Management of blood pressure in children

Abstract

Purpose of review This review summarizes recent insights into the epidemiology of primary hypertension in children, with emphasis on the most important risk factors for the development of hypertension, and also updates current options for treating primary hypertension in children. Recent findings There is growing evidence that the prevalence of hypertension has increased over the past decade and that the epidemic of obesity has played a key role in the increase of blood pressure (BP) in the USA and abroad. Recent studies have shown that in addition to obesity, environmental factors such as second-hand smoking and sedentary lifestyle are important in development of hypertension even in preschool age children. Studies also have confirmed the effect of vegetables and fruits on lowering BP. Recent clinical trials of valsartan and olmesartan have provided efficacy and safety information for use in children. Summary The increased prevalence of hypertension in children in recent years emphasizes the need for a more aggressive approach to screen and diagnose elevated BP even in early childhood. Early initiation of treatment is important to decrease the risk of cardiovascular morbidity in adulthood.

Effect of Childhood Obesity Prevention Programs on Blood Pressure

“…Elevated blood pressure (BP) during childhood, recognized as an important health issue in children over the past several decades 1 , is associated with premature death risk in Native Americans 2 and elevated BP later in life 3 . Recent research indicates that even modest elevations in BP post a risk to health 4 .…”

Pediatric Hypertension

“…A study of 1071 9-to 10-year-olds in Iceland found the prevalence of elevated blood pressures to be 13.1% at the first screen, 6% at the second screen, and 3.1% at the third screen. 2 In a study of more than 6000 adolescents in Hong Kong, the prevalence of elevated blood pressures similarly decreased from 9.54% at the first evaluation to 1.44% by the third assessment. 2 Ambulatory blood pressure monitoring (ABPM) should be considered in the setting of intermittent elevated blood pressures, when the diagnosis of white-coat hypertension is being considered or when the caregiver reports normal blood pressures outside of the clinic.…”

Management of hypertension in children and adolescents

“…6 Considerable advances have been made in recent years in identifying conditions often associated with and considered responsible for high BP in children and adolescents. 1 Overweight is probably the most important of the conditions associated with elevated BP in childhood 1,4 and accounts for more than half of the risk for developing hypertension. showed that African-American children had a higher prevalence of overweight/obesity and left ventricle hypertrophy (LVH) than non-African-American children.…”

“…showed that African-American children had a higher prevalence of overweight/obesity and left ventricle hypertrophy (LVH) than non-African-American children. 4,7 Sleep disorders including sleep apnea are associated with hypertension, coronary disease, heart failure and stroke in adults. Although limited data are available, they suggest an association of sleepdisordered breathing and higher BP in children.…”

“…3 Longitudinal studies have made it clear that BP abnormalities during childhood do translate into adult hypertension. [1][2][3][4][5][6] Where there was in the past a predominance of secondary hypertension in children, associated with renal disorders and/or drug therapy, there is now an increasing frequency of essential hypertension. There are two major reference frames for the management of hypertension in children: The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents from the National Heart, Lung and Blood Institute 6 and the revised guidelines of the European Society of Hypertension.…”