Hypertension in children and adolescents is an increasingly common problem. High blood pressure diagnosed in children and adolescents also persists into adulthood and can lead to serious complications. What are the causes and symptoms of hypertension in children and adolescents? What is the treatment?

Hypertension in children and adolescentsis an increasingly common problem. High blood pressure diagnosed in children and adolescents also persists into adulthood. Blood pressure values ​​that allow the diagnosis of arterial hypertension in children and adolescents are lower than in adults. This is due to the fact that in properly developing children and adolescents, systolic blood pressure values ​​increase annually by certain values, therefore the level of pressure depends on the child's age. Specialists have developed pressure height distribution curves in children and adolescents in the form of percentile grids. Arterial hypertension in this age group is diagnosed when blood pressure values ​​exceed the 95th percentile in office measurements during 3 different visits.

Hypertension in children and adolescents - causes

Hypertension in children and adolescents may be primary (spontaneous, its cause is unknown), but it is secondary to other diseases much more often than in the adult population. Among the secondary causes of arterial hypertension in children and adolescents, diseases of the parenchyma and kidney vessels dominate. Thyroid diseases are also mentioned among other causes. Essential hypertension is more common in children with family history of hypertension and in overweight or obese children.

The level of blood pressure also seems to be of importance - the higher its value, the higher the probability of hypertension being secondary.

Hypertension in children is diagnosed when the blood pressure in a child exceeds the 95th percentile in office measurements during 3 different visits.

Hypertension in children and adolescents - classification

Definition and classification of hypertension in children and adolescents (modified from Task Force on High Blood Pressure in Children andAdolescents1

Normal blood pressureSCT and RCT<90. centyla dla płci, wieku i wzrostu
High normal blood pressure
  • ≥ 90. to<95; ≥ 120/80 mm Hg
  • ≥ 120/80 mm Hg, even if<90. percentyla u nastolatków
Stage 1 of arterial hypertension95. percentile to 99th percentile for gender, age, and height plus 5 mm Hg
Stage 2 of hypertension>99th percentile for gender, age, and height plus 5 mm Hg

SBP - systolic arterial pressure; DBP - diastolic blood pressure

According to an expertKrystyna Knypl, MD, PhD, internist

Normal blood pressure and heart rate of a sixteen-year-old girlDoctors said that at my age blood pressure should not be measured, because why? But I have dizziness, headaches and very frequent headaches, facial flushing and an extremely high heart rate (up to 130). What should I do?

Dr. Krystyna Knypl, internist - The optimal pressure for a girl of your age is 113/63, but it should not exceed 130/78. Heart rate of 130 / minute is too high. A tendency to baking may indirectly suggest that your blood pressure is temporarily elevated above normal. In this situation, control measurements should be carried out at home and in a doctor's office. Parents or guardians should be asked to make an appointment with your GP. There are no rigid rules regarding the frequency of blood pressure measurements - it is measured whenever the patient experiences symptoms (it may be headaches, dizziness, pains in the heart area, feeling of fast or uneven heartbeat), when we want to determine what the pressure values ​​are or when we want to evaluate the effectiveness of the antihypertensive drugs used. Blood pressure measurement can be performed on adults, adolescents and children of all ages. Even in some situations, very young children (newborns, infants) also have their blood pressure measured - in such cases, special cuffs of correspondingly smaller sizes are used. a 16-year-old person, if he or she experiences such discomfort as you described, should have his blood pressure checked periodically.

Hypertension in children and adolescents - symptoms

Increased blood pressure in a childoften has no symptoms. However, they may appear:

  • headaches
  • dizziness
  • vomiting, nausea
  • reluctance to eat
  • no weight gain
  • visual disturbance
  • anxiety, agitation
  • disturbance of consciousness

Ifthe cause of high blood pressure in children and adolescents is kidney disease (usually causing high blood pressure in this age group), symptoms such as:

  • pale mucous membranes
  • swelling of the face and limbs
  • urination disorder
  • polyuria
  • history of urinary tract inflammation
  • bedwetting

Hypertension in children and adolescents - diagnosis

The diagnosis of arterial hypertension in children and adolescents is possible thanks to the systematic measurements of blood pressure values ​​during routine medical visits, taking into account the rules regarding the adequacy of the measurement, and then thanks to the comparison of the obtained results with biological standards (percentile values) and the use of appropriate definition.

Diagnosis and treatment of hypertension in children must be carried out by a specialist, hypertensiologist and / or pediatric nephrologist.

Important

According to experts, blood pressure measurement should be part of a routine medical examination in a child from 3 years of age. In infants and toddlers, it is recommended to measure blood pressure in children with a history of perinatal, kidney diseases, cardiovascular diseases, and neoplasms.1

Hypertension in children and adolescents - treatment

With regard to children, as well as adults, the decision to start treatment should not be made solely on the basis of blood pressure values. You should also consider possible organ complications or their absence, and other risk factors and medical conditions such as obesity, kidney disease, and diabetes.

