High blood pressure in children

Overview

High blood pressure (hypertension) in children is blood pressure that is at or above the 95th percentile for children who are the same sex, age and height as your child. There isn't a simple target range for high blood pressure in all children because what's considered normal changes as children grow. However, in teenagers, high blood pressure is defined the same as for adults: A blood pressure reading greater than or equal to 130/80 millimeters of mercury (mm Hg).

The younger a child is, the more likely it is that the high blood pressure is caused by a specific and identifiable medical condition. Older children can develop high blood pressure for the same reasons adults do — excess weight, poor nutrition and lack of exercise.

Lifestyle changes, such as eating a heart-healthy diet low in salt (sodium) and exercising more, can help reduce high blood pressure in children. But for some children, medications may be necessary.

Symptoms

High blood pressure usually doesn't cause symptoms. However, signs and symptoms that might indicate a high blood pressure emergency (hypertensive crisis) include:

• Headaches
• Seizures
• Vomiting
• Chest pains
• Fast, pounding or fluttering heartbeat (palpitations)
• Shortness of breath

If your child has any of these signs or symptoms, seek emergency medical care.

When to see a doctor

Your child's blood pressure should be checked during routine well-check appointments starting at age 3, and at every appointment if your child is found to have high blood pressure.

If your child has a condition that can increase the risk of high blood pressure — including premature birth, low birth weight, congenital heart disease and certain kidney problems — blood pressure checks might begin soon after birth.

If you're concerned about your child having a risk factor for high blood pressure, such as having obesity, talk to your child's doctor.

Causes

High blood pressure in younger children is often related to other health conditions, such as heart defects, kidney disease, genetic conditions or hormonal disorders. Older children — especially those who are overweight — are more likely to have primary hypertension. This type of high blood pressure occurs on its own, without an underlying condition.

Risk factors

Your child's risk factors for high blood pressure depend on health conditions, genetics and lifestyle factors.

Primary (essential) hypertension

Primary hypertension occurs on its own, without an identifiable cause. This type of high blood pressure occurs more often in children age 6 and older. The risk factors for developing primary hypertension include:

• Being overweight or having obesity
• Having a family history of high blood pressure
• Having type 2 diabetes or a high fasting blood sugar level
• Having high cholesterol
• Eating too much salt
• Being Black or Hispanic
• Being male
• Smoking or exposure to secondhand smoke
• Being sedentary

Secondary hypertension

Secondary hypertension is caused by another condition. It's more common in young children. Other causes of high blood pressure include:

• Chronic kidney disease
• Polycystic kidney disease
• Heart problems, such as severe narrowing (coarctation) of the aorta
• Adrenal disorders
• Overactive thyroid (hyperthyroidism)
• Narrowing of the artery to the kidney (renal artery stenosis)
• Sleep disorders, especially obstructive sleep apnea
• Certain drugs and medications, including those used to relieve a stuffy nose (decongestants), stimulants used to treat attention-deficit/hyperactivity disorder (ADHD), caffeine, nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids
• Cocaine, methamphetamine and similar drugs

Complications

Children who have high blood pressure are likely to continue to have high blood pressure as adults unless they begin treatment.

If your child's high blood pressure continues into adulthood, your child could be at risk of:

• Stroke
• Heart attack
• Heart failure
• Kidney disease

Prevention

High blood pressure can be prevented in children by making the same lifestyle changes that can help treat it — controlling your child's weight, providing a healthy diet low in salt (sodium) and encouraging your child to exercise.

High blood pressure caused by another condition can sometimes be controlled, or even prevented, by managing the condition that's causing it.

Diagnosis

The doctor will perform a physical exam and ask questions about your child's medical history, family history of high blood pressure, and nutrition and activity level.

Your child's blood pressure will be measured. The correct blood pressure cuff size is important for measuring accurately. It is also important that blood pressure be measured with proper technique, in a quiet environment, with the child resting comfortably. During a single visit, your child's blood pressure might be measured two or more times for accuracy.

For a diagnosis of high blood pressure, your child's blood pressure must be higher than normal when measured during at least three visits to the doctor.

