Children With High Blood Pressure?

What’s this I hear about little kids having high blood pressure? Is this true? Significant? Are we going to have a generation of kids on medication for high blood pressure?

– November 20, 2007

Surprising as it may seem, high blood pressure can occur among children and, sadly, it often goes undiagnosed. This is very bad news because unchecked high blood pressure at any age can lead to serious health problems.

The latest news on this subject comes from a study involving more than 14,000 youngsters, from age three to age 18 in the Cleveland, Ohio area. The study began in 1999 and ended in 2006. During those years, the kids were observed at least three times at outpatient clinics. The diagnosis of hypertension or pre-hypertension wasn’t made on the basis of a single elevated reading – instead, a child’s blood pressure would have to have been recorded as high on three different visits. Of the more than 14,000 kids participating in the study, 507 (3.6 percent of the total) were found to have hypertension. Of this number, only 131 had been diagnosed with high blood pressure in the normal course of their medical care. By extrapolating those numbers to the whole population of the United States, the study authors concluded that approximately two million American kids have high blood pressure, but only 500,000 cases will be diagnosed. The study was published in the August 22/29, 2007 issue of the Journal of the American Medical Association.

These numbers are shocking, but we don’t have to look far for the cause – the epidemic of childhood obesity is largely to blame. It’s estimated that about 30 percent of overweight and obese kids have high blood pressure – and if the epidemic continues, the problem is likely to get worse.

The reason so much of this high blood pressure is being missed is because blood pressure considered "normal" for kids isn’t readily apparent. It depends on their height, age, and sex. Few doctors are likely to remember the numbers that are normal for, say, a girl of four who is tall for her age versus a nine year old boy who is short for his age and so on – the variations are endless. Experts on this subject say that convenient new tools are needed to help the average pediatrician recognize the numbers that signal high blood pressure in children.

The strategies for treating high blood pressure even in very young patients are similar to those for hypertensive adults: exercise, cutting back on salt and making healthy changes in diet to slim down. If kids – or their parents – are not willing to make the necessary changes (or if those changes don’t help), medication may be needed. Otherwise, these youngsters face increased risk of heart problems, stroke, and kidney damage in later life, just like adults with undiagnosed or uncontrolled high blood pressure.

Andrew Weil, M.D.

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