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May 19, 2024

High blood pressure can affect kids but often goes undiagnosed

Blood pressure can be measured with a cuff on your arm. Dangerously high blood pressure can affect even young kids, and too few doctors are screening for it, two new reports warn. urbazon/E+/Getty

Blood pressure can be measured with a cuff on your arm. Dangerously high blood pressure can affect even young kids, and too few doctors are screening for it, two new reports warn.

urbazon/E+/Getty Images Plus

By Erin Ross

August 23, 2023 at 6:30 am

Nearly half of U.S. adults have hypertension. You might have heard of it as very high blood pressure. It’s worrisome because high blood pressure has been linked to serious diseases. But hypertension isn’t only a problem for adults. A growing body of research now shows high blood pressure can affect kids — from babies to teens. Unfortunately, this potential danger tends to go undetected in kids.

“In the last two decades, we’ve really proven that elevation of blood pressure in youth, including children and adolescents, is associated with what we call target organ damage,” says Poornima Kunani. She’s a pediatrician with Kaiser Permanente near Los Angeles, Calif. By target organ damage, she means problems in organs affected by high blood pressure: the heart, parts of the circulatory system, kidneys — even the brain.

“Years ago, it was not thought that children could have hypertension unless it was caused by [some disease],” says Bonita Falkner. She’s a pediatrician at Thomas Jefferson University in Philadelphia, Pa. High blood pressure in kids can silently cause both immediate and life-long health problems. Some studies show that high blood pressure makes it hard to think. That can hurt kids’ performance in school. Others have found lasting changes to kids’ hearts, arteries and veins.

There’s been a lot of research on the health impacts of hypertension in kids. But it takes time for doctors to learn about new research and use it to change how they care for those kids, Falkner says. That’s why she coauthored a new statement issued by the American Heart Association. It appeared March 30 in Hypertension. As many as one in every 20 U.S. kids already has high blood pressure, it reports. But because this has long been considered an “adult” problem, many pediatricians don’t properly screen for it.To do this properly, doctors need to take several readings, sometimes over the course of months, explains Falkner. One quick measurement with a blood pressure cuff may not be enough.

Families and their doctors need to understand that high blood pressure is a problem in many kids, Falkner says — one that should no longer go ignored.

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Doctors are most likely to monitor blood pressure in kids who have other risk factors, too, such as obesity. But a March 14 study in JAMA Network Open finds that high blood pressure doesn’t affect only those kids. Even lower-weight children and teens can have high blood pressure.

Kunani at Kaiser Permanente was an author of that new study. “We wanted to find out exactly where the problem of hypertension was beginning,” she says. So her team looked at data from 800,000 children from 3 to 17 years old. Then they looked at the kids’ blood pressure again, five years later.

Doctors tend to assess body fat as a sign of how healthy someone’s weight is. To gauge that, they calculate what’s known as a BMI. That stands for body-mass index. BMI compares the ratio of someone’s height to their weight. And a BMI that’s considered “normal” varies by age. For kids up to age 10, a BMI of roughly 14 to 18 is normal. By 16, the normal range rises to between 17 and 23. By age 20, it’s roughly 19 to 27.

Overall, the likelihood that kids would have high blood pressure rose with BMI. But even kids with a BMI on upper end of normal for their age were at risk of having or developing blood pressure that was high — sometimes very high.

What this means, Kunani says, is that doctors should be reviewing more than weight. “We need to ask about [a kid’s] diet and exercise and sleep,” she says. In affected kids, “there’s almost always some unhealthy habit.”

High blood pressure can have long-term impacts on your life and health. So the best way to treat high blood pressure is to prevent it. And the best way to prevent it is through a healthy lifestyle, Kunani says. “You have to feed your mind and your body healthy foods and healthy activities.”

That means spending less time in front of screens and more time being active.

“There is no one kind of physical activity that is better than any other,” says Elaine Urbina. “So kids can just go out and have fun.” Urbina is a pediatric cardiologist in Ohio. Working at Cincinnati Children’s Hospital Medical Center, she studies how to prevent heart problems in children. Any activity that bumps up your heart rate is good, she says, so “go run after your dog or dance to music!”

Eating a healthy diet also is important. Highly processed or salty foods, such as cookies, soft drinks and lunch meats, increase the risk of high blood pressure. Better for blood pressure are colorful natural foods like fruits and veggies. Unfortunately, Kunani notes, not all kids and families have access to such healthy foods.

There are many drugs available to treat high blood pressure. And the same medicines that work in adults can also help kids. It’s important to treat blood pressure early, says Urbina, because once it’s treated, some injuries caused by high blood pressure can start to heal.

adolescent: Someone in that transitional stage of physical and psychological development that begins at the onset of puberty, typically between the ages of 11 and 13, and ends with adulthood.

artery: (in biology) Part of the body’s circulation system. There are several. Each is a major tube running between the heart and blood vessels that will move blood to all parts of the body.

blood pressure: The force exerted against vessel walls by blood moving through the body. Usually this pressure refers to blood moving specifically through the body’s arteries. That pressure allows blood to circulate to our heads and keeps the fluid moving so that it can deliver oxygen to all tissues. Blood pressure can vary based on physical activity and the body’s position. High blood pressure can put someone at risk for heart attacks or stroke. Low blood pressure may leave people dizzy, or faint, as the pressure becomes too low to supply enough blood to the brain.