If your child is diagnosed with high blood pressure, it's important to determine whether it's primary or secondary. These tests might be used to look for another condition that could be causing your child's high blood pressure:

• Blood tests to check your child's kidney function, electrolytes, and cholesterol and triglyceride levels (lipids)
• Urine sample test (urinalysis)
• Echocardiogram to create pictures of the heart and blood flow through the heart
• Ultrasound of your child's kidneys (renal ultrasound)

Ambulatory monitoring

To confirm a diagnosis of high blood pressure, your child's doctor might recommend ambulatory monitoring. This involves your child temporarily wearing a device that measures blood pressure throughout the day, including during sleep and various activities.

Ambulatory monitoring can help rule out blood pressure that's temporarily raised because your child is nervous at the doctor's office (white-coat hypertension).

Treatment

If your child is diagnosed with slightly or moderately high blood pressure (stage 1 hypertension), your child's doctor will likely suggest trying lifestyle changes, such as a heart-healthy diet and more exercise, before prescribing medications.

If lifestyle changes don't help, your child's doctor might recommend blood pressure medication.

If your child is diagnosed with severely high blood pressure (stage 2 hypertension), your child's doctor will likely recommend blood pressure medications.

Medications might include:

• Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax your child's blood vessels by blocking the formation of a natural chemical that narrows blood vessels. This makes it easier for your child's blood to flow, reducing blood pressure.
• Angiotensin II receptor blockers. These medications help relax blood vessels by blocking a natural chemical that narrows your child's blood vessels.
• Calcium channel blockers. These medications help relax the muscles of your child's blood vessels and may slow his or her heart rate.
• Diuretics. Also known as water pills, these act on your child's kidneys to help your child remove sodium and water, reducing blood pressure.

Your child's doctor will tell you how long your child will need to stay on the medication. If your child's high blood pressure is caused by obesity, losing weight might make medication unnecessary. Treating other medical conditions your child has might also control his or her blood pressure.

Although little is known about the long-term effects of blood pressure medication on a child's growth and development, many of these medications are generally considered safe to take during childhood.

Self care

High blood pressure is treated similarly in children and adults, usually starting with lifestyle changes. Even if your child takes medication for high blood pressure, lifestyle changes can make the medication work better.

• Control your child's weight. If your child is overweight, achieving a healthy weight or maintaining the same weight while getting taller can lower blood pressure.
• Give your child a healthy diet. Encourage your child to eat a heart-healthy diet, emphasizing fruits, vegetables, whole grains, low-fat dairy products and lean sources of protein, such as fish and beans, and limiting fat and sugar.

• Decrease salt in your child's diet. Cutting the amount of salt (sodium) in your child's diet will help lower his or her blood pressure. Children ages 2 to 3 shouldn't have more than 1,200 milligrams (mg) of sodium a day, and older children shouldn't have more than 1,500 mg a day.

  Limit processed foods, which are often high in sodium, and limit eating at fast-food restaurants, whose menu items are full of salt, fat and calories.

• Encourage physical activity. All children should get 60 minutes of moderate to vigorous physical activity a day.
• Limit screen time. To encourage your child to be more active, limit time in front of the television, computer or other devices.
• Get the family involved. It can be hard for your child to make healthy lifestyle changes if other family members don't eat well or exercise. Set a good example. Your whole family will benefit from eating better. Create family fun by playing together — ride bikes, play catch or take a walk.

Preparing for your appointment

Your child's blood pressure will be checked as part of a routine complete physical exam or during any pediatric doctor appointment when indicated. Before a blood pressure check, make sure your child hasn't had caffeine or another simulant.

What you can do

Make a list of:

• Symptoms your child has, and when they began. High blood pressure rarely causes symptoms, but it is a risk factor for heart disease and other childhood illnesses.
• Key personal information, including a family history of high blood pressure, high cholesterol, heart disease, stroke or diabetes.
• All medications, vitamins or supplements your child takes, including doses.
• Your child's diet and exercise habits, including salt intake.
• Questions to ask your doctor.

For high blood pressure, questions to ask your doctor include:

• What tests will my child need?
• Will my child need medications?
• What foods should he or she eat or avoid?
• What's an appropriate level of physical activity?
• How often do I need to schedule appointments to check my child's blood pressure?
• Should I monitor my child's blood pressure at home?
• Should my child see a specialist?
• Can you give me brochures or other printed material? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your child's doctor is likely to ask you questions, such as:

• When was your child's blood pressure last checked? What was the blood pressure measurement then?
• Was your child premature or underweight at birth?
• Does your child or anyone in your family smoke?