than normal, the first approach is TLC: medical shorthand for therapeutic lifestyle change. That means exercising, watching weight, eating more fruits and vegetables and cutting down on salt and sugar, typically with support of the entire family.

Some children still require medication, particularly youngsters whose hypertension produces symptoms; those whose hypertension stems from other disorders; those with diabetes and those for whom diet and exercise didn’t do enough.

The latest guidelines, released last month at the American Society of Hypertension meeting in New York, recommend starting with a single drug, but don’t favor any particular class of medications. Although parents and children may question the side effects of taking medications long-term, doctors say that if pressures can be returned to normal, lifestyle changes may be sufficient to maintain them.

It’s tougher to evaluate blood pressure in children than in adults, and the extra time and effort required may sometimes be a deterrent for doctors. (They also must have blood pressure cuffs sized for small arms.)

Unlike adult hypertension, with its threshold reading of 140/90, children’s thresholds are variable. Doctors must consult newly revised tables to see where the child’s readings fall relative to what’s normal for sex, age and height.

Children whose pressure falls into the 95th percentile or higher for size and age are considered hypertensive. Those in the 90th to 95th percentiles are now called pre-hypertensive; among adolescents, the threshold for pre-hypertension is 120/80.

Once hypertension is confirmed by repeated high readings, the new guidelines instruct doctors to look for an underlying cause and for related illnesses, such as sleep apnea -- a breathing problem associated with excess pounds, as well as high cholesterol and diabetes. The guidelines also recommend echocardiograms to identify damage, particularly thickening of the heart’s left ventricle, which occurs in more than a quarter of hypertensive children.

“We know that for kids who have blood pressure in the higher ranges, when nothing is done about it, they will be clearly hypertensive in young adulthood,” said Dr. Bonita Falkner, who led the panel that revised the guidelines. She’s a professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia.