While hypertension is a lifestyle disease and generally impacts adults, it is now starting to affect even children and adolescents. While it can cause heart failure and stroke in adults, it can cause cardiovascular complications in children, especially as they grow older. So, if a child has been diagnosed with hypertension, they need to make certain changes in their lifestyle, so that they can control the condition and prevent it from impacting their life negatively. It is a critical medical condition and should be taken seriously by clinicians and families.
Hypertension is defined as a condition where the force of the blood against the artery walls is too high. The more blood the heart pumps, the chances are higher for the arteries to become narrow, which therefore increases the blood pressure. A blood pressure reading is given in millimetres of mercury (mm Hg) and is depicted through two numbers, namely the systolic and diastolic pressures. If either or both measurements are above the upper limit of their range in healthy children of the same age, sex, and height, it will lead to a diagnosis of hypertension. Also, keep in mind that these measurements must be taken three times before a diagnosis is confirmed.
Further, based on blood pressure level compared to normal levels, hypertension is staged as stage 1 (mild) or stage II (severe). If a child has been diagnosed with hypertension, they are at a higher risk of heart and lung failure complications. They would also require treatment for the condition depending on the severity and specific situation.
While hypertension in children younger than three is rare, some situations, including the below, can result in them.
Complications at birth (prematurity, slight for date, meagre birth weight, intensive care stay)
Known heart disease, kidney disease; urinary tract infections, urinary loss of red blood cells (haematuria) or proteinuria in the child/parent
Solid-organ or bone marrow transplant
Brain disease associated with increased intracranial pressure
Malignancy illness associated with hypertension (e.g., neurofibromatosis, tuberous sclerosis, sickle-cell disease)
Therapy with drugs known to raise blood pressure (e.g., corticosteroids, oral contraceptives, stimulants used to treat attention deficit and hyperactivity disorders)
Classifying hypertension in children
Hypertension found in children can also be classified into two categories. The first type is essentially seen in older kids with no precise cause for the high blood pressure while the second type which is termed as secondary hypertension is mostly seen in younger kids, which might be due to some other underlying disease that is most related to the kidneys. Remember, it is best to check BP once a year in all children who are above three years of age, however if they have any risk factors, make sure monitoring starts as early as possible.
Children who suffer from mild hypertension may not show any symptoms, while symptoms for severe hypertension include headache, nausea, vomiting, blurred vision, dizziness, nosebleed, and fast heartbeat. In addition, high blood pressure levels can sometimes also lead to fits (seizures), altered consciousness, breathlessness, or rapid breathing.
Since the above symptoms are quite complex, children might not always be able to recognise them or communicate the same, even to their parents. That is why the only reliable way to diagnose hypertension is by periodically checking the blood pressure levels through a BP machine that can be purchased from any medical store. As most children do not show specific symptoms, blood pressure levels should be measured yearly in every child older than three years of age.
Risk factors
There are some risk factors that are associated with cases of hypertension.
Obesity is directly linked to hypertension, and children who are overweight need to pay special attention to their lifestyle and diet.
Parents who have hypertension tend to have children who suffer from the condition, so it is better to monitor BP levels regularly.
Being diagnosed with hypertension, especially in children, can be challenging for everyone in the family. The first step that should be taken after a diagnosis includes a report on how the high BP is affecting the kidneys, heart, and eyes of the child. To do this, an echocardiogram, detailed examination of the eyes, and blood tests are required. Additionally, a doctor will advise the parents for specific blood and urine tests, besides an ultrasound that will help the medical team evaluate the kidneys and their vessels. All the above are essential as the treatment plan, including medication and prognosis, is dependent on specific case history and relevant reports.
Living with hypertension is not easy as children might not be able to understand the long-term implications of their conditions. But simple measures like the ones mentioned below can help them tackle this situation better.
Parents must give particular focus to the diet of the child. If the child is overweight, meals should be freshly made and cooked at home. While losing weight is essential, focusing on a well-balanced and healthy meal is crucial.
Encourage children to be physically active with outdoor activities and exercises. Inculcating good lifestyle habits in childhood can go a long way in controlling hypertension, especially in children. They must spend about 30–60 minutes on aerobic exercises at least 3–5 days every week.
Make lifestyle changes
Hypertension can be controlled if proper lifestyle changes are made. If a child suffers from the same, making changes at the family level is sure to have more impact as children tend to imitate their parents and elders. Also, if you notice any symptoms related to hypertension in any family member, make sure you reach out to a specialised expert/doctor at the earliest.
(Dr Asmita Mahajan, Consultant Neonatologist & Pediatrician, SL Raheja Hospital, Mahim)
