Blood pressure (BP) is a vital sign of human health. It is measured by noninvasive methods that are available at all levels of health care and is simple and economical. The harm that can be done by missing a high BP clearly exceeds any inconvenience in taking a BP measurement.
The prevalence of arterial hypertension (HTN) among children and adolescents is 3–5%, and lower in neonates and infants (ranging from 0.2% to 0.8%). It increases with age, reaching about 10–13% in 18-year-olds. An elevated BP is the most significant potentially reversible cardiovascular (CV) risk factor, so detecting an elevated BP is critical to preventing CV disease and promoting a healthy lifestyle. Blood pressure must, of course, first be measured, especially since an elevated BP may not cause symptoms and go on unnoticed.
Blood pressure varies, depending on a child’s activity level, stress, and other circumstances. Broad variability may impact other organs, including the heart, brain, and eyes. Due to its variability, it should be measured regularly. Development of HTN among adolescents has an incidence rate of 1.4% per year.
Primary hypertension (PH) is becoming the dominant cause of HTN in children. Its rise in childhood is closely associated with visceral obesity and metabolic abnormalities typical of metabolic syndrome. More than one in ten children between ages 8 and 17 years had elevated BP; one in five children manifested significant metabolic abnormalities.
Primary HTN progresses slowly. Although cardiac events are rare in children with PH, mediated organ damage can take the form of an enlarged heart and hypertensive arteriopathy, described as early vascular aging, observed in about 40% of children with PH at diagnosis. It is more often expressed as secondary HTN, which develops with chronic kidney disease (CKD), aorta coarctation or with diabetes mellitus. Data from 545 children with CKD stage 2–5 show that 26.1% of children had uncontrolled HTN and an increased prevalence from 24.4% in stage 3 to 47.4% in stage 5 CKD.
High BP has an effective treatment and is one of the most treatable CV risk factors, with important health implications when left untreated. The most dramatic effects were documented in children with CKD, after controlled lowering of BP, resulted in significant slowing of progression towards end-stage renal disease. Antihypertensive treatment is associated with beneficial effects, both in terms of decreasing BP and even leading to regression of hypertensive target organ damage.
Blood pressure measurement is a safe procedure. Improper BP measurements and the wrong interpretation of results obtained could lead to an over- or under- diagnosis of HTN. It is therefore important to decide in whom and how BP should be measured. Guidelines of the European Society of Hypertension do not recommend universal measuring of BP in children younger than 3 years if they are not in a risk group such as prematurity, inborn kidney or heart disease, but to measure to all children above that age.
Early diagnosis of elevated BP can promote the introduction of lifestyle changes and reduction of CV risk later in life.
Prof. Augustina Jankauskienė, Pediatric Center, institute of Clinical Medicine, Vilnius University
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