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Hypertension Can Hide Out in Kids

That's why health officials urge screenings starting at age 3

SATURDAY, July 10, 2004 (HealthDayNews) -- Add hypertension to the list of concerns for American parents.

That's right -- hypertension, also known as high blood pressure. In kids.

Screening for the condition should start at age 3 and continue throughout life, according to new guidelines from the federal government's National High Blood Pressure Education Program Working Group.

"Hypertension and prehypertension are significant health issues for Americans of all ages, including the very young," said Dr. Bonita Falkner, a professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia and chairman of the working group.

"We estimate that 1 to 3 percent of the nation's children and adolescents may have one of these conditions and be at risk of developing long-term, often serious and irreversible health problems as a consequence," she said.

The revised guidelines for child and adolescent blood pressure were unveiled at the American Society of Hypertension's recent annual meeting in New York City and appear in the July issue of Pediatrics. They replace guidelines last issued in 1996.

Hypertension is often called a "silent killer" because it can cause serious damage to many organs and even death before its presence is detected.

It occurs when blood pressure stays elevated over time. The increased pressure puts a strain on the circulatory system, which can ultimately lead to problems, such as stroke, heart disease and kidney failure.

An estimated 50 million Americans have hypertension.

In adults, hypertension is described in terms of systolic and diastolic blood pressure, typically pegged at readings above 130/90. Prehypertension is a relatively new blood pressure classification for readings between 120/80 and 130/90.

"The adult model for defining hypertension and prehypertension is not appropriate for children and adolescents because kids vary so widely in body size, shape, height, weight and other characteristics at every age," said Dr. Kenneth Lieberman. He is chief of Children's Kidney Diseases and Hypertension at Joseph M. Sanzari Children's Hospital of Hackensack University Medical Center in New Jersey.

"The new guidelines take that into account with blood pressure tables that include the 50th, 90th, 95th and 99th percentiles by sex, age and height," he added. "These are similar to the growth tables that pediatricians, family doctors and other medical specialists presently use to identify children whose physical growth is unusually fast or unusually slow. The new blood pressure tables will help physicians and nurse practitioners determine when a child's blood pressure is higher than it should be for their body size."

The guidelines define hypertension in children as blood pressure above the 95th percentile, and prehypertension as blood pressure between the 90th and 95th percentiles. For adolescents, prehypertension is defined as blood pressure greater than 120/80.

Doctors don't recommend making a special appointment just to have a child's blood pressure checked. But most agree that parents should make certain that blood-pressure screening becomes a part of their children's annual physical exam, beginning before the child enters school.

"Particularly in families with a history of hypertension, it is essential for mothers and fathers to be advocates for children receiving an annual blood pressure measurement," said Dr. John K. Stevens Jr., section chief for pediatric cardiology for Children's Healthcare of Atlanta at Scottish Rite.

"That is going to require some changes in the way parents and physicians think about hypertension," he said. "Today many children have their first blood pressure screening as part of a physical for participation in athletics. That may be too late to prevent permanent damage if a child has had high blood pressure that has not been diagnosed or treated earlier in life. The new guidelines will help parents and physicians include routine blood pressure measurement as a tool to promote children's health."

The guidelines recommend that children with hypertension have echocardiography assessment for left ventricular hypertrophy (enlargement of the heart's main pumping vessel), the most obvious evidence of heart damage.

"Left ventricular hypertrophy (LVH) is the most prominent clinical evidence of target-organ damage caused by hypertension in children and adolescents," Falkner said. "The presence of LVH is an indication for physicians to initiate or intensify antihypertensive therapy."

The first line of treatment should be weight loss and exercise.

Drug therapy, when needed, should begin with a single medicine. Acceptable drug classes for use in children include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor antagonists, beta blockers, calcium channel blockers and diuretics, Falkner said.

"The long-term health risks for hypertensive children and adolescents can be substantial. It is important that clinical measures be taken to reduce risks and to optimize positive health outcomes," she said.

More information

Learn more about high blood pressure in children and how it is treated from the Lucile Packard Children's Hospital at Stanford University.

SOURCES: Bonita Falkner, M.D., professor, medicine and pediatrics, Thomas Jefferson University, Philadelphia; Kenneth Lieberman, M.D., chief, Children's Kidney Diseases and Hypertension, Joseph M. Sanzari Children's Hospital of Hackensack University Medical Center, Hackensack, N.J.; John K. Stevens Jr., M.D., section chief, pediatric cardiology, Children's Healthcare of Atlanta at Scottish Rite
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