In children with essential hypertension, treatment should first include the elimination of risk factors for an increase in BP (i.e. overweight, excessive s alt intake, low physical activity).

In children with diagnosed secondary arterial hypertension, specific treatment of the underlying disease should be started immediately after its diagnosis.

The use of drugs is necessary in children with secondary hypertension in whom causal treatment is not possible or ineffective, and in children with primary hypertension in the case of ineffective non-pharmacological treatment or organ complications. In children, treatment should be started with one low-dose antihypertensive drug to avoid a sharp drop in blood pressure. If the blood pressure is not reduced enough after a few weeks, usually within 4-8 weeks, start with the full dosedrug. If a child does not respond adequately to treatment, or significant side effects develop, it is recommended that the antihypertensive medication be changed to a different class of antihypertensive drug.

In children with kidney diseases, the use of one drug is often not enough, therefore early combination therapy is necessary.

Hypertension - what are some home remedies for lowering blood pressure?

According to an expertKrystyna Knypl, MD, PhD, internist

What is the normal blood pressure in a child?My daughter is 4 years old. On the balance sheet of the four-year-old, it turned out that his blood pressure was too high 110/90. I would like to know what is the correct pressure and what may mean such increased?

Dr. Krystyna Knypl, internist - Measurement of blood pressure in a young child is a difficult issue, and the issue of standards cannot be commented on by quoting one value. This is due to the fact that children develop at different rates and the concept of the norm at this age is quite broad. The so-called percentile grids. Data falling between the 3rd and 97th percentiles are considered norms. The grid allows you to assess, among other things, height, weight, head circumference - in the pediatrician's office, you may have seen curves placed on the grid, thanks to which you can read the percentile of a given parameter. For some time now, we have also had a percentile grid for pressure values ​​in young children. They were developed on the basis of pressure measurements in young children. In the literature it is believed that if the pressure in a child exceeds the 90th percentile, there is an increased risk of developing hypertension in adulthood. For a 4-year-old girl, the 90th percentile pressure values ​​are 111/68. So in the case of a baby girl, the systolic blood pressure is slightly below the 90th percentile, while the diastolic blood pressure is above the 90th percentile. It should be noted here that the measurement of diastolic pressure (contrary to appearances, which may be derived from the observation of the measurement itself) is a rather complicated issue and there are many considerations on this subject in the specialist literature. When we test the pressure, we hear tones in the handset having different volumes. There are 5 phases of these tones. Phase IV is to lower the tones, and Phase V is the complete disappearance of these tones. Some experts consider phase IV to correspond to diastolic pressure, others to phase V, i.e. complete disappearance of tones. Since the tones between phase IV and V are very soft, it is sometimes difficult to accurately assess whether phase V is taking place - for example, when there is noise during the examination, or when the baby is crying. Accurate assessment of tones is possible when a mercury apparatus is used for the measurement. When used to measure the cameraAnother situation takes place electronically - the diastolic pressure value is then automatically calculated by the apparatus based on the formula. Not all formulas are sufficiently accurate and they do not always adequately reflect what is taking place in the body of the tested person. A reliable pressure measuring device should be validated by an appropriate scientific committee. Therefore, in the case of a baby girl, blood pressure measurements should be continued - it is important to use appropriate measuring equipment and due diligence during the test. Not every child who had high blood pressure during the checkup as a child must develop high blood pressure in adulthood. The development of hypertension is favored by the coexistence of overweight and a diet rich in sodium ion. You should develop he althy eating habits in your daughter, avoiding s alty snacks such as - s alted popcorn, crisps, crackers, s alty sticks. If a child has high blood pressure and the family has high blood pressure in their parents or grandparents, this also increases the risk of developing high blood pressure in adulthood. Adolescence is an important period in keeping up with the child's blood pressure, as this is the time when familial hypertension is often revealed.

Hypertension in children and adolescents - complications

Hypertension in children reduces their cognitive skills, argue scientists from the University of Rochester in New York, who published the results of their research in the journal "Journal of Pediatrics " 2The study took part 150 children aged 10-18 years, of whom 75 had hypertension and 75 had normal blood pressure. The cognitive abilities of both groups were assessed. At the same time, the presence of other factors that could have falsified the results of the study was excluded, e.g. learning disabilities, attention deficit hyperactivity disorder (ADHD), sleep disturbance. "We wanted to make sure that the differences in cognitive performance were related to the hypertension itself and not to other factors," explains Dr. Lande.

Children with high blood pressure scored worse on tests of visual skills, visual and verbal memory, and processing speed of data and reports. What's more, researchers found that high blood pressure was more common among children who had trouble sleeping, which backs up a previous study that found the effects of poor sleep quality on cognitive skills.

Bibliography:

1. Lurbe E., Hypertension in children and adolescents, European Society of HypertensionScientific Newsletter: Update on Hypertension Management 2010; 11: No. 13 revised version

2. Childhood Hypertension Associated with Cognitive Issues: http://www.jpeds.com/content/jpedslande

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Cardiology