Explore emerging challenges and effective treatment strategies for pediatric hypertension with expert insights from Meri Sehat.

Pediatric Hypertension: Emerging Challenges And Treatment Strategies

Pediatric hypertension refers to elevated blood pressure levels in children and adolescents۔

Introduction

In recent years, pediatric <a href="https://merisehat.pk/disease/hypertension">hypertension</a> has become a growing concern among healthcare professionals and parents alike.

At least 1 in 25 kids ages 12 to 19 have hypertension, more commonly seen in boys, those older than 12 years, and Hispanic or non-Hispanic Black ethnicity.<a href="#accordion">[2]</a>

Despite its relatively low prevalence compared to adult hypertension, the implications of high blood pressure in children can be severe and long-lasting. 
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Understanding The Evolving Nature Of Pediatric Hypertension

While the exact causes may vary, factors such as genetics, obesity, poor diet, teen pregnancy, smoking, and a lack of physical activity play significant roles in its development.

A family or personal history of conditions like hypertension, cholesterol, kidney disease, and diabetes should be considered as well.

Certain drugs and medications, including decongestants, caffeine, NSAIDs, and steroids, may also increase blood pressure.<a href="#accordion">[4]</a> 
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Pediatric hypertension can be classified into primary (essential) and secondary types.<a href="#accordion">[4]</a>

<ul>
	<li>Primary Pediatric Hypertension: Also known as essential hypertension, this type occurs when a child&#39;s blood pressure is consistently elevated without an identifiable cause. It often results from a combination of genetic, lifestyle, and environmental factors.</li>
	<li>Secondary Pediatric Hypertension: Secondary hypertension in children arises due to an underlying medical condition or external factor. Conditions such as kidney disease, heart defects, hormonal disorders, and certain medications can lead to elevated blood pressure in children. 
	&nbsp;</li>
</ul>

Diagnosing pediatric hypertension can be challenging since its symptoms often go unnoticed. Symptoms may include headaches, fatigue, vision problems, and difficulty breathing.

Accurate blood pressure measurement is crucial for diagnosing pediatric hypertension. Healthcare providers use age, height, and gender-specific norms to interpret blood pressure readings in children.

In addition to blood pressure measurement, laboratory tests such as urinalysis, blood tests, ECG, and renal ultrasound may be conducted to identify underlying conditions.

Some doctors suggest ambulatory monitoring to check if the child has high blood pressure. This means the child wears a special device for a short time to track their blood pressure all day, even while sleeping and playing. It ensures that high blood pressure isn&#39;t just because the child feels nervous at the doctor&#39;s office. 
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The new Clinical Practice Guidelines (CPG) released by the American Academy of Pediatrics (2017) state:[1]

<table cellspacing="0" class="1" style="border-collapse:collapse; border:none; width:464px">
	<tbody>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:99px">
			&nbsp;
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:182px">
			Systolic and/or Diastolic BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:182px">
			Systolic and/or Diastolic BP
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Age category
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;13 years
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;13 years
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		</tr>
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			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Normal BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;90th percentile
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;120/80 mmHg
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		</tr>
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			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Elevated BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th &lt;95th percentile + 12

			or

			120-130/&lt;80 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			120-130/&lt;80 mmHg
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		</tr>
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			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Hypertension Stage 1
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th &lt;95th percentile + 12

			or

			130-140/80-90 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			130-140/80-90 mmHg
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		</tr>
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			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Hypertension Stage 2
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th + 12 or &ge;140/90 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;140/90 mmHg
			</td>
		</tr>
	</tbody>
</table>

The new method helped with accurate diagnosis and understanding of the impact of different criteria on estimating high blood pressure prevalence and associated health risks:

<ul>
	<li>The approach lowered the levels used to define high blood pressure by 1&ndash;3 mmHg for children and over 4 mmHg for adolescents.</li>
	<li>It led to more children being identified as at risk of high blood pressure compared to the old criteria, sparking debates among scientists, especially with European researchers involved in setting guidelines.</li>
	<li>It resulted in higher estimates of high blood pressure prevalence compared to the old criteria.</li>
	<li>It identified that the prevalence of high blood pressure varied based on factors like age, weight, and the study setting. For instance, some children may experience higher blood pressure readings initially due to stress (white coat hypertension), which could lead to overestimation of high blood pressure prevalence.</li>
	<li>Studies show that children identified as hypertensive under the new criteria had a higher risk of cardiometabolic problems compared to those classified under the old criteria. 
	&nbsp;</li>
</ul>

Early intervention helps prevent the progression of pediatric hypertension and reduces the risk of complications later in life.

Untreated pediatric hypertension can lead to heart disease, stroke, kidney damage, and cognitive impairment.

<ul>
	<li>Lifestyle Modifications &ndash; Lifestyle modifications such as adopting a healthy diet, increasing physical activity, reducing sodium intake, and managing stress are essential to pediatric hypertension treatment.</li>
	<li>Medications &ndash; In some cases, medications such as ACE inhibitors, calcium channel blockers, angiotensin II receptor blockers, and diuretics may be prescribed to help lower blood pressure levels in children and adolescents. These medications are typically used in conjunction with lifestyle changes.</li>
</ul>

Note: Regular monitoring and follow-up appointments are necessary to track the effectiveness of treatment and make adjustments as needed. 
&nbsp;

Coping with a child&#39;s diagnosis of hypertension can be challenging for parents. Seeking support from healthcare professionals and connecting with other parents facing similar challenges can be helpful.

Moreover, collaboration among healthcare providers, parents, schools, and community organizations is important to promote a supportive environment for children and adolescents to effectively manage the condition. 
&nbsp;

Conclusion

Preventing pediatric hypertension involves promoting healthy lifestyle habits early on, including proper nutrition, regular physical activity, and stress management techniques. Make sure that they get quality sleep and avoid vaping, smoking, or even exposure to secondhand smoke.

Other precautions include:

<ul>
	<li>Children (aged 2-3 years) &lt;1200 mg of sodium a day</li>
	<li>Older children &lt;1500 mg of sodium a day</li>
	<li>All children 60 minutes of physical activity a day</li>
</ul>

Also, children should have their blood pressure checked at least once a year as part of their routine healthcare visits, starting at age 3. 
&nbsp;

Key Takeaways

<ul>
	<li>Pediatric hypertension refers to elevated blood pressure levels in children and adolescents. Stage II hypertension is diagnosed if a child&#39;s BP is greater than the 99th percentile plus 5 mm Hg.</li>
	<li>Symptoms of pediatric hypertension include headaches, fatigue, vision problems, and difficulty breathing.</li>
	<li>Diagnosis involves measuring blood pressure and conducting laboratory tests like urinalysis and blood tests to assess kidney function and identify underlying conditions.</li>
	<li>Causes and risk factors include genetics, obesity, poor diet, lack of physical activity, family history, excess weight, sedentary lifestyle, high-sodium diet, and certain underlying medical conditions.</li>
	<li>Treatment of pediatric hypertension includes lifestyle modifications such as diet and exercise changes, and medications may be prescribed in some cases.</li>
	<li>Untreated pediatric hypertension can lead to heart disease, stroke, kidney damage, and cognitive impairment.</li>
	<li>Promoting a healthy lifestyle from an early age through proper nutrition, regular physical activity, and stress management techniques can help prevent pediatric hypertension.</li>
</ul>

[1] Di Bonito P, Di Sessa A. New Diagnostic Criteria for Hypertension in Children and Adolescents: Lights and Shadows. Children (Basel). 2020;7(11):196. Published 2020 Oct 24.

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