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Health Matters: Hypertension

By Virginia Lester,
RN, MSN, ARNP

Hypertension (HTN) is a well established risk factor for cardiovascular diseases in adults. Although the incidence of persistent HTN is low in children, it has become clear that HTN begins in childhood and adolescence and can contribute to early development of cardiovascular disease. There is increasing evidence that essential HTN begins during childhood and predicts increased adult blood pressure levels.Approximately 40 to 45 percent of cases have the beginning evidence of left sided heart enlargement and early development of atherosclerosis.

Essential HTN is the most common form in older children and adults and is a diagnosis of exclusion. This means all other causes of HTN have been excluded to make the diagnosis. Secondary HTN is a condition that accompanies other more severe illness such as kidney or endocrine diseases and also illicit drugs and medications such as over-the-counter decongestants, oral contraceptives, stimulants, caffeine, nicotine, licorice or performance enhancing steroids

The definition of childhood HTN is statistically defined based upon the normal distribution of blood pressures (BP) measured in healthy children. BP percentiles are based on gender, age, height and measurements taken on three separate occasions. The systolic (top number) and diastolic (bottom number) have equal importance. Tables have been developed to make evaluation easier for the clinician based on all of the above criteria. Normal BP is defined as the systolic and diastolic measurements below the 90th percentile.

The prevalence of HTN in children is lower than in adults, however it is increasing. Between the years 1989 to 2002 the prevalence increased from 1.1 percent to 4.5 percent. Reasons for these changes are believed to be an increase in mean body mass index (BMI), increased obesity and perhaps ethnicity.

Family history also plays a major role in the development of childhood and adolescent HTN. In children and adolescents with the diagnosis of essential HTN, 70 to 80 percent had family history of HTN as compared to 40 percent or less in those without a family history. It should be noted that these percentages include both genetic and environmental factors.

As of 2002, approximately 4.5 percent of children have HTN, defined as a BP reading of equal to or greater than the 95th percentile. Based upon this observation, identifying children at risk of hypertension could have an important impact on long-term outcomes of adult cardiovascular disease. The American Heart Association Council on high blood pressure research has suggested that all children over the age of three years should have their blood pressure measured at least yearly. Unfortunately, many children do not visit health professionals regularly because they appear to be healthy and are only examined on an, as needed, random basis.

Your clinic provides free blood pressure measurement to any person upon request. Children are included. This is especially important for children with a positive family history.
Please note: The clinic hours will be different for the week of February 12. We will be open on Monday, February 13 & 14. I will not be in the office of February 15 & 16 because of an educational conference. However, Chris or Valerie will be answering the phone during my absence and I will be picking up messages.