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Hypertension in children: symptoms, causes and treatments
May 11, 2021
Hypertension is usually associated in the medical field with the adult population. And it is not for less, since It is estimated that 1 in 4 people over 18 years of age suffer from it. In any case, when addressing this issue, we must not forget about the pediatric age: hypertension in children is more common than it seems.
According to studies that we will cite later, 2-4% of the world's children have high blood pressure. This prolonged situation in time favors the appearance of sustained ventricular hypertrophy, coronary insufficiency, arrhythmias, atherosclerosis and even strokes.
For all these reasons, monitoring hypertension in pediatric patients is a must. If you want to know all about high blood pressure in young children, read on.
Basics of high blood pressure
Blood pressure is a a measure that quantifies the force exerted by the blood against the walls of the arteries As the heart beats As indicated by the United States National Library of Medicine, This figure consists of 2 pieces of information: the systolic pressure (while the heart beats) and the diastolic pressure (between beats). It is measured in millimeters of mercury (mmHg).
In adult humans, the point of normality is 120 mmHg systolic pressure and 80 mmHg diastolic pressure. With this delimiting figure, we can establish the following table:
Normal blood pressure: less than 120/80 mmHg.
Pre-hypertension: systolic pressure between 120-139 mmHg and diastolic pressure between 80-89 mmHg.
Stage 1 hypertension: systolic pressure between 140-159 mmHg and diastolic pressure between 90-99 mmHg.
Stage 2 hypertension: systolic more than 160 mmHg and diastolic more than 100 mmHg. Hypertension is considered severe and a reason for hospital admission when the values exceed 210/120 mmHg. In this scenario, the patient's life is in grave danger.
Due to this pressure exerted by the blood, the heart has to beat harder and the arteries are subject to more physiological stress. In adult humans, most of the time no clear triggering cause is found, so it is known as essential hypertension or primary.
To know more: White coat hypertension
What is normal blood pressure in children?
According to the Boston Childrens Hospital portal, the question changes a lot in children. In them there are no standardized values, since the cardiac structure is still developing and a figure that describes normality in all cases has not been found. For this reason, each patient must be compared with the rest of the children of his age.
Thus, the infant hypertension value is established when it is higher than the blood pressure of most children with the same weight, the same age, the same height and gender of the patient. The criteria are as follows:
Pre-hypertension: the same (or higher) blood pressure as 90-95% of children the same age, height, weight, and gender.
Stage 1 hypertension: values higher than 95% of its peers (between 95 and 99%). About 5 mmHg are added to the values.
Stage 2 hypertension: values higher than 99% of its peers. 5 mmHg is also added.
Thus, the normality of blood pressure (BP) in children is not recorded, but those cases that are out of the average are detected. If childhood hypertension is defined as higher than 90% of the mean, it is concluded that 5 to 20% of infants suffer from it. The prevalence is higher in the Hispanic population (up to 25%) and much lower in Asians.
Symptoms associated with hypertension in children
As the Mayo Clinic indicates, hypertension in children and adults is usually a silent clinical event. In any case, there are a series of signs that can show a medical emergency. Among them we highlight the following:
Headache: only 10% of all hypertensive patients have any symptoms and the majority of those who suffer from it have headaches. If a headache has no apparent cause in a young child, it is always best to use a blood pressure monitor to measure his blood pressure.
Seizures: which can be preceded by vision problems and fainting spells.
Abdominal pain: accompanied by heart palpitations.
Short of breath.
However, it should be noted that a hypertensive child rarely has clinical signs. The increase in blood pressure is usually detected in a routine analysis or when you are being evaluated for a sports practice, for example.
Causes and Risk Factors of Hypertension in Children
To understand childhood hypertension, first we must differentiate the most common variants of the pathology. As the magazine indicates Clinical Hypertension, two groups must be taken into account: primary and secondary.
1. Primary hypertension
In adults, this is the most common variant. Hypertension is primary or essential when there is no justifying cause, that is, it is idiopathic in nature. When this clinical picture occurs in children, one of the clear suspicious predisposing factors is family inheritance.
Children with hypertensive parents are much more likely to develop primary hypertension before 18 years of age. In addition, the heritability pattern is multifactorial, since the manifestation of high blood pressure depends on the genetic load, the environment and your lifestyle.
2. Secondary hypertension
Unlike what happens with adults, 85% of hypertensive children have an underlying pathology that is causing it. Kidney disease is usually the most common cause, but there are many more:
First year of life: causes are usually arterial renal thrombosis, bronchopulmonary dysplasia, parenchymal kidney disease, tumors, and congenital abnormalities located in the kidneys.
From the year to 10 years of life: Renovascular diseases, parenchymal kidney disease, tumors and endocrine causes.
From 10 to 18 years old: parenchymal kidney disease, tumors, and sustained endocrine diseases.
As you can see, kidney failure is an etiology that occurs in all age groups. Up to 80% of hypertensive children have kidney failure to a greater or lesser degree, so it is postulated that it is the first cause of sustained hypertension in this age group.
As we have said before, childhood hypertension almost never causes symptoms. Thus, the abnormality is likely to be detected in a clinical setting, during a routine analysis, or a test for another condition. However, an isolated high value is not always indicative of disease.
Blood pressure measured in the hospital setting can be very different from the real one. Therefore, if an abnormal figure is detected, the doctor will probably recommend that parents measure the child's blood pressure at different times of the day from home.
Once hypertension is detected, It is time to go for blood and urine tests, focused on detecting possible kidney or liver failure. Protein in the urine or ammonia in the blood are indicative that something is wrong. An echocardiogram and ultrasound techniques can also quantify kidney dysfunction.
Treatment of hypertension in children
Obesity in children is clearly correlated with the development of primary hypertension. Therefore, when faced with pre-hypertensive conditions with a high body mass index (BMI), diet and weight loss are always the first approaches to follow.
If changes in diet and exercise fail to address pre-hypertension for a period of 6 months, it is time to seek drug treatment. For example, if kidney failure is detected, diuretics are helpful, as they help excrete excess sodium and water.
Beyond diuretics, other well-established antihypertensive drugs are also useful in the treatment of adults, such as calcium channel blockers, angiotensin II receptor blockers, and beta-blockers.
You may be interested in: Pulmonary hypertension in pregnancy
Changes in lifestyle
As we have said, hypertension in children in its primary variant it is correlated with obesity and sedentary lifestyle. Therefore, if a child has a higher than normal BMI and a pre-hypertensive picture, it is always a good option to put their health in the hands of a nutritionist and change their daily habits.
If all this does not work, it is evident that only changes in the routine are not enough. It is important to explain to the child their condition and be transparent without generating alarm, since may require chronic treatment if the hypertension has no specific cause.
At what age should hypertension begin to be managed?
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