Having your child’s blood pressure checked is routine during their annual well visit. That’s because high blood pressure (hypertension) gives doctors a sense of their overall risk of future heart disease.

This condition occurs in about 3 percent of children. With increasing prevalence of obesity, elevated blood pressure in children is more common. Usually we work with the pediatric nephrology department to determine the cause of this condition. Possibilities include heart conditions, kidney disease, and hormones. Once we determine the cause of hypertension, treatment is focused on the cause of problem. The majority of cases are multifactorial and we will design a management plan based on your child’s individual needs. Also, we monitor to see if hypertension is having any other effects on the heart.

We check blood pressure using an arm cuff. We pump the cuff full of air, which restricts your blood flow for a few seconds. As we release the pressure, your blood starts flowing again, and your health care provider can listen to this flow with a stethoscope. With each heartbeat, your heart is pushing blood through your arteries. This pushing creates pressure on your arteries, or major blood vessels; we call it blood pressure. You want to have the right amount of blood flowing through your arteries. As with air in tires, you don’t want to have too much pressure or too little. 

Blood pressure readings give us two numbers. The first number (systolic) tells us how blood flows when it is moving at its fastest, right after the cuff stops squeezing the arm and the blood vessels within. The second (diastolic) gives us the blood pressure when the blood vessel is relaxed. If either number is too high, your heart is working harder than it should. There are two types of blood pressure. Some types have no clear cause (called primary or essential). Others (called secondary) stem from problems with your sleep, kidneys, adrenal glands, thyroids, or heart defects or certain medications.

If blood pressure is high, it is likely to rise over time. We divide blood pressure measurements into four categories:

• Normal blood pressure: Below 120/80 mm Hg.
• Elevated blood pressure. Your first number (systolic) is between 120 and 129 mm Hg and the second (diastolic) is less than 80 mm Hg.
• Stage 1 hypertension. The systolic measurement is between 130 to 139 mm Hg or the diastolic pressure is 80 to 89 mm Hg.
• Stage 2 hypertension. The systolic pressure is higher than 140 mm Hg or higher or the diastolic pressure is more than 90 mm Hg.

The above numbers are chosen from adult studies but can be used in children older than 12 years. For younger children we use age, gender, and height-specific cut-off values to define abnormalities.  Your child is at greater risk for high blood pressure if they are African American, overweight, or inactive, or if you have a positive family history of high blood pressure.

Treatments

We treat high blood pressure with lifestyle changes or medications or both.

You can help your child make lifestyle changes such as:

• Improving their diet: Encourage your child to eat plenty of fruit, vegetables, fish, and low-fat dairy. Avoid sugar-sweetened beverages. Avoid processed foods.
• Getting plenty of exercise: Try to help your child get at least 60 minutes of moderate to vigorous physical activity daily (5 days a week). 
• Controlling their body weight: Assist your child in maintaining a healthy weight or losing weight if necessary.
• Managing stress: You can help your child lower stress by letting them know you are there to talk—if they want to—and listening to what they have to say before you respond. Decreasing stress can help the whole family. Your child’s doctor may also screen for depression and stress and refer for counseling if appropriate. 

Medication

We use a variety of types of medications to treat blood pressure. In general, medications can help your blood vessels open, which improves blood flow. We may use one or more of them. These include:

• ACE inhibitors and angiotensin II receptor blockers: These help your blood vessels relax and open.
• Calcium channel blockers: These relax and open narrowed blood vessels.
• Diuretics: They help the body get rid of excess salt (sodium) and water.
• Vasodilators: These can help your blood vessels relax and open.