Blood pressure screening for children should start at age 3, according to the latest government diagnosis and treatment guidelines

May 19 2004

“The long-term health risks for hypertensive children and adolescents can be substantial,” said Bonita Falkner, MD, Professor of Medicine and Pediatrics at Thomas Jefferson University, Philadelphia. “We want to update clinicians on the latest scientific evidence regarding blood pressure in children and adolescents and to provide treatment recommendations to meet this growing public health challenge. Based on the way hypertension is diagnosed in the young, it is estimated that one to three percent of children and adolescents may have hypertension.”

The fourth report from the National High Blood Pressure Education Program Working Group updates the previous 1996 guidelines. The latest guidelines are scheduled to be published in the July issue of Pediatrics.

“The strong association of high blood pressure with obesity and the marked increase in the prevalence of childhood obesity indicate that both hypertension and prehypertension are becoming a significant health issue in the young,” explained Dr. Falkner, chair of the working group. “The guidelines recommend therapeutic lifestyle changes such as weight reduction, regular physical activity and restriction of sedentary activity to help prevent increases in blood pressure.

“We recommend encouraging dietary modification in children and adolescents who have blood pressure levels in the prehypertension range as well as in those with high blood pressure,” she said. “The entire family has to work together to improve success.”

Prehypertension, greater than 120/80 mm Hg, is a relatively new blood pressure measurement classification. It was introduced last year in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7).

“The guidelines for children and adolescents are consistent with JNC 7,” Dr. Falkner said. “It is important to note that in adults the systolic and diastolic numbers define hypertension.

“This does not work in children because of the vast range in body size, age, height and other developmental parameters,” she noted. “The new report contains revised blood pressure tables to include the 50th, 90th, 95th and 99th percentiles by sex, age and height to help physicians avoid misclassifying children who are either very tall or very short.”

Hypertension in children occurs when blood pressure is above the 95th percentile. Prehypertension is when blood pressure is between the 90th and 95th percentile, or in adolescents if blood pressure is greater than 120/80.

The latest guidelines call for physicians to measure blood pressure of children starting at age 3. The preferred method of measurement is auscultation (listening to sounds). Elevated blood pressure must be confirmed on repeated visits.

“The evaluation of hypertension in children should also include assessments for additional risk factors such as diabetes and cholesterol disorders,” Dr. Falkner said. “In addition, physicians should take a sleep history due to an association of sleep apnea with overweight and high blood pressure.”

The guidelines recommend that pediatric patients with established hypertension undergo echocardiography assessment for left ventricular hypertrophy (enlargement of the heart’s main pumping vessel), the most prominent evidence of target-organ damage.

“Left ventricular hypertrophy (LVH) is the most prominent clinical evidence of target-organ damage caused by hypertension in children and adolescents,” Dr. Falkner said. “The presence of LVH is an indication for physicians to initiate or intensify antihypertensive therapy.”

The new guidelines note that pharmacological therapy, when indicated, should begin with a single drug. Acceptable drug classes for use in children include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor antagonists, beta-blockers, calcium channel blockers and diuretics.

“The goal of antihypertensive treatment in children and adolescents is reduction of blood pressure,” Dr. Falkner said. “The long-term health risks for hypertensive children and adolescents can be substantial. It is important that clinical measures be taken to reduce risks and to optimize positive health outcomes.”

The American Society of Hypertension (ASH) is the largest US organization devoted exclusively to hypertension and related cardiovascular diseases. ASH is committed to alerting physicians, allied health professionals and the public about new medical options, facts, research findings and treatment choices designed to reduce the risk of cardiovascular disease. http://www.ash-us.org/