Hypertension in Kids Linked to Overweight, Adult Diabetes

By John Henry Dreyfuss, MDalert.com staff.

Save to PDF PediatricsPublic HealthPerformance-Based Medicine By
  • As many as 44% of high school athletes are overweight or obese; 15% have hypertension.
  • National guidelines state that blood pressure should be measured every year in children, starting at age 3.
  • Treating hypertension, overweight in children can prevent later T2DM cases.
  • You can break the cycle by checking blood pressure in all kids and counseling parents on healthy weight.

A significant portion of children and adolescents have hypertension or pre-hypertension, according to expert opinion and several recent reports. In many cases, high blood pressure in these populations is due to overweight or obesity. The combination of overweight and hypertension can be a precursor to diabetes later in life.

In order to prevent the development of diabetes in children and adolescents, and later in adulthood, physicians should measure blood pressure (Figure 1) in children annually beginning at age 3. In fact, guidelines published recently by the U.S. Department of Health and Human Services, The National Institutes of Health, and The National Heart, Lung, and Blood Institute make this very recommendation.

 

Figure 1. Sphygmomanometer.
(Sources: Flickr/By Jasleen Kaur/Creative Commons.)

Overweight and Obesity in Children and Adolescents

A study published recently in The Journal of Pediatrics examined middle-school and high-school athletes in Philadelphia. The researchers found that 20% were overweight and 24% were obese; about 15% were hypertensive (Figure 2).

Among children ages 3 to 18 over all, 3.4 percent have pre-hypertension and 3.6% have hypertension, doctors at Massachusetts General Hospital have reported, according to an article published recently in The Journal of the American Medical Association.

Among adolescents who are obese, >30% of boys and between 23% and 30% of girls have pre-hypertension or hypertension reported researchers in American Family Physician.  

 

Figure 2. Navy Hospital Corpsman 3rd Class Marcus Ferrill, of Cameron, Calif.,
takes a child’s blood pressure aboard the U.S. Military
Sealift Command Hospital ship USNS Mercy.
(Sources: Wikipedia/By by Photographer's Mate 2nd Class Erika N. Jones/
U.S. Navy photo/Copyright U.S. Navy/Public Domain.)

A Variety of Conditions Lead to Missed Diagnosis

“The diagnosis of hypertension [in children] is missed in the majority of cases,” Goutham Rao, MD, told The New York Times.

“In three-fourths of children with pre-hypertension and hypertension the condition is not detected,” he said in an interview. Among them was a 13-year-old boy in Pittsburgh with a blood pressure of 180 over 100. No note was made in the child’s chart of his very seriously elevated blood pressure, and no follow-up was suggested to determine a cause and prescribe a remedy, Dr. Rao wrote in a recent issue of Pediatrics.

Dr. Rao is Chairman of the Department of Family Medicine and Community Health at the University Hospitals, Cleveland, Case Medical Center, and Clinical Professor of Family Medicine at the Case Western Reserve University School of Medicine.

Another barrier to accurate diagnosis of hypertension in children may be the definition of normal blood pressure in the population. In contrast to adults, in adolescents, for example, a blood pressure of 120/80mmHG is considered pre-hypertension.

Parents also have little understanding of what constitutes hypertension in their children. In fact, many parents simply do not enquire after the pediatrician measures blood pressure in a child. Many seem to simply expect that children will always have normal and safe blood pressure levels.

In fact, parents should always ask the pediatrician about the measure blood pressure in a child. If they do not, the physician should relay the information to the parent. Both physician and parents should bear in mind that a safe blood pressure in a child will always be lower than a safe level in an adult. For those parents who have an understanding of this aspect of physiology, many assume that a measurement of 120/70 is normal in both children and adults. In fact, this is pre-hypertension in a child.

A major barrier to diagnosis, he said, “is doctors’ lack of knowledge about how to treat high blood pressure in kids. The more doctors know about treatment, the more likely they are to make a diagnosis,” Dr. Rao told the New York Times.

Treat Hypertension in Children

If a child is hypertensive or pre-hypertensive, overweight or obesity will often be the cause. In a subset of children, the hypertension will be intrinsic. In both cases, the blood pressure should be treated to prevent the long-term effects of the condition (Figure 3), either with a weight control program or with medication.

 

Figure 3. The effects of hypertension. 
(Sources: Wikipedia/By Blausen.com staff. "Blausen gallery 2014"/Creative Commons.)

First, the physician can counsel parents to improve a child’s diet in order to reduce the child’s bodyweight. If weight loss cannot be achieved, or the hypertension is intrinsic, the physicians should prescribe antihypertensive medication. As in an adult, the physician can begin with a thiazide diuretic. If this too is ineffective, the physician can advance to angiotensin conversion inhibitors, beta blockers, alpha blockers, and other more potent antihypertensives.

The combination of weight-loss approaches and direct treatment of high blood pressure can both prevent the development of diabetes in the child and can prevent hypertension induced organ damage.


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