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The high level of obesity among American children has brought with it another related disorder in the form of high blood pressure, according to new research. Obese and overweight children do have high blood pressure, but doctors fail to spot this mainly because the blood pressure values in childhood show a wide variation based on age, sex, and height of the children.
High blood pressure or hypertension is very common in adults and is one of the so-called lifestyle diseases. However it is not such a common finding in children. The present study differs in this opinion and says hypertension is actually more common in children than previously thought.
Blood pressure involves two measurements. The upper measurement is called the systolic pressure and denotes the highest pressure in the arteries as the heart pumps blood out. This reading is normally 120 mm of Hg (mercury). The lower measurement is called diastolic blood pressure and denotes the pressure in the arteries when the heart relaxes. This reading is normally 80 mm of Hg (mercury).
There is a wide variation in what is perceived as normal blood pressure. Usually a range is given, but this is not possible in children due to a variety of compounding factors involved.
According to the American Academy of Pediatrics, about five of every hundred children have higher than normal blood pressure, although fewer than one in a hundred has medically significant hypertension. Usually high blood pressure in children is related to another underlying problem like kidney disease, heart disease or dysfunction of the glands.
In the present study researchers from the Case Western Reserve University analyzed data on 14,187 patients enrolled in an Ohio-based health plan. All participants were aged between 3 to 18 years.
Reporting in the August 22/29 edition of The Journal of the American Medical Association, the researchers said that all children visited their doctors on three separate occasions for their physical and all had electronically accessible data.
Among the records, researchers were able to diagnose 507 cases of children having high blood pressure. However doctors had correctly diagnosed just 131 or 26 percent of the cases. Additionally 485 children were diagnosed as having pre-hypertension, but only 55 or 11 percent received a correct diagnosis from their doctors.
"Identification of elevated blood pressure in children meeting prehypertension or hypertension criteria is important because of the increasing prevalence of pediatric weight problems," the researchers write. "If abnormal blood pressure is not identified by a patient's pediatric clinician, it may be years before the abnormal blood pressure is detected, leading to end-organ damage."
A previous study published by Paul Muntner and colleagues in the May 17, 2004 issue of the Journal of American Medical Association had found a change in blood pressure among children and adolescents coinciding with weight gain from 1998 to 2000.
The study had used data from the third and the fourth National Health and Nutrition Examination Survey (NHANES), which had nationally representative samples of children and adolescents, aged 8 to 17 years. The researchers found in 1999-2000 the mean systolic blood pressure was 106.0 mm Hg, while the mean diastolic blood pressure was 61.7 mm Hg.
The study concluded by saying, "Blood pressure has increased over the past decade among children and adolescents. This increase is partially attributable to an increased prevalence of overweight."
Most experts agree that the problem with diagnosing high blood pressure in children is the lack of set data like in adults. Usually if the blood pressure readings cross 140/90 mm Hg in adults they are diagnosed as being hypertensive. Because many factors influence the readings in children there is no such cut-off compounding the problem faced by pediatric clinicians.
The current study co-author Dr. David Kaelber, an internist and pediatrician at Children's Hospital Boston said it was feasible for any electronic medical record company to develop a program that would enable clinicians to identify upper and lower blood pressure limits by simply feeding in the child's age, sex and height.
American Heart Association President Daniel W. Jones agreed with this assessment saying that simplifying the diagnosis of high blood pressure in children would help clinicians better recognize the signs and handle them.
The American Heart Association recommends that all children age 3 and older have blood pressure measurements annually. Early detection of high blood pressure will improve health care of children. High blood pressure is a major risk factor for heart disease and stroke in adulthood.
The American Academy of Pediatrics says the following signs may indicate high blood pressure in children
*Headache
* Dizziness
* Shortness of breath
* Visual disturbances
* Fatigue
It adds that early diagnosis is the key and that restricting the use of table salt in children will reduce mild hypertension.
The prevalence of obesity and overweight among children has made it more likely that they will suffer from high blood pressure. Parents need to watch their child's weight and restrict the use of salt even if the child has normal blood pressure. Easing off junk foods, which are laden with excess salts, will also go a long way in maintaining normal blood pressure.
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