A Hidden Crisis: High Blood Pressure in Kids and Teens

Chris and Bradley Ewing were vacationing near Lake Michigan in July 2023 when their 15-year-old son, Nate, started telling them that his heart was racing and that he was “not feeling right.” Nate had just had a cardiac arrest and collapsed during basketball practice. The news was all over social media.

After all, Nate was thin and fit, and although he’d been diagnosed with ADHD in second grade, he’d had normal wellness exams ever since. But when he continued to report lightheadedness and unusual feelings in his chest, they sought help. Yet visits to the school nurse, then their pediatrician, and a cardiologist all ended with assurances that Nate’s heart was normal and healthy.

Nate is now on blood pressure medication and doing better.

Alarming Statistics

As many as 5% of U.S. children and teens under age 18 may have hypertension, according to the American Academy of Pediatrics (AAP). That’s up to 3.6 million kids with a serious condition that used to be found mainly in older adults. And 10% more, or 7.3 million, may have elevated blood pressure, putting them in danger of developing hypertension later. (Elevated blood pressure is above normal but below hypertension.) These statistics are four times higher than they were 30 to 40 years ago.

The causes are clear. Childhood obesity rates rose from 5% in the late 1970s to 19.7% in 2020, according to the CDC. This is a major risk factor for hypertension, as are poor nutrition, a sedentary lifestyle, too much sodium, poor sleep, energy drinks packed with sugar and caffeine, and (as is likely in Nate’s case) genetics.

All can chronically raise blood pressure. In March 2023, the American Heart Association (AHA) published a scientific statement calling pediatric hypertension an “unrecognized condition” and alerting medical personnel (and parents) about how common it is and how to accurately diagnose and treat it.

Bonita Falkner, MD, who led the team of experts who wrote the AHA statement, sees cause for concern. “Essentially, many of these children have a medical profile that’s already similar to their grandparents,” says Falkner, a professor emeritus of medicine and pediatrics at Thomas Jefferson University who has studied pediatric hypertension for 20 years.

Blood Vessels Aging Too Soon

“The problem with children having unmanaged hypertension or elevated blood pressure is that it adds a pressure burden to their cardiovascular systems and kidneys for a much longer time,” Falkner says. “These children are already showing signs of vascular aging, meaning their blood vessels are a little stiffer and their heart muscles are a bit bigger. Fortunately, hypertension can be managed and even reversed with lifestyle changes (including better nutrition, more exercise, and weight loss) and, if necessary, medication. This first requires awareness of the problem and then early and accurate detection — two things that the AAP says are lacking.

“The diagnosis is missed in up to 75% of pediatric patients in primary care settings,” the AAP stated in its 2017 guidelines on pediatric hypertension. The AHA’s more recent statement shows that progress has been slow.

A Routine Check That’s Often Skipped

Before the mid-1970s, doctors typically didn’t measure blood pressure in children without symptoms. “It was assumed children did not have hypertension,” Falkner says. Since 2017, the AAP has recommended making it a routine part of annual wellness checks from age 3.

But this procedure isn’t as routine as it may sound.

Margaret Solomon, MD, is a pediatrician and internal medicine doctor at the Redwood Health Center in Salt Lake City, UT. Since 2005, she has been attending to an ethnically diverse and often economically disadvantaged patient population. Despite her best efforts to make everyone more aware of this “silent illness” through accurate diagnosis, education, and management, “a lot of these kids with blood pressure issues are becoming adults with hypertension,” she says. “I’ve been here long enough to see the evolution.”

Getting an accurate reading from youngsters is challenging. Solomon says, “They rush in from school, they’re here to get shots, they’re nervous, they can’t sit still … so we’re often dealing with measurement issues.” This is the first obstacle. Some busy doctors, who can see up to 25 patients a day with their families, may attribute a high reading to anxiety (so-called “white coat hypertension”) and dismiss it, or just make a note to check it at the child’s next wellness visit.

“At our center we always do an initial automated blood pressure measurement,” Solomon says. “If that’s abnormal, we wait for a while until the child is less anxious and do two manual measurements. Then we average the three.”

The second obstacle is determining what that number means. Because kids’ blood vessels are smaller overall, the blood pressure levels used to separate normal from abnormal in adults don’t apply to those under 13 years of age. Doctors must figure out what percentile the child is in based on age, sex, and height, then consult a standardized table to determine their blood pressure category. For teens, the benchmarks are the same as for adults.

This process isn’t simple. “Kids are dynamic organisms,” says Solomon. “They’re growing and changing, so you have to look at different charts to assess their blood pressures. I’ve always found it a bit overwhelming.” Even Falkner, with decades of expertise, admits it can be time-consuming and confusing for doctors, not to mention parents.

By Joe Kita

Source: webmd.com


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