Hypertension, or high blood pressure, has for long been envisioned as a middle-aged person’s disease. Popular imagination would make us believe only adults and older individuals could have high blood pressure, but a deeper look into the numbers would reveal that children around the world are also susceptible to the condition.
Dr Fazal Nabi, Director, Department of Paediatrics, Jaslok Hospital & Research Centre, tells FIT, “Hypertension can be present at any age. It is not rare in children, but it often goes unnoticed. Studies show its prevalence in Indian children may be up to 11.7%.”
This presumption that hypertension is rare in kids often means that it is not diagnosed in time. FIT speaks to doctors to understand why that could be worrying, and how we may prevent it.
On World Hypertension Day 17 May, we look at this in detail.
What is high blood pressure/hypertension?
High blood pressure or hypertension is when the force of blood pushing on the blood vessel wall is too high. This causes problems, because the heart has to pump harder and the vessels are under great strain. This could potentially damage the heart, the blood vessels as well as other organs.
Almost one-fifth of Indians have hypertension, and it is a major risk factor for cardiovascular disease – the leading cause of death in the country.
How important is early detection of hypertension in kids?
Dr Sushil Azad, Principal Consultant, Paediatric Cardiology, Fortis Escorts heart Institute, explains that childhood blood pressure, whether normal or high, is strongly predictive of adult blood pressure. Therefore, elevated blood pressure which persists into adulthood could indicate serious cardiovascular events in adults.
Dr Nabi agrees, “It is important to detect hypertension early as sustained high blood pressures can cause long term organ damage to heart, brain, kidneys and eyes. Most of the times, it’s asymptomatic, but in rare cases, it could cause headache, blurry vision, dizziness or a fluttering heartbeat.”
How is high blood pressure diagnosed in children?
Dr Azad tells us that hypertension in children, like adults, is diagnosed using age-appropriate blood pressure cuffs, and there are normative blood pressure charts available depending upon the age of the child, the sex of the child and the height of the child. “If the blood pressure falls more than 90% of the expected, it is called ‘elevated’ blood pressure, and if it is more than 95%, it is labelled as hypertension,” he says.
How does the cuff work? Dr Nabi explains, “When the cuff inflates the arm or the leg (in small babies), it squeezes a large artery, stopping the blood flow for a moment. Blood pressure is measured as the air is slowly let out of the cuff, which lets blood flow through the artery again. There are two numbers which help decide BP - systolic - when the heart pumps and diastolic - when the heart rests in between.”
“Any reading of more than 90th percentile needs further evaluation by a medical professional,” he adds.
How often should children be screened for hypertension?
According to the doctors, it is recommended that all children above three years of age should get an annual BP check. If the child is at high-risk, for instance, when they have diabetes, chronic kidney disease or if they are obese, then a check at every routine visit should ideally be conducted.
Children with a difficult or long hospital stay in the newborn period may need screenings sooner than three years.
Why is it more challenging to diagnose hypertension in children?
Dr Nabi explains that it gets tricky to check children’s blood pressure at it could fluctuate if they are nervous.
For kids who are anxious in a doctor’s office, their blood pressure may be measured somewhere else, like at home or by the school nurse. Sometimes, the child has to wear the cuff for a whole day and night for constant monitoring.
“So, an average of three BP measurements in different visits helps to diagnose hypertension in a child,” he says.
What are the causes for high blood pressure in kids?
Dr Sushil Azad explains that hypertension could either be primary/essential, when there is no underlying cause, or secondary, when there is an underlying condition like kidney disease, heart disease, lung problems, obesity, endocrine disorder etc.
“Obesity, lack of physical activity, family history of hypertension, sleep disorders make the child more susceptible to hypertension,” he says.
How is hypertension treated in children?
The treatment would depend on whether the case is of essential hypertension or secondary hypertension. If the condition is caused due to an underlying cause, then that cause needs to be targeted to get the blood pressure back to normal, Dr Fazal Nabi says.
Dr Azad adds that the first line of management is through non pharmacological measures like weight reduction in obese patients, regular exercise (at least 30 to 50 minutes of moderate to vigorous exercise five times in a week), dietary modification, stress reduction, preventing dyslipidemia, avoiding smoking, alcohol, caffeine or in the case of kids, energy drinks. If this does not work for six months and BP continues to remain high, then we need to start medicines.
How can high blood pressure be prevented among children?
Promoting healthy lifestyle choices and educating families to assist with appropriate dietary and activity choices to improve overall health could reduce the risk of hypertension, Dr Azad adds.
Dr Nabi lists down some basic prevention tips:
1. Eating a healthy diet with fruits, vegetables, and low-fat dairy
2. Limit salt intake
3. Avoid packaged food and caffeine in sodas tea coffees energy drinks
4. In adolescents, avoid alcohol and smoking
5. Getting regular exercise for 60 minutes daily
If lifestyle changes do not work, anti-hypertensive medications can be started, which have been tested and proven to be safe for short-term and long-term treatment.
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