Blood pressure is the force of the blood pushing against artery walls. Hypertension is blood pressure that’s the same as or higher than 95% of children of the same sex, age, and height. What’s normal for children changes as they grow, so there’s no target blood pressure reading like that for adults. What may be high for a 4-year-old boy may be normal for a 10-year-old girl. Hypertension is either primary (essential, meaning occurring on its own) or secondary (caused by another medical condition).
Causes differ according to a child’s age. Children younger than 10 usually have secondary hypertension. Diabetes, adrenal disorders, and hyperthyroidism can cause it. Hypertension in babies can result from prematurity or problems with kidneys, lungs, heart, and blood vessels. Some children get hypertension for the same reasons as adults: being overweight, eating a poor diet (such as too much salt), and not getting enough exercise. Older children and teens usually have primary hypertension.
Many children have no symptoms, but symptoms of secondary hypertension usually point to the underlying disease. Some children may have chest pain, fatigue, headaches, and trouble concentrating and sleeping.
Blood pressure readings can vary greatly, so an average of at least three separate measurements is used for diagnosis. The measured pressure is compared with values that are normal for children of the same sex, age, and height. Pressure in both arms and legs should be measured. Cuff size also affects measurement. Before diagnosis, other causes of high blood pressure such as pain, being nervous at the doctor’s office, and drugs must be ruled out. Regular health care provider checkups, starting when children are 3 years old, are important for screening. The health care provider must check out medical conditions causing secondary hypertension.
Therapy aims to reduce blood pressure and thereby risks of organ damage and problems later in life. These problems include stroke, heart attack, and kidney disease. Treatments include lifestyle changes such as losing weight, eating more vegetables and fruits, increasing physical activity, and reducing dietary salt (sodium). Children should never start smoking or should stop. If these changes don’t work, drugs can be tried. Control of other medical conditions such as diabetes is essential.
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