Hypertension In Children

Adolescent Hyperension. Children and even young babies can have high blood pressure. The American Heart Association recommends that children 3 and old have annual blood pressure exams, as early detection will greatly improve the prognosis.

In children and adolescents, hypertension is defined as blood pressure that is, on repeated measurement, at the 95th percentile or greater adjusted for age, height, and gender.

The fifth Korotkoff sound is used to define DBP. Clinicians should be alert to the possibility of identifiable causes of hypertension in younger children (i.e., kidney disease, coarctation of the aorta).

Most children have what is called secondary hypertension, a condition in which the high blood pressure is being caused by an underlying disease. In a small number of cases, there is no directly identifiable cause of the hypertension. This is called primary or essnetial hypertension.

Blood Pressure in Children

A child's blood pressure is normally much lower than an adult's. Generally, children are at risk for hypertension if they exceed the following levels:

• Ages three to five: 116/76 mm Hg
• Ages six to nine: 122/78 mm Hg
• Ages 10 to 12: 126/82 mm Hg
• Ages 13 to 15: 136/86 mm Hg

Lifestyle interventions are strongly recommended, with pharmacologic therapy instituted for higher levels of blood pressure or if there is insufficient response to lifestyle modifications. Choices of antihypertensive drugs are similar in children and adults, but effective doses for children are often smaller and should be adjusted carefully. ACEIs and ARBs should not be used in pregnant or sexually active girls.

Uncomplicated hypertension should not be a reason to restrict children from participating in physical activities, particularly because long-term exercise may lower BP. Use of anabolic steroids should be strongly discouraged. Vigorous interventions also should be conducted for other existing modifiable risk factors (e.g., smoking).