Paediatric Hypertension: Causes and Symptoms

What is high blood pressure in children?

Paediatric Hypertension, also known as high blood pressure in children, is a condition in which a child has consistently elevated blood pressure readings.

In recent years, the prevalence of high blood pressure in children and adolescents has increased with the prevalence of overweight and obesity due to poor eating habits. Due to increased Child’s blood pressure in children, heart disease and stroke risk have also increased.

Globally, 1 in 25 youth aged 12 to 19 deals with Hypertension, and one in ten has elevated blood pressure or prehypertension. In India, 7% school going children are hypertensive, 4% have sustained Hypertension, and 10% are pre-hypertensive. This rate is higher among urban children as compared to their rural counterparts. Furthermore, children with obesity have a significantly high prevalence of Hypertension (29%) than normal-weight children (7%). This highlights that Hypertension is becoming a public health threat in India, and hence, the problem must be addressed.

There are two types of Hypertension in Children, mentioned below:

1. Secondary Hypertension

When high blood pressure in children results from multiple factors, including obesity, genetics, kidney disease, sleep apnea and other medical conditions, it is referred to as secondary hypertension. The cause of a child’s high blood pressure is identifiable in secondary hypertension.

2. Primary Essential Hypertension

Children who consume a diet high in salt, fat, and sugar and do not get enough physical activity are more likely to develop high blood pressure. In such cases, the cause of Paediatric Hypertension is unknown. When the cause of high blood pressure in Children is unidentifiable, it is referred to as primary essential hypertension.  

What are normal blood pressures for paediatrics?

In children, regular blood pressure readings vary based on age, height, and gender. According to paediatric hypertension guidelines, in children 1 to 13 years of age, normal untreated blood pressure is <120/80mm Hg and elevated blood pressure is 120/80 mmHg to <95th percentile.

In children above and equal 13 yrs, normal blood pressure is <120/<80mm Hg, and elevated blood pressure is 120/<80 to 129/<80 mmHg.

During Stage 1 hypertension, the blood pressure ranges from 130/80 mmHg to 139/89 mm Hg.

During stage 2, the blood pressure can exceed 140/90 mmHg.

Untreated or uncontrolled Child’s blood pressure can lead to serious health problems, including damage to the heart, blood vessels, kidneys, and brain damage. Therefore, regular blood pressure monitoring is an essential part of preventive health care for children. At the same time, they require treatment with lifestyle changes and medications to control their condition.

What are the symptoms of Paediatric Hypertension?

Children with prehypertension and Hypertension may experience no symptoms at all, or they may experience symptoms that are not clear and difficult to identify. Infants may show irritability, failure to thrive, vomiting, feeding problems, seizures or difficulty breathing. Sometimes they experience nosebleeds.

However, some children at an advanced stage of Hypertension may experience the following symptoms:

• dysuria (painful urination)
• thirst
• polyuria (frequent urination)
• nocturia (frequent urination at night)
• hematuria (blood in urine)
• swelling
• weight loss
• inability to gain weight
• rapid heartbeat
• Shortness of breath during physical activity
• sweating
• fever
• paleness 
• chills
• absence of the menstrual cycle

Sustained Hypertension in children can cause chronic complications, including organ damage. The Symptoms that indicate organ damage due to Hypertension in children include: 

• headache, especially in the back of the head.
• nose bleeding
• dizziness, particularly when children stand up quickly from a sitting or lying position.
• visual disturbance 
• facial paralysis
• stroke
• seizure  

It is important to note that the symptoms of Paediatric Hypertension can be similar to those of other conditions. So, it’s best to seek medical guidance to make a diagnosis. Early detection and treatment of Hypertension in children can prevent serious health problems in the future.

What causes Paediatric Hypertension?

