New Blood Pressure Guidelines for Children: What They Mean for You

Most of us think of high blood pressure as an adult problem. But it affects a growing number of children. An estimated 3.5 percent of all children and teens, or more than 2.5 million people under 18 suffer from high blood pressure. Probably many more, as that estimate relates to the obesity epidemic in children and doesn’t count the many children who have no outward signs of high blood pressure and who haven’t been accurately tested.

Why should we be concerned? Shobha Natarajan, MD, Co-Director of the Hypertension and Vascular Evaluation Program at Children's Hospital of Philadelphia, explains. “High blood pressure can be a marker of other medical conditions such as kidney disease or specific types of heart defects, or can be a problem in itself. In particular, kids with obesity or diabetes can develop hypertension early on. High blood pressure puts extra strain on the heart, leading to thickening of heart muscle. It can also damage arteries, reducing oxygen and nutrients to important organs including the brain, the heart and the kidneys.”

Research shows that heart disease in adults often has its roots in childhood and that early diagnosis can lead to better long-term outcomes. “Children are more resilient than adults,” says Natarajan. “When high blood pressure is treated in young people, damage to the heart and arteries can often be reversed.”

In response to this growing public health problem, the American Academy of Pediatrics has issued new guidelines for identifying and treating high blood pressure in children and adolescents, published in the September issue of Pediatrics.

New AAP guidelines

• The threshold numbers for what is considered high blood pressure have been changed based on re-analysis of the previous data, excluding obese children.
• The cutoff is slightly lower in the new guidelines for young children, and slightly higher for children over 13. This will help doctors flag health problems more accurately and with more confidence.
• Children’s blood pressure should be measured once a year, at annual well visits. This recommendation decreases the risk of “false positives” when blood pressure is measured at visits for vaccinations or health problems. During these types of visits, a child’s anxiety in the presence of a doctor can lead to artificially high readings.
• Readings that are slightly above the threshold in the doctor’s office, when taken by the blood pressure machine, should be rechecked manually over a period of days to weeks.
• Where there is uncertainty about whether the blood pressure is elevated above threshold, it should be verified by having the child wear an ambulatory monitor over a 24-hour period to track their blood pressure (ABPM) during a window of normal life.
• When high blood pressure is detected in overweight children and adolescents, the suggested first steps in treatment, in most cases, are changes to diet and physical activity. Removing salty and fatty foods from a child’s diet and increasing the amount of exercise is often all that’s needed to bring blood pressure down to healthy levels. Only when the readings are very high, or the levels do not come down with lifestyle changes, are heart imaging and medication recommended.
• High blood pressure in infants and young children may be a sign of other medical conditions, such as kidney disease or a heart defect or hormonal disorders. The new guidelines do not change the approach of seeking an underlying cause through additional tests in these cases.
• An older child with a family history of hypertension or those who are overweight/obese may not need additional testing prior to treatment if the child’s history and physical examination are reassuring.

“The good news is that the new guidelines will assist medical professionals in accurately detecting high blood pressure early,” says Dr. Natarajan. “The guidelines encourage families and medical professionals to work together to achieve optimal blood pressure control in order to prevent permanent damage to the child’s organs and optimize long-term heart, kidney and brain health into adulthood.”

More information

Children and adolescents who are at risk for high blood pressure, or who have cardiovascular risk factors associated with other medical conditions, will receive coordinated, outpatient care through the Hypertension and Vascular Evaluation Program. For more information, contact Ashley Kicsak, program coordinator, at 215-590-2200.