Focus on prevention, diagnosis and treatment of hypertension in children and adolescents

Abstract

The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem.This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children’s gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child’s age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention of high blood pressure is based on correct lifestyle and nutrition, starting from childhood age. The treatment of primary hypertension in children is almost exclusively dietary/behavioral and includes: a) reduction of overweight whenever present b) reduction of dietary sodium intake c) increase in physical activity. Pharmacological therapy will be needed rarely and only in specific cases.

O sobrepeso e a obesidade não estão associados com a pressão arterial elevada em jovens praticantes de esportes

“…In addition to overweight, HBP is positively associated with heredity, low birth weight, high salt intake and alcohol consumption 12 , factors which were not analyzed in the present study.…”

“…Prior to the implementation of the measures, all the young people were instructed not to use any stimulating substance 12 . They remained seated with their feet on the floor and the lower back supported by a chair for five minutes.…”

“…It has been reported that HBP is associated with behavioral, biological and hereditary characteristics 12 . One of the behavioral aspects that have been widely studied in young people is physical activity, which can be defined as any bodily movement produced by skeletal muscles that result in expending energy 13 .…”

Evaluation of salt content in school meals

“…Not only awareness about nutrition is increasing, but we can also observe that students can relate nutrition to common diseases. Consumer concerns and awareness about food and nutrition are increasing 51,52 and should be regarded as an opportunity to intervene, especially when considering a younger population 25,26 . At the same time we observe that taste (flavour) is the main factor when choosing a meal, which might override nutritional concerns.…”

“…Studies of younger populations also clearly show the negative effect of salt on blood pressure and the future negative effect of high salt intake at young ages 20,21 . Hypertension represents a major challenge in terms of public health, and several researchers and official organizations have stated that prevention strategies, detection, treatment, and control should be prioritized [22][23][24] , particularly among the younger population 8,25,26 .…”