BMI: Short for body mass index. It's a person’s weight in kilograms divided by the square of his or her height in meters. BMI can be used to evaluate if someone is overweight or obese. However, because BMI does not account for how much muscle or fat a person has, it is not an accurate measure.

cardiology: The branch of medicine dealing with functions and diseases of the heart. A doctor that specializes in this field is known as a cardiologist.

develop: To emerge or to make come into being, either naturally or through human intervention, such as by manufacturing. (in biology) To grow as an organism from conception through adulthood, often undergoing changes in chemistry, size, mental maturity or sometimes even shape.

diet: (n.) The foods and liquids ingested by an animal to provide the nutrition it needs to grow and maintain health. Sometimes this is a specific food-intake plan.

factor: Something that plays a role in a particular condition or event; a contributor.

gauge: A device to measure the size or volume of something. For instance, tide gauges track the ever-changing height of coastal water levels throughout the day. Or any system or event that can be used to estimate the size or magnitude of something else. (v. to gauge) The act of measuring or estimating the size of something.

heart rate: Or heart beat, the number of times per minute that the heart — a pump — contracts, moving blood throughout the body.

hypertension: The medical term for high blood pressure. It can put a strain on blood vessels and the heart.

network: A group of interconnected people or things. (v.) The act of connecting with other people who work in a given area or do similar thing (such as artists, business leaders or medical-support groups), often by going to gatherings where such people would be expected, and then chatting them up. (n. networking)

nutrition: (adj. nutritious) The healthful components (nutrients) in the diet — such as proteins, fats, vitamins and minerals — that the body uses to grow and to fuel its processes. A scientist who works in this field is known as a nutritionist.

obesity: (adj. obese) Extreme overweight. Obesity is associated with a wide range of health problems, including type 2 diabetes and high blood pressure.

organ: (in biology) Various parts of an organism that perform one or more particular functions. For instance, an ovary is an organ that makes eggs, the brain is an organ that makes sense of nerve signals and a plant’s roots are organs that take in nutrients and moisture.

overweight: A medical condition where the body has accumulated too much body fat. People are not considered overweight if they weigh more than is normal for their age and height, but that extra weight comes from bone or muscle.

pediatrician: A doctor who works in the field of medicine that has to do with children and especially child health.

physical: (adj.) A term for things that exist in the real world, as opposed to in memories or the imagination. It can also refer to properties of materials that are due to their size and non-chemical interactions (such as when one block slams with force into another). (in biology and medicine) The term can refer to the body, as in a physical exam or physical activity.

processed foods: Foods purchased from a grocery store that are substantially different from the raw materials that went into them. Examples include most foods that come in cans, bottles or boxes. Examples include breakfast cereals, frozen pizzas, canned tuna, jars of spaghetti sauce and dill pickles.

range: The full extent or distribution of something. For instance, a plant or animal’s range is the area over which it naturally exists. (in math or for measurements) The extent to which values can vary (such as the highest to lowest temperatures). Also, the distance within which something can be reached or perceived.

ratio: The relationship between two numbers or amounts. When written out, the numbers usually are separated by a colon, such as 50:50. That would mean that for every 50 units of one thing (on the left) there would also be 50 units of another thing (represented by the number on the right).

risk: The chance or mathematical likelihood that some bad thing might happen. For instance, exposure to radiation poses a risk of cancer. Or the hazard — or peril — itself. (For instance: Among cancer risks that the people faced were radiation and drinking water tainted with arsenic.)

screening: A health test that is performed early, often before any symptoms are present. Such tests can help find disease when it is easiest to treat. Screenings can include blood tests (such as for HIV, diabetes or high cholesterol), X-rays or scans (such as mammograms for breast cancer).

Journal: B. Falkner et al. Pediatric primary hypertension: An underrecognized condition: A scientific statement from the American Heart Association. Hypertension. Vol. 80, March 30, 2023, p. e101. doi: 10.1161/HYP.0000000000000228.

Journal: C. Koebnick et al. Association of high normal body weight in youths with risk of hypertension. JAMA Network OPEN. Vol. 6, March 14, 2023, p. e231987. doi:10.1001/jamanetworkopen.2023.1987..

Website: Centers for Disease Control and Prevention. About Child & Teen BMI. Last updated September 24, 2022.

Journal: D.R. Jacobs et al. Childhood cardiovascular risk factors and adult cardiovascular events. New England Journal of Medicine. Vol. 386, May 19, 2022, p. 1877. doi: 10.1056/NEJMoa2109191.

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