This can be alarming news for both parents and teens. Hypertension, the medical term for chronically high blood pressure, is a major risk factor for stroke and heart disease in adults. Approximately 75 million adults in the U.S. have high blood pressure, a primary or contributing factor to more than 410,000 deaths nationally in 2014, according to the CDC.
High blood pressure in children and adolescents may be associated with an increased risk for hypertension and potentially other cardiovascular conditions, including heart attack, stroke, atherosclerosis, as well as other organ dysfunction in adulthood, like kidney failure and abnormal vision.
The Earlier, The Better
When the CDC study applied new guidelines set by the American Academy of Pediatrics (AAP) in 2017 to national data from 2013 to 2016, it lowered the blood pressure threshold for hypertension in teens. The good news is that the new guidelines should lead to earlier identification of teens who may be at risk for heart-related issues, triggering earlier intervention.
“By redefining and lowering normative values for blood pressure in children, adolescents, and adults, clinicians are able to capture those persons at risk for hypertension and intervene before there may be untoward effects due to chronically severe elevations in blood pressure,” said Adrienne Walton, M.D., a pediatric cardiologist affiliated with Children’s Heart Center at Children’s Memorial Hermann Hospital who specializes in preventive cardiology.
A Refresher on Blood Pressure
Blood pressure is the force of blood on the arterial walls. It is measured by gauging units of pressure when the heart beats (systolic) and while it rests between beats (diastolic). The systolic measurement is presented over the diastolic measurement.
Blood pressure can change throughout the day and vary with environmental stimuli. Most medical offices use an automated device applied to a person’s right arm to measure blood pressure. Elevated values should be re-checked manually, according to Dr. Walton.
Complications arise from high blood pressure because it facilitates narrowing of the coronary arteries through the buildup of plaque. Narrow arteries cause the heart to work harder than it should to pump blood. Excess damage and stress from narrowed arteries can lead to many health problems.
Understanding the New Normal
Children 13 and older have the same blood pressure threshold for normal blood pressure as adults now. Under the new AAP guidelines for hypertension and the American Heart Association guidelines for adults, the new normal blood pressure is less than 120 systolic and less than 80 diastolic (<120/<80).
Blood pressure thresholds for children 12 and younger did not change and are still based upon percentiles that factor in a child’s age, gender and height.
Being Aware of Risk Factors
There are several risk factors for high blood pressure among children and adolescents, including some that a child and family may not be able to control on their own.
“The younger a child is diagnosed with hypertension, especially if under 6 years of age, the higher the likelihood that the hypertension may be associated with some other abnormal organ process,” Dr. Walton said. “Examples include prematurity and abnormal lung development in these patients, abnormalities of the kidneys, structural defects of the heart or other vascular abnormalities.”
The percentage of children with secondary hypertension dramatically decreases beyond 10 years of age, Dr. Walton said. The rise in obesity over the last three decades is in large part the reason children are being diagnosed with hypertension, according to Dr. Walton.
Several risk factors for the development of hypertension in children and adolescents directly correlate with lifestyle and are completely preventable, according to Dr. Walton. She recommends parents and teens try to avoid the following:
- Overly processed foods or canned goods that are not low in sodium. Include vegetables, which are naturally low in sodium, with each meal. A balanced plate should be half vegetables. Choose colorful non-starchy vegetables such as leafy greens to accompany every meal.
- Fast food. Fast food is typically high in calories, larger portions than needed, and high in saturated fats and sodium. We all live busy lives with very little time on most days to prepare meals daily for the family. The key is meal prepping in advance, so health is not sacrificed for the sake of convenience.
- Artificially sweetened beverages, sodas with caffeine and energy drinks. Sports energy drinks should be reserved for consumption during or in recovery from exercise to replace electrolytes lost in sweat. They should not be used as “juice,” as they contain similar amounts of sugar as other sweetened beverages in addition to salt. This could promote hypertension if consumed on a regular basis by those at risk.
- Eating at separate locations in the house. Separate eating may allow a person to eat less healthy foods in exchange for larger portions of the most desirable foods—which for many are not healthy. Eat together as a family at least three times a week for dinner.
- A sedentary lifestyle. Children and adolescents should exercise seven hours per week through moderately intense activity or sports. Consider joining team sports at school or in the community. Exercising or family sports is a wonderful way to build and strengthen family bonds.
- Too much screen time. Turn off the television, social media, computers and gaming systems. The AAP advises less than two hours per day should be spent on these devices.
The Importance of a Yearly Checkup
Parents don’t have to look any further than their child’s pediatrician or primary care provider, for regular monitoring of their blood pressure as an important determinant of overall health.
“Recognizing hypertension in children and adolescents can be difficult, because children and adolescents do not always have symptoms,” Dr. Walton said. “This underscores the importance of annual routine checkups.”
Pediatricians begin monitoring blood pressure at annual well visits, starting when children are 3 years old. Children with chronic illness, including diabetes, may have their blood pressure monitored earlier and more frequently than annually at a well-child visit.
Annual visits to a primary care provider allow physicians to enforce preventive strategies to recognize potential harmful behaviors that may predispose development of hypertension and other diseases.
To schedule an appointment with a family medicine physician or pediatrician, click here.
To learn more about cardiovascular services for children, visit http://childrens.memorialhermann.org/heart/.