The majority of people think that hypertension affects only adults. However, these days, hypertension affects persons of all age groups-including children. High blood pressure (hypertension) in kids is a problem often neglected. Values of healthy blood pressure are based upon sex, height and age and can be found in the form of standardized tables. Pre-hypertension in children is characterized by a value of blood pressure in the 90^th percentile, and no more than 95^th percentile. Hypertension in children is characterized by a blood pressure value in the 95^th percentile or more based on at least 3 separate measurements done. The tables of abnormal and normal values of blood pressure based on sex, height and age are available at the following links:

https://www.cc.nih.gov/ccc/pedweb/pedsstaff/bptable1.PDF   (for boys)

https://www.cc.nih.gov/ccc/pedweb/pedsstaff/bptable2.PDF  (for girls)

Causes and Risk Factors of High Blood Pressure in Children

The risk factors for high blood pressure in children are:

• Obesity-It is considered as the main risk factor for causing hypertension. It puts your child at the risk for developing not only hypertension but also a host of other health illnesses such as diabetes and heart disease.
• Family history of hypertension or cardiovascular disease.
• Medical illnesses including sleep apnea and other sleep disorders.
• Being male increases the risk of hypertension.
• History of maternal smoking during pregnancy.

Hypertension is divided into two types:

• Primary
• Secondary

Primary hypertension is the genetic form of hypertension and is often found in children who are overweight or obese. The cause is unknown for primary hypertension.

Secondary hypertension is due to an underlying cause including an abnormality of the kidney, a congenital abnormality of heart such as coarctation of aorta, narrowing of arteries in kidneys or rare tumors of adrenal glands.

What Causes Childhood Obesity?

In the majority of the cases, obesity occurs due to the following factors:

• Eating more food than required: Many children eat more food than required by their body. Obesity may occur when a child eats a diet rich in sugary beverages and unhealthy snacks. Due to this reason, keep a check on both the quantity and quality of what your child eats.
• Engaging in very less physical activity: Many kids do not engage in enough physical activity and spend many hours in sedentary activities such as playing video games and watching TV. This can also lead to obesity in children.

What Are the Symptoms of Hypertension in Children?

Hypertension usually produces no signs and symptoms and is a silent killer. When it becomes very advanced or severe, it may produce symptoms of headache, reduced kidney function or fainting.

In later stages, symptoms of convulsions or seizure may occur. Majority of the patients who have hypertension feel fine and are not aware that they have elevated blood pressure.

How is Hypertension Diagnosed in Children?

Children greater than three years old must have their BP measured at each medical visit by auscultation. To correctly measure the blood pressure, a cuff that is appropriate to the size of the child’s upper arm is required. If blood pressure is found elevated at a visit, it must be confirmed on repeated visits before diagnosing a child as having hypertension.

How to Treat Hypertension in Children

In general, treatment for high blood pressure in children is similar to treating high blood pressure in adults. You have to work with your kid’s physician closely to find out which management plan works best for your kid. Some general guidelines to treat hypertension in kids are as follows:

1. Make your child follow DASH (Dietary Approaches to Stop Hypertension) eating plan: This diet plan involves eating less saturated and overall fat and more of foods made of whole grains and fresh vegetables and fruits. Limit your child’s salt intake to 1.2 g per day in 4-8 year old kids and 1.5 g per day in kids older than 8 years. You and your kid can take the help of a dietitian to meet these dietary goals without compromising on great flavors and favorite foods.

2. Keep a watch on your kid’s weight: As already stated obesity is the major risk factor for developing hypertension in your kid. Hence, you should keep a watch on your child’s weight. You should make your child follow a DASH diet plan and let them get regular exercise to lose excess weight. It is recommended that your child should engage in at least 30-60 minutes of moderate aerobic physical activity on most days of the week. Moreover, their sedentary activity should be restricted to less than 2 hours per day. You can discuss with your kid’s physician to help set goals for them to lose weight. Your kid’s physician may also provide reference to other professionals who can assist in setting up a program for weight loss for your child.

3. You should make sure that your child is protected from tobacco smoke: Tobacco smoke can elevate blood pressure. Moreover, it can also damage your child’s blood vessels and heart. Hence, protect your kid from smoke of tobacco-even secondhand tobacco smoke.

4. Medicines for hypertension in children: If high blood pressure in your child is severe or it doesn’t get better with changes in lifestyle, then their physician may prescribe some medicines. Drugs that are used to treat hypertension are:

• Diuretics (Hydrochlorothiazide): They reduce the extra fluid in the body by reducing the extra sodium.
• ACE inhibitors (Vasotec, Lotensin), calcium channel blockers (Clonodine) and alpha-blockers: They help the blood vessels from contracting.
• Beta-blockers (Metoprolol): They prevent the secretion of hormone adrenaline, which is a stress hormone. Adrenaline increases the heart beat and contracts the arteries, thereby, increasing the blood pressure.

How Can You Help Your Kid with High Blood Pressure?

You can help your child control their hypertension by following the plan given by the physician carefully. Additionally, you can follow the below mentioned steps:

• Limit the time your kid spends watching TV or playing video games.
• Make dietary and exercise changes a family affair: Each and every person in the family benefits from the changes made.
• Ensure that your kid gets their blood pressure measured as recommended by their physician.

Now you know various aspects of hypertension in children.