Childhood hypertension is increasingly becoming a significant health concern in the United States, with alarming statistics that reveal its prevalence among young individuals. The American Heart Association (AHA) brought attention to this issue in March 2023, labeling pediatric hypertension as an “unrecognized condition.” As childhood obesity rates have surged from 5% in the late 1970s to 19.7% in 2020, according to the Centers for Disease Control and Prevention (CDC), an estimated 5% of U.S. children and teenagers under 18 may be grappling with hypertension, as reported by the American Academy of Pediatrics (AAP).
The situation is compounded by the fact that around 10%, or approximately 7.3 million, of these young individuals might have elevated blood pressure, increasing their risk of developing hypertension later in life. These statistics are four times higher than they were three to four decades ago, highlighting a concerning trend that necessitates immediate attention from both healthcare providers and parents.
The AHA's scientific statement serves as a crucial alert to medical professionals and parents about the commonality of pediatric hypertension and the importance of accurate diagnosis and treatment. Since 2017, the AAP has recommended incorporating blood pressure checks into annual wellness visits starting at age three. Despite these efforts, many children with hypertension exhibit medical profiles resembling those of their grandparents, as noted by Bonita Falkner, MD.
"Pediatric Primary Hypertension: An Underrecognized Condition: A Scientific Statement From the American Heart Association." – Hypertension
Several factors contribute to the rising rates of hypertension among children, including poor nutrition, sedentary lifestyles, high sodium intake, inadequate sleep, consumption of energy drinks laden with sugar and caffeine, and genetic predispositions. For instance, Nate Ewing, a 15-year-old boy, was diagnosed with hypertension after experiencing symptoms such as a racing heart and anxiety. His initial blood pressure reading was abnormal, but doctors initially dismissed it as "white coat hypertension."
To enhance diagnosis accuracy, a "best practice alert" system has been developed in collaboration with the University of Utah Health system's IT department. This system automates multiple blood pressure readings and analyses, schedules follow-up visits, and provides treatment recommendations. Margaret Solomon, MD, emphasizes the importance of parents advocating for their children's well-being regarding pediatric hypertension.
"They rush in from school, they're here to get shots, they're nervous, they can't sit still… so we're often dealing with measurement issues." – Margaret Solomon, MD
Dr. Solomon advocates for a thorough approach to measuring blood pressure in children. At her center, initial automated blood pressure measurements are standard practice. If abnormalities are detected, they perform two additional manual measurements after allowing the child time to relax. This method ensures a more accurate assessment by averaging the three readings.
"At our center we always do an initial automated blood pressure measurement," – Margaret Solomon, MD
"If that's abnormal, we wait for a while until the child is less anxious and do two manual measurements. Then we average the three." – Margaret Solomon, MD
The significance of accurate readings is further highlighted by Jennifer Bright's experience with her son Austin. During a routine check-up, Austin's initial reading alarmed the nurse due to its high value. However, Bright requested a retake after calming her son and explaining how stress could affect the results. The subsequent measurement was normal.
"The nurse looked at me, alarmed, and launched into a speech about the dangers of high blood pressure," – Jennifer Bright
"I calmly asked if she could take it again. Then I turned to Austin and explained that blood pressure can read high if you're talking or under stress. So I asked him to relax, rest his feet on the floor, close his eyes, and take some deep breaths. When the nurse took it again, it was normal. He was just nervous." – Jennifer Bright
To combat pediatric hypertension effectively, simple lifestyle changes can play a pivotal role. Encouraging family activities that promote physical fitness and making healthier dietary choices can substantially reduce the risk of hypertension in children.
"Ask for the number and where that stands given the child's percentile or age. If it's a little high, ask the doctor if more tests are needed or what else can be done." – Bonita Falkner, MD
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