Blood pressure is the force that your blood puts on artery walls. High blood pressure, also known as hypertension, happens when that force is consistently too high.
High blood pressure in children is rare, but it can be a serious problem. About 3.5 percent of children and teens have high blood pressure. About the same percentage of children have blood pressure that is above what is considered optimal, but not high enough to diagnose as hypertension. Among obese and overweight children, the rate of high blood pressure can reach almost 25%.
Detecting high blood pressure in children is important because over time, hypertension can damage a child’s circulatory system and contribute to heart attack, stroke, and other health problems later in life. In general, the longer a child has high blood pressure, the greater the potential for damage to the child’s heart and other organs including kidneys, brain, or eyes.
Screening children for hypertension is also important because it can be an indicator of underlying conditions like diabetes, or kidney disease.
Most people with high blood pressure aren’t aware of it because there are often no obvious symptoms. The only way to find out if a child has high blood pressure is to have it checked.
How is blood pressure measured?
Blood pressure was traditionally measured in healthcare settings using a blood pressure cuff with a pressure gauge (sphygmomanometer). This air-filled cuff wraps around the upper arm and obstructs blood flow. By releasing small amounts of air from the cuff, blood slowly flows back into the arm. The pressure measured inside the cuff is the same as the pressure inside the arteries.
There are two numbers measured for blood pressure. Systolic blood pressure is the pressure when your heart beats. Diastolic pressure is when the heart relaxes between beats and the pressure drops. Together, they are written as systolic over diastolic pressure. For instance, a blood pressure of 120/80 mm Hg (millimeters of mercury) corresponds to a systolic pressure of 120 and a diastolic pressure of 80.
Using a sphygmomanometer is still considered the best method but, more commonly, devices that combine a blood pressure cuff with electronic sensors are used to measure blood pressure. Another method is to have the child wear a device that monitors and records the blood pressure at regular intervals during the day to evaluate blood pressure over time. This is especially helpful during the diagnostic process and can help rule out "white coat" hypertension, the high measurements that can occur when the child is at the doctor's office and not at other times.
A single measurement of blood pressure is not enough to diagnose hypertension. Typically, multiple readings are taken on different days. A diagnosis of high blood pressure is made if measurements are consistently high.
A child’s blood pressure may vary greatly between healthcare visits, or even within visits. So, it is important to obtain multiple measurements over time before diagnosing and treating a child for hypertension.
What is normal blood pressure?
High blood pressure in children ages 1 to 18 is defined differently than it is in adults. The 2017 American Academy of Pediatrics Clinical Practice Guideline recommends comparing a child’s blood pressure to tables that use data from healthy children of the same sex and height class. If a child has a blood pressure higher than 90 to 95 percent of other children in their age and height class, then they may have high blood pressure.
The 2017 American Academy of Pediatrics (AAP) Clinical Practice Guideline, endorsed by the American Heart Association, recommends starting blood pressure measurement for healthy children at age 3, then measuring it annually. Children younger than 3 should have their blood pressure measured at every healthcare visit if they are increased risk for developing hypertension. Some of these risks include:
The AAP recommends that children with certain conditions have their blood pressure measured during every healthcare visit. The conditions include:
- Taking medication known to raise blood pressure
- Kidney disease
- A severe narrowing in the aorta, the major blood vessel carrying oxygenated blood to the body
The American Heart Association and American Thoracic Society’s 2015 guidelines on hypertension in children acknowledge that the causes of hypertension in children are often different from those in adults. They focus on classifying the type of hypertension a child has and determining treatment.
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