Monitoring, prevention strategies needed for ‘underrecognized’ hypertension in children
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Key takeaways:
- Primary hypertension in children and teens is underrecognized, yet a strong predictor of hypertension in adulthood.
- Primordial prevention, including good lifestyle habits and a healthy diet, is important.
Primary hypertension is now the leading type of pediatric hypertension, especially in adolescents, raising their subsequent risk for CV events in adulthood, according to a new scientific statement from the American Heart Association.
The overall prevalence of hypertension in childhood is 2% to 5%, driven by the childhood obesity epidemic. In the statement, the authors note that children with BP levels in the higher range of the BP distribution tend to maintain that level into adulthood.
Data were derived from Falkner B, et al. Hypertension. 2023;doi:10.1161/HYP.000000000000228.
Leading risk factors for children with primary hypertension are excess adiposity and suboptimal lifestyles; however, environmental stress, low birth weight and genetic factors may also be important, according to the authors.
“Primary hypertension in children and adolescents is commonly unrecognized and undertreated,” Bonita Falkner, MD, FAHA, emeritus professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia and chair of the scientific statement writing committee, told Healio. “There are secondary causes of hypertension that can be found in childhood such as chronic kidney disease, endocrine abnormalities, cardiac disorders, and others, in which the hypertension is caused by the underlying disorder. For primary (essential) hypertension in childhood, as in adults, the cause of the hypertension is not known. Importantly, primary hypertension is the most common type of hypertension in childhood, especially in adolescents.”
The statement was published in Hypertension.
Elevated CV risk in adulthood
Children and adolescents with primary hypertension are “highly likely” to become adults with hypertension and have measurable target organ injury, particularly left ventricular hypertrophy and vascular stiffening. The statement highlights the importance of ambulatory and home BP monitoring to facilitate diagnosis.
“Children and adolescents with primary hypertension can have target organ damage such as left ventricular hypertrophy and vascular stiffness,” Falkner told Healio. “There is now evidence that that primary hypertension in adolescents is associated with preclinical cardiac dysfunction.”
The American Academy of Pediatrics, European Society of Hypertension, and Hypertension Canada all define hypertension as repeated BP readings greater than the 95th percentile for children. However, thresholds across the three associations vary:
- American Academy of Pediatrics adopts 130/80 mm Hg starting at age 13 years;
- European Society of Hypertension adopts 140/90 mm Hg starting at age 16 years; and
- Hypertension Canada adopts 120/80 mm Hg for those aged 6 to 11 years and 130/85 mm Hg for those aged 12 to 17 years.
“Adolescents entering adulthood with a BP less than 120/80 mm Hg is an optimal goal,” the researchers wrote.
When hypertension is diagnosed, evidence-based treatment guidelines should be implemented.
“A healthy lifestyle in childhood may be extremely helpful in mitigating the risk of developing hypertension in youth,” Falkner said in the release. “Preventive measures for families that promote healthy lifestyles in children are important, such as eating healthy food, encouraging physical activity that leads to improved physical fitness and healthy sleep, and avoiding the development of obesity. Regular blood pressure monitoring by a health care clinician is also essential so that if high blood pressure is present, it can be quickly detected and addressed.”
Primordial prevention of primary hypertension
The statement notes that primordial prevention is an important public health goal; a population with lower BP will have fewer comorbidities related to hypertension and CVD. “Ongoing primordial prevention efforts such as obesity prevention campaigns that promote increased physical activity and healthy diets such as the [Dietary Approaches to Stop Hypertension] diet may contribute to a reduced prevalence of hypertension,” the researchers wrote. “Of the behavioral risk factors for hypertension in youth, poor diet has the highest prevalence and may offer the greatest opportunity for intervention.”
Clinicians and policymakers should also consider social determinants of health when assessing patients, including factors such as food insecurity and exposure to traumatic events.
“These factors can strongly affect whether an individual or family has access to the resources needed to implement primordial prevention strategies,” the researchers wrote. “Of interest are strategies to prevent or mitigate these conditions by improving access to healthy foods and health care, increasing social support for families, and promoting resiliency with subsequent effects on childhood BP and hypertension.”
Additionally, the authors wrote that applying lower sodium content standards to commercially processed and prepared foods in the U.S. and including healthier food choices in schools could lead to a reduction of almost 700 mg sodium per day in children. As Healio previously reported, the FDA recently proposed a rule that would allow the use of “safe and suitable salt substitutes” in standardized foods, providing manufacturers with greater flexibility for reducing sodium content.
“Research is needed on reducing risk factors that are associated with primary hypertension in childhood,” Falkner told Healio. “These include high-salt diets, obesity, low birth weight and other adverse environmental factors. Currently guidelines on treatment/management of primary hypertension are based on expert opinion. Evidence-based guidelines based on clinical trials are needed for treatment of primary hypertension in adolescents.”
For more information:
Bonita Falkner, MD, FAHA, can be reached at bonita.falkner@jefferson.edu.
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