The factors that are responsible for Paediatric Hypertension include:

1. Perinatal history of the child

•   low birth weight and gestational age 
•   Decreased amniotic fluid 
•   deficiency of oxygen 
•   Umbilical artery catheterisation in newborn 
•   blood clotting

2. Other medical conditions in Child  

•   Urinary tract infection/renal/urologic diseases
•   Systemic diseases (systemic lupus erythematosus)
•   Cardiac diseases
•   Endocrine diseases
•   Neurologic conditions
•   Growth retardation 

3. Medications that can cause high blood pressure in children 

• Anti-hypertensive drugs
• Steroids
• Cyclosporine and Tacrolimus (medicines that decrease the activity of the immune system)
• Tricyclic antidepressants
• decongestants
• Contraceptive pills
• Diet pills
• Amphetamines and cocaine (stimulant drugs) 

4. A family history of these medical conditions can make a child prone to high blood pressure 

• Hypertension
• Cardiovascular and cerebrovascular disease 
• Diabetes mellitus 
• Imbalanced lipids and cholesterol levels 
• Obesity
• polycystic kidney
• Alport syndrome (blood vessel damage in the kidney)
• kidney tumour
• Syndromes accompanied by Hypertension (neurofibromatosis)

How to treat Paediatric Hypertension?

Suppose the child’s hypertension is mild to moderate. If the child’s hypertension is moderate to severe, it requires medication to lower blood pressure. The medicines are recommended for children over six years old. Then changing your child’s diet and exercise habits can be a primary step in treating Paediatric hypertension.

Medications for Paediatric Hypertension

A paediatrician will likely recommend the following medicines to control high blood pressure in children:

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors are generally well-tolerated and effective. Some commonly prescribed ACE inhibitors for Paediatric hypertension include:

• Enalapril
• Lisinopril
• Ramipril
• Captopril
• Perindopril

Angiotensin receptor blockers (ARBs)

ARBs are also prescribed for children over six years. ARBs help block the action of angiotensin II, a hormone that narrows blood vessels and increases blood pressure. Some commonly prescribed ARBs for Paediatric hypertension include:

• Losartan
• Valsartan
• Irbesartan
• Olmesartan
• Candesartan

Calcium channel blockers

Calcium channel blockers help relax the blood vessels and lower blood pressure in children. Some commonly prescribed calcium channel blockers for Paediatric hypertension include:

• Amlodipine
• Nifedipine
• Diltiazem
• Verapamil

Diuretics

Diuretics help excrete salt and water from the body, reducing blood volume and lowering blood pressure. Some commonly prescribed diuretics for Paediatric hypertension include:

• Hydrochlorothiazide
• Furosemide
• Spironolactone
• Chlorthalidone
• Bumetanide

It is important to note that the medications prescribed to treat high blood pressure in children depend on their age and medical history.

What can parents do to manage Paediatric Hypertension?

Paediatric Hypertension treatment requires proper management and monitoring. If your child is at risk of developing Hypertension or you notice the above symptoms in your child. Then a proper diagnosis should be conducted with the help of a doctor. Here are some steps that you as a parent can take to help manage their condition:

• Follow the treatment plan: Ensure your child follows the recommended treatment plan, including any prescribed medications and lifestyle changes.
• Healthy diet: Encourage your child to adopt a healthy diet low in salt and fat. It can help to reduce blood pressure and promote overall health.
• Regular exercise: Encourage your child to be physically active regularly. Physical activity can help to reduce blood pressure and improve overall health.
• Monitor blood pressure: Regular blood pressure monitoring is essential to ensure that the treatment plan is effective. Your doctor will advise you on how often your child’s blood pressure should be checked.
• Avoid risk factors: Help your child avoid known risk factors for Hypertension, such as excessive weight, a sedentary lifestyle, and tobacco and alcohol use.

With the proper Paediatric Hypertension treatment and support, most children with Hypertension can lead healthy and active lives. Your child needs emotional support and encouragement to overcome the condition. You should work closely with your child’s healthcare provider to develop an appropriate management plan for your child’s needs.

Disclaimer: The information given in this article is true to our best knowledge. Still, we recommend you consult your doctor first if you notice the signs of high blood pressure in your child.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096568/
2. https://pubmed.ncbi.nlm.nih.gov/33796994/
3. https://pubmed.ncbi.nlm.nih.gov/28827377/
4. https://www.indianPaediatrics.net/feb2007/feb-103-121.htm