What You Need to Know About Pediatric Hypertension

Unfortunately, we have seen a dramatic rise in pediatric hypertension over the last few years. Now, up to 10% of children have elevated blood pressure. If we apply this to the population of children in Connecticut, roughly 70,000 are affected!

What are the risk factors for pediatric hypertension?

The biggest risk factor is being overweight. There is a direct link between increased pediatric hypertension with the rise in childhood obesity. The good news is that by working as a team with our families to implement healthier approaches to eating and getting adequate exercise, both of these problems can be often be cured!

Besides being overweight, other risk factors for hypertension are:

• Being born prematurely
• Having kidney disease
• Abnormal levels of certain hormones
• Heart disease
• Diabetes

Medication can also raise blood pressure. Many commonly used medications such as steroids for asthma, medications for Attention-Deficit/Hyperactivity Disorder (ADHD) and birth control pills can cause hypertension.

Any child with these risk factors should have their blood pressure checked at ALL health care visits (not just at the annual physical).

Is there a typical blood pressure reading that would be considered as too high for children, or does it vary by child?

Yes, and yes. Anyone whose blood pressure is above 120/80 mmHg is considered abnormal. As normal blood pressure varies by age, sex and height, what is considered elevated varies based on each child. Below is a rough guideline for blood pressure readings that should prompt the health care team to take a closer look, based on what is normal for that individual child.

What are some signs parents should look for if they suspect their child has pediatric hypertension, and what should they do next?

The scariest part about high blood pressure is that there are often no symptoms. That means unless you look for it, you won’t find it. The problem is that when high blood pressure occurs in kids, it starts to cause damage while they are still kids.

Children with untreated high blood pressure can develop heart damage, blood vessel damage, and kidney and eye damage during childhood. With treatment, many of these problems can be reversed or prevented. For those children that do develop symptoms, more common complaints are headaches, nose bleeds and chest pain.

The most important thing parents can do is to make sure their children are having regular blood pressure checks and being referred for further evaluation if they are abnormal. Never assume the child is “just nervous” if the blood pressure is persistently elevated.

What is Ambulatory Blood Pressure Monitoring (ABPM), and how does it benefit patients and families?

ABPM is the gold standard for diagnosing hypertension in children. ABPM is a special blood pressure machine that children wear at home. Each child is custom measured for the appropriately sized cuff and wears the machine for 24 hours. This way, instead of getting a few readings in the office, we can get 40+ readings while the child is home, including during sleep. This allows us to more definitely say if a child has true, sustained hypertension.

After the 24 hours, the monitor is returned and the study is uploaded to special software and reviewed by a physician with advanced training to interpret the results. Unless there are preexisting signs of damage from hypertension or a child’s blood pressure is extremely elevated, parents should not accept a diagnosis of hypertension unless this study is performed.

Nearly 50 percent of children who are referred for elevated office-based blood pressure have normal blood pressure on ABPM. This is typically called “White Coat Hypertension, and often results in unnecessary testing and more frighteningly, prescriptions for medication children may not need, which could have potential negative side effects. Kids with elevated office-based blood pressure still need to be monitored as they are at an increased risk of developing sustained high blood pressure in the future, but they do not require medication.

Where is ABPM offered?

Connecticut Children’s offers the largest ambulatory blood pressure monitoring program in the region and the most comprehensive pediatric hypertension program in the state. We perform nearly 50 monitors monthly and this number is increasing. We recognize how difficult it can be for families to take time off from work, arrange child care and for children to miss school. Therefore, we work hard to bring these services where it is most convenient. We offer ABPM at nearly all of our satellite locations across Connecticut and are able to offer this service to patients living in Fairfield County and even as far as Massachusetts and Western NY. We are working to make this technology available in high risk school systems as well.

At Connecticut Children’s, every family is provided a team approach to help their child. In addition to being evaluated by a physician specially trained in pediatric hypertension, each child is seen by our renal dietitian to help incorporate dietary and lifestyle changes to combat hypertension. We have a team of dedicated nurses to assist in ambulatory blood pressure monitoring and provide education. Social work services are also available to help ensure we are treating the whole child and not just one specific health concern. In addition to our robust ambulatory blood pressure monitoring program, we have state-of-the art access to laboratory testing, diagnostic imaging and accessibility to Connecticut Children’s Weight Management program.

We work closely with our families and often help to ensure the whole family is adopting a healthy lifestyle, which helps to motivate parents and provide the best environment for our patients.

How does Connecticut Children’s care for pediatric hypertension patients beyond their initial diagnosis?

We take pediatric hypertension very seriously, as we know that damage from high blood pressure starts in childhood. For children diagnosed with hypertension, our expert providers will develop a specialized plan that encompasses diagnostic work-up and treatment customized for each individual child. We work together with our families and other members of the pediatric hypertension team to ensure we are addressing all aspects of care. With close follow up and medication, where necessary, we are able to control blood pressure to a safe level.

Our goal is to make sure no child under our care develops damage from hypertension, and that all patients achieve normal blood pressure and live a healthy childhood.

Dr. Matloff is a pediatric nephrologist at Connecticut Children’s

Learn more about Connecticut Children’s pediatric nephrology services >