PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Calm Under Pressure- Is your Child Getting Screened for Hypertension?

In medicine you can categorize diseases many different ways: by body system, character of disease (like infection or trauma or cancer, etc.). Lots of grouping. One of my personal favorites is also pretty simple: “adult-y” illnesses and “kid-ish” illnesses (these are scientific terms, of course). Sometimes an illness can go in both categories, and others belong in just one. For example, not many adults get croup; that’s a kid illness. And most kids don’t get heart attacks (hooray!). Many medical students pick the field they are going to enter based on these categories. I’m not sure I was one of them: I think I was one of the “body fluid” deciders—I found that I handled a kid coughing up a lung better than an adult, kid diapers better than adult incontinence…. You get the idea.
One paragraph in and I’m already getting off track. Today I want to bring up one of the diseases that’s been resolutely in the adult category forever, but is creeping into the kid category more and more. It’s one that often goes unnoticed and undiagnosed…

High Blood Pressure.

What kid gets that, right? When was the last time your child’s blood pressure (BP) was even checked?

Exactly.

Research study

In a recent volume of the journal Pediatrics, a research study in the PROS (Pediatric Research in the Office Setting) network analyzed health records from almost 400,000 children between the ages of 3 and 18. The study found that more than 12,000 met criteria for high blood pressure (also known as hypertension – 25 cent word!), yet only 23% of those were actually diagnosed with hypertension and less than 6% were given medication for it! Notably, about half of the group were normal weight, half were female, and a little less than half were white. With half-boys and half-girls, about half of those in the study being white and not obese, we can’t really identify a particular at-risk group based on demographics alone from this data.  Obesity, however, has been previously identified as high risk.
High blood pressure is a tricky one because in children, specifically, it is most often silent. It doesn’t typically cause headaches or add to chest pain like it does in grown ups. So we have to depend on routine and periodic screening of mostly otherwise healthy kids to be able to pick it up. And then we need to know how to manage it. The actual number readings for high blood pressure in children vary depending upon the age of the child—younger children have lower blood pressures normally, so what’s high for a 5-year-old may be normal for a 13-year-old. High blood pressure must be measured on 3 different occasions in order for a child to be diagnosed with it.

The GREAT news is that at the end of the day not many kids have high blood pressure in the first place. That being said, we don’t want a single one of them to be missed because if we do and hypertension goes untreated for a long time, it can have negative effects on the kidney and other systems like the endocrine (gland) system. Children who do have prolonged high blood pressure are at risk for having continued high blood pressure as adults with all its associated issues — cardiovascular disease being the most prominent and severe. It’s important that we identify this group as early as possible and get them into specialty treatment.

The evaluation for a child with high blood pressure involves some blood work and urine testing, and occasionally a bit of radiology like an ultrasound. The same lifestyle recommendations that are given to adults—watch diet and weight, and increase physical activity—ring true for children with high BP, and some may still need medicine for adequate control.

This recently published research spoke to me as a call to action to write today’s blog — NOT to describe all the medical details of treating high blood pressure in children, but merely to let YOU know that this relatively rare kid-ish disease in fact does exist in a small number of children. Please make sure that you are paying attention to your children’s health screening visits, so you are certain that their blood pressure gets checked at and after the 3-year-old check up. Then you can speak up and ask if for any reason it is not!

#nowyouknow

Reference: Kaelber DC, et al. Pediatrics. 2016;138:e20162195

Feelin’ academic? Read the full study here.

 

 

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