New research published in the May 2019 issue of the American Heart Association’s journal Hypertension not only reveals how updated guidelines (published in September 2017 in the journal Pediatrics) have identified more youngsters as having high blood pressure, but also shows how children with elevated pressure are more likely to develop a thickening of the heart muscle wall and metabolic syndrome (a group of conditions that raises the risk of type 2 diabetes, stroke, and heart disease) compared with those who have normal blood pressure. “The newer 2017 guidelines identified a group of children with heart disease risk and outcomes that were underestimated by the previous 2004 guidelines,” says Lydia Bazzano, MD, senior author of the study and associate professor of epidemiology at the Tulane School of Public Health and Tropical Medicine in New Orleans. In 2017, the American Academy of Pediatrics updated its 2004 recommendations for the screening and management of high blood pressure in children and adolescents. For those ages 13 to 17, the new guidelines were simplified so any reading greater than or equal to 130 millimeters of mercury (mmHg) systolic over 80 mmHg diastolic is now considered high blood pressure, with no adjustment for age, sex, or height. This aligns with the current definition of high blood pressure in adults. The earlier 2004 guidelines also had established blood pressure norms based on data including children with obesity. The new blood pressure thresholds for children up to age 12 were established without considering the overweight and obese (although age, sex, and height are factored in for this population). “A larger percentage of children now have been identified as having high blood pressure, mostly because the measures are now based on normal weight children, whereas the previous group used as a reference included kids who were obese,” says Dr. Bazzano. In a sense, the old guidelines forgave blood pressure elevation that might be related to obesity.
Heart Troubles Ahead for Many Youngsters
To see if this redefining of high blood pressure could help spot children at greater risk of heart disease, scientists reviewed health records of 3,940 children who were followed over the course of 36 years as part of the Bogalusa Heart Study. The youngsters ranged in age from 3 to 18; 47 percent were male and 35 percent were African-American. Researchers found that 11 percent of the participants would be considered to have high blood pressure under the new guidelines compared with 7 percent under the old standards. The study authors also observed similar associations with developing adulthood hypertension and metabolic syndrome. Of those with high blood pressure according to the 2017 measures, 19 percent developed a thickening of the heart muscle during the follow-up period, compared with 12 percent when high blood pressure followed the 2004 guidelines. “We think that chronic effect of having high blood pressure over time is what ultimately does damage to the heart and blood vessels,” says Stephen Daniels, MD, professor and chair of the department of pediatrics at the University of Colorado School of Medicine and a pediatrician-in-chief at Children’s Hospital Colorado in Aurora. “The new guidelines are reassuring because they are helping us find those kids who need the most attention.” The results of this investigation support research by the Centers for Disease Control and Prevention (CDC) that used the 2017 guidelines and found that about 4 percent of youth ages 12 to 19 have hypertension, and another 10 percent have elevated blood pressure (previously called “prehypertension”). “High blood pressure turns out to be not uncommon in the pediatric age range,” says Dr. Daniels, who was not involved in this study.
The Good News: High Blood Pressure Is Treatable
While having hypertension when young can lead to heart disease and stroke later in life, the condition can be reversed and prevented. “Limiting processed foods, fast foods, and restaurant foods; keeping a healthy body weight; and getting daily exercise will go a long way towards maintaining normal blood pressure,” says Sarah Samaan, MD, a cardiologist with Baylor Scott and White Legacy Heart Center in Plano, Texas, who was not a research author. The American Heart Association recommends that kids get at least one hour of moderate- to vigorous-intensity physical activity each day, and participate in muscle- and bone-strengthening activities at least three days per week. Bazzano suggests eating plenty of legumes, nuts, whole grains, lean protein, and five servings per day of fruits and vegetables, particularly those that are nutrient-dense and nonstarchy. Kids are advised to limit salt, added sugars, and saturated and trans fats. If the blood pressure levels are not going down with diet and exercise, doctors may prescribe medication. “We try not to use drugs to treat high blood pressure in kids, but there are some patients where the blood pressure continues to be high despite lifestyle changes,” says Daniels. Study authors note that the investigation is limited by a lack of data on actual heart attacks and strokes during adulthood, although that information is currently being collected. Also, participants in the Bogalusa Heart Study are from one community in Louisiana, so the results may not be generalizable to the nation as a whole. “This research shows that children can indeed have high blood pressure and it can have an adverse impact on their cardiovascular system,” says Daniels. “Pediatricians and family physicians will focus on repeating the measurement over time to be sure that pressure is persistently high. From a parent standpoint, you should make sure to have your child’s blood pressure checked regularly.”
