High Blood Pressure: The New Childhood Scourge

Overweight kids face risk of heart disease as adults

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By
HealthDay Reporter

FRIDAY, Jan. 14, 2005 (HealthDayNews) -- Add high blood pressure -- that's right, high blood pressure -- to the list of childhood ills that have historically included diseases like chicken pox and the mumps.

A recent study in the Journal of the American Medical Association found a strong upward shift in the blood pressure levels among 5,582 American children, aged 8 to 18, who were tracked for the last 16 years.

"This is not a good sign because, although these children may not be having heart attacks in their teens, one of the strongest predictors of heart disease in adults is high blood pressure in childhood," said Paul Muntner, an epidemiologist at the Tulane University School of Medicine and the study's lead author.

"The overall increase in blood pressure levels was only 1 or 2 percent, but the big issue is that there was a significant shift in the whole blood pressure distribution to higher levels," Munter added.

From 1988 to 1994, the children's average systolic blood pressure (the force on the arteries when the heart beats) was 104.6 mm Hg and their average diastolic pressure (the force on the arteries when the heart is resting between beats) was 58.4 mm Hg. By 1999-2000, their average systolic pressure was 106 mm Hg and their average diastolic reading was 61.7 mm Hg.

A big reason for the blood pressure problem among many American kids is that too many of them are carrying too much weight, Muntner said.

An estimated 15 percent of American children between the ages of 6 and 19 are overweight, according to the U.S. Centers for Disease Control and Prevention. But other factors, such as poor diets and a lack of exercise, are also to blame.

In response to the blood pressure problem and its potential health implications, the American Heart Association has published guidelines to help doctors and parents focus on the risks of cardiovascular disease in children. They include a recommendation to track blood pressure in kids.

And the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), is formulating new clinical guidelines that revise blood pressure tables and recommend lifestyle and drug therapies for children with high blood pressure, also known as hypertension, Muntner said.

"The focus on high blood pressure in adults seems to have been quite effective since the 1970s, and substantial improvements have been made, and the NIH is now serious about pursuing a similar effort in children," he added.

Still, there are difficulties unique to children and blood pressure, Muntner said.

First of all, there traditionally have been no clear recommended guidelines for blood pressure levels in children the way there are for adults, because children are still growing.

"Age, gender and height all affect recommended blood pressure levels. It's a complicated rubric," Muntner said. "A children's chart is quite complex, even to me, and makes it much more difficult to communicate the message of what's a healthy blood pressure level."

But a pediatrician will know how to calibrate your child's weight, height and gender to assess what his or her blood pressure should be, Muntner said, adding that the new guidelines issued by NIH will help doctors in this task.

Second, the problem of high blood pressure is often connected to a weight problem, and overweight is an emotional issue with many parents, said Dr. Rae-Ellen W. Kavey, head of cardiology at Children's Memorial Hospital in Chicago.

"Parents can accept it when I tell them about a heart defect in their children. But if I say the child is overweight, the parents take it personally. It's a very sensitive topic," she said.

To surmount that hurdle, Kavey said she explains to parents that many children have a genetic predisposition to weight gain and that they can address the problem the same way they deal with other unique qualities of their child.

"I tell a parent that her daughter has gorgeous hair and also a tendency to gain weight easily, and put it in a practical context," she said, which can defuse a potentially emotional confrontation.

The good news, Kavey added, is that doctors and parents are increasingly aware of the perils of overweight and high blood pressure among children and are willing to do something about it.

"There is major concern among pediatricians about obesity in children and how to address that because of its association with hypertension and type 2 diabetes," she said. "And parents are very concerned as well."

To help parents, Kavey and Muntner recommend the following:

  • Ask your pediatrician to take your child's blood pressure on each visit. If it's high, ask the doctor what that means and what should be done.
  • Tell your pediatrician if there is a family history of overweight or hypertension so he can pay special attention to these risks in your children.
  • If you think your child is overweight, again, talk to the pediatrician. She can look at your child's growth chart, where height and weight are plotted on a graph. If the two are rising on the graph at the same rate, your child is probably normal weight. But if the weight is climbing faster than the height, you can discuss with the doctor diet and lifestyle changes for your child.

Kavey also recommends some simple lifestyle changes that can help your child stay healthy and avoid weight gain. Limiting juice intake to a small glass at breakfast is a good idea, because large quantities can lead to overweight, she said.

Encouraging physical activity is also important. Many schools are reintroducing physical education to promote exercise in school, she said, but you can do some things at home as well that would be fun for your kids. For instance, buy some hula hoops or jump ropes for the family.

More information

To read a summary of the study on the increase in pediatric blood pressure levels, visit the National Institutes of Health.

SOURCES: Rae-Ellen W. Kavey, M.D., chairman of cardiology, Children's Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago; Paul Muntner, Ph.D., assistant professor of epidemiology and medicine, Tulane University School of Medicine, New Orleans

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