Hypertension in Children

Hypertension in children has become a serious issue and is rapidly growing.  With the increase in number of obese children worldwide,  there is a corresponding increase in pediatric hypertension as well as other medical conditions especially juvenile onset diabetes Mellitus. Hypertension in general is a precursor of a host of diseases/conditions. 

Blood pressure is determined by the balamce/equilibrium between cardiac output and vascular resistance.  When one of the two increases without a compensatory decrease in the other,  an increase in blood pressure ensues. 

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Due to incomplete blood pressure screening during visits to the pediatric doctor or children, the incidence of hypertension in children has been poorly documented and/or understood. It is thought that there are much more children with hypertension than is currently estimated. 

Evaluation of the frequency of the frequency of hypertension screening revealed that only two thirds of routine pediatrics visits had BP measurements and there was no BP screening in 20% of overweight or obese children during their routine visits.  Furthermore, 75% cases of hypertension and 90% cases of prehypertension were not further investigated. In fact at the hospital I currently work in Nigeria,  BP screening of pediatrics patients is basically nonexistent. This is partly due to the absence of pediatric BP monitor cuffs and in part due to the common misconception that only adults suffer hypertension. 

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A lot of factors affect the distribution of hypertension in children.  Age,  sex,  race,  genetics, weight all play individual roles.  There's a strong correlation between the blood pressure of parents and their children especially if the child is obese.  Blacks are said to be at an increased (this is however poorly documented in children). Adolescent males on the other hand have slightly higher BP than their female counterparts. In general,  children have an increased incidence of secondary hypertension (hypertension with known causes)  compared to essential hypertension (hypertension without a known cause) which is prevalent in adults. 

CLASSIFICATION OF HYPERTENSION IN CHILDREN

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RISK FACTORS

• Obesity
• Family History of hypertension or stroke
• Male sex
• Maternal smoking during pregnancy 
• Black/ African Race (although not strongly established) 

CAUSES (ETIOLOGIES)  OF PEDIATRIC HYPERTENSION 

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MANAGEMENT AND TREATMENT

Hypertension is managed based on cause and risk factors. 

Starting with obesity,  the child would have to lose weight through diet modification as well as increase in physical activity (exercise). 

For those who have any of the diseases listed in the fourth image (table of ETIOLOGIES), treatment of the causative (Primary)  condition will cause a corresponding decrease and normalisation of blood pressure.

For the unlucky few who have essential hypertension, permanent placement on anytihypertensive medications is usually the option as well as maintaining a good weight and diet to avoid worsening of the hypertension. 

COMPLICATIONS OF HYPERTENSION 

• Strokes
• Enlarged heart 
• Heart failure (hypertensive heart failure) 
• Kidney failure

These are usually if it is left untreated or undiagnosed for a long time,  over years. 

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For parents reading this,  insist your child is properly checked (the blood pressure)  by the pediatrician especially if the child or overweight or obese;  also if there's a family history of the disease irrespective of if the child is 3 years or 17 years old. 

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