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High blood pressure - children

High blood pressure (hypertension) is an increase in the force of blood against the arteries in the body. This article focuses on high blood pressure (HBP) in children, which is often a result of being overweight.

Causes

Blood pressure measures how hard the heart is working and how healthy the arteries are. There are 2 numbers in each blood pressure measurement:

  • The first (top) number is the systolic blood pressure. This measures the force of blood released when the heart beats.
  • The second (bottom) number is the diastolic pressure. This measures the pressure in the arteries when the heart is at rest.

Blood pressure measurements are written this way: 120/80. One or both of these numbers can be too high.

Many things can affect blood pressure, including:

  • Hormone levels
  • The health of the nervous system, heart, and blood vessels
  • The health of the kidneys

Most of the time, no cause of HBP is found. This is called primary (essential) hypertension.

However, certain factors can increase the risk of HBP in children:

  • Being overweight or obese
  • Family history of HBP
  • Race -- African Americans are at increased risk for HBP
  • Having type 2 diabetes or high blood sugar
  • Having high cholesterol

In most children, HBP is related to being overweight.

HBP can be caused by another health problem. It can also be caused by a medicine your child is taking. Secondary causes are more common in infants and young children. Common causes include:

  • Thyroid problems
  • Heart problems
  • Kidney problems
  • Certain tumors
  • Sleep apnea
  • Medicines such as steroids, birth control pills, NSAIDs, and some common cold medicines

HBP will return to normal once the medicine is stopped or the condition is treated.

The healthiest blood pressure for children is based on a child's gender, height, and age. Your health care provider can tell you what your child's blood pressure should be.

Symptoms

Most children do not have any symptoms of HBP. High blood pressure is often discovered during a checkup when a provider checks your child's blood pressure.

Exams and Tests

In most cases, the only sign of HBP is the blood pressure measurement itself. The provider will measure your child's blood pressure many times before diagnosing your child with high blood pressure.

Your child's provider will ask about family history, your child's sleep history, risk factors, and diet.

The provider will also do a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your child's body.

Other tests your child's provider may want to do include:

Treatment

The goal of treatment is to reduce HBP so that your child has a lower risk of complications. Lifestyle changes are the best way to help lower blood pressure in children.

Healthy habits can help your child not gain any more weight, lose extra weight, and lower blood pressure. Working together as a family is the best way to help your child lose weight. Work together to help your child:

  • Follow the DASH diet, which is low in salt with plenty of fruits and vegetables, lean meats, whole grains, and low-fat or non-fat dairy
  • Cut back on sugary drinks and foods with added sugar
  • Get 30 to 60 minutes of exercise every day
  • Limit screen time and other sedentary activities to less than 2 hours a day

If lifestyle changes alone don't work, or your child has other risk factors, your child may need medicines for HBP. Blood pressure medicines used most often for children include:

  • Angiotensin-converting enzyme inhibitors
  • Angiotensin receptor blockers
  • Beta-blockers
  • Calcium channel blockers
  • Diuretics

Your child's provider may recommend that you monitor your child's BP at home. Home monitoring can help show if lifestyle changes or medicines are working.

Outlook (Prognosis)

Most of the time, HBP in children can be controlled with lifestyle changes and medicine, if needed.

Possible Complications

Untreated HBP in children may lead to complications in adulthood, which may include:

  • Stroke
  • Heart attack
  • Heart failure
  • Kidney disease

When to Contact a Medical Professional

Call your child's provider if home monitoring shows that your child's blood pressure is still high.

Prevention

Your child's provider will measure your child's blood pressure at least once a year, starting at age 3.

You can help prevent high blood pressure in your child by following lifestyle changes designed to bring blood pressure down.

Alternative Names

Hypertension - children; HBP - children; Pediatric hypertension

References

Falkner B. Hypertension in children and adolescents. In: Black HR, Elliott WJ, eds. Hypertension: A Companion to Braunwald's Heart Disease. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 38.

Flynn JT, Falkner BE. Management of hypertension in children and adolescents. In: Antman EM, Sabatine MS, eds. Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 34.

Marcdante KJ, Kliegman RM. Hypertension. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics. 7th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 166.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555-576. PMID: 15286277 www.ncbi.nlm.nih.gov/pubmed/15286277.

O'Neill JA Jr. Renovascular hypertension. In: Holcomb GW III, Murphy JP, Ostlie DJ, eds. Ashcraft's Pediatric Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 63.

Review Date 8/31/2016

Updated by: Liora C. Adler, MD, Pediatric ER, Joe DiMaggio Children’s Hospital, Hollywood, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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