Hypertension in Children
Recently I did an echo on a mixed race 17 year-old female with hypertension. Pretty young for this disease, so how can this be?
To begin, what are the normal for children? Typically, you may find the following values:
1-5 years of age: 90/60
6-12 years of age: 100/60
13-17 years of age: 115/70
Hypertension is one of the most common diseases in adults, but is unusual in children. It is poorly recognized, but may very well be a precursor to primary hypertension in adults. The prevalence of hypertension in children is increasing, and is most likely due to obesity, genetics, renal problems and some congenital heart defects.
Hypertension in children should be recognized early in order to save damage to the kidneys. Be careful that HTN may be as a result of “white coat syndrome”, or a fear of doctors that may result in high blood pressure when they are measured at the clinic, but have normal pressures at home. This is extremely common, even in adults.
I spend a lot of my time teaching patients about heart disease, but you would be amazed by the number of patients who are diagnosed with HTN, but have no idea what the numbers mean.
I explain it this way: the top number is the pressure in the heart during contraction, and the bottom number is the pressure in the heart during relaxation. While not completely accurate, patients understand blood pressure when presented this way.
If one is hypertensive, I always suggest that they buy a blood pressure kit and measure it themselves. A good idea is to take your pressure several times a day for a few days before you go to the doctor. This way the doctor can weed out white coat syndrome as a cause for high readings, and it gives the doctor a good baseline for which to prescribe appropriate medication.
Typically with children, any value over 130/80 would be considered childhood hypertension. The prevalence of childhood hypertension may be as high as 5%.
Hypertension in children is most often due to obesity and secondarily to renal disease or just a genetic predisposition to the disease. Prolonged HTN can cause cardiomyopathy and heart failure. Aortic coarctation I an important cause, but not well understood. Perhaps the loss of cardiac output in the periphery may lead to vasoconstriction, and thus peripheral hypertension.
Endocrine disorders may be another factor such as cortisol disorders e.g. Cushing’s syndrome. It very often goes back to renal problems such as the hormone renin.
Drug therapy is the primary curative for this disorder, but the underlying causes must be explored. If drug therapy is used, it should be done cautiously and with the lowest doses possible.
Ken Heiden RDCS