Hypertension in children
Blood pressure is the force of blood that acts on the walls of arteries when blood flows throughout the body. Forcing capacity of the heart at the same time are the main link in the creation of blood pressure. A certain amount of blood pressure is extremely necessary to make the blood flow properly in all parts of the body.
Blood pressure is an important marker of human health and is determined first of all, along with temperature and heart rate.
Blood pressure changes throughout the day. The lowest rate is determined in the morning, and during the day it gradually rises. Anxiety, anxiety and physical exertion can also contribute to a change (increase or decrease) in blood pressure.
Video: What is Hypertension? High Blood Pressure explained for children - Ask Dr.Smarty
Key indicators of blood pressure
There are two numbers for measuring blood pressure, and both are important:
- The top number is systolic blood pressure . It shows how much blood hits the artery wall while the heart is contracting.
- The lower index is diastolic blood pressure . It shows how much blood hits the artery wall during the period of relaxation of the heart between beats.
Principles of blood pressure measurement
To check the level of blood pressure, a cuff is put on the arm. It is different in width, therefore it is selected in accordance with the child's age:
- Up to 12 months - cuff width 3.5-7 cm.
- Up to 24 months - 4.5-9 cm.
- Up to 4 years old - 5.5-11 cm.
- Up to 7 years old - 6.5-13 cm.
- Up to 10 years - 8.5-15 cm.
At the age of 10 years and older, standard blood pressure cuffs are used, that is, as in adults.
It is important that the cuff is properly positioned - on the shoulder, most often of the right hand. Sometimes for comparison, blood pressure is determined in turn on two hands.
A stethoscope is placed under the cuff, above the artery in the area of the elbow bend. Next, air is pumped into the cuff, so that it begins to squeeze the arm. Then the air is slowly released. Sounds begin to be heard through the stethoscope when blood flows through constricted arteries.
- The very first audible sound is upper, or systolic, blood pressure.
- The last sound to be heard on the background of the expansion of the artery - is diastolic blood pressure.
Some devices for measuring blood pressure can determine these measurements automatically without the need to listen with a stethoscope.
Normal blood pressure in children
Since blood pressure can be affected by various causes such as anxiety, time of day, and other daily factors, blood pressure should be measured several times a day.
Blood pressure in children depends on three factors: age, sex, and height / weight of the child. Also, the definition of blood pressure after physical or emotional stress will lead to increased performance.
Normal blood pressure in children of different ages
|Age l||Girls||The boys|
|one||104/58 - 105/59||103/56 - 104/58|
|6||111/74 - 113/74||114/74 - 115/75|
|12||123/80 - 124/81||123/81 - 125/82|
|17||129/84 - 130/85||136/87 - 138/87|
If there are discrepancies between the systolic and diastolic pressures, the condition of the child is considered to be in accordance with a higher value.
Video: Children with Hypertension
Causes of arterial hypertension in children
Hypertension can be primary (i.e., idiopathic) or secondary. In general, the younger the child and the higher the blood pressure (BP), the higher the likelihood that hypertension is secondary to the identifiable cause.
The most common cause of high blood pressure is a hereditary (genetic) form, known as primary hypertension. This explains most cases of hypertension in adults and children. The cause of primary hypertension is unknown. Children and adolescents with primary hypertension are often overweight. However, in an obese child, hyperinsulinemia may increase blood pressure by increasing sodium reabsorption and sympathetic tone.
The remaining high blood pressure cases are related to the main cause, which may be:
- Kidney problems.
- Narrowing of the arteries in the kidneys.
- Congenital defect of the heart, such as coarctation of the aorta.
- Rare tumoral diseases of the adrenal glands.
When there is another problem that causes high blood pressure, then they also talk about secondary hypertension.
|1-6 years||7-12 years old|
Renal artery thrombosis or vein
Congenital renal anomalies
Coarctation of the aorta
Renal artery stenosis
Renal parenchymal disease
Coarctation of the aorta
Renal parenchymal disease
Renal parenchymal disease
A review of the literature showed that most children with secondary hypertension had a renal parenchymal anomaly. In other cases, the causes of hypertension (in order of frequency) were renal artery stenosis, aortic coarctation, pheochromocytoma, and a number of other conditions. [1 - Gavrilovici C; Boiculese LV; Brumariu O; Rev Med Chir Soc Nat Iasi. 2007; 111 (1): 70-81]
Symptoms of hypertension in children
Hypertension is known as a silent killer, because it usually has no signs or symptoms. Most children with hypertension feel good, and their parents or other adults who care for them do not know that their blood pressure is high.
When hypertension is severe or very severe, symptoms may include the following:
- Loss of consciousness.
- Impaired renal function.
In the later stages, seizures may occur, which is why many serious risks are associated with hypertension, both for the health of the patient and his life.
Video: What causes high blood pressure in children?
Hypertension in children: treatment
When determining a child with high blood pressure, it is important to re-measure it. If blood pressure remains high, it is recommended to do the following:
- Normalize weight when overweight with diet and exercise suitable for children with excessive weight
- Cut the salt in the diet.
Usually, modern users consume between 5,000 and 8,000 mg of sodium per day. If blood pressure is high, it is best to reduce salt intake to 2,000–3,000 mg / day. When it is worth remembering that a teaspoon contains 2196 mg of sodium.The main sources of sodium in the human diet are:
- Adding salt to food during cooking and at the table.
- Add sodium to food during processing (hidden salt).
- Sodium, which is naturally found in food and water.
To reduce the sodium content in the diet, you need to remove the salt shaker from the table and do not add it (or in a small amount) during cooking. Herbs and spices can be a tasty alternative. In addition, you need to limit the amount of processed foods that are used in the daily diet.
Processed meats, bacon, sausage, cheese, prepared foods and most canned foods have a high sodium content. Many snacks, including crackers, chips and pastries, also contain large amounts of sodium.
Some sodium is found in foods such as meat, poultry, seafood, and dairy products, as well as a minimal amount in fresh vegetables and fruits. Such products should not be limited.
It is important to look at the labels! We must try to balance the sodium in food and snacks. When eating outside the house should avoid sauces, and also it is advisable to ask to cook food without salt.
Some restaurants, including those with Asian and Mexican cuisine, offer especially a lot of sodium, but they usually change their food according to their preferences.
Avoid smoking, excessive use of caffeine and alcohol. These recommendations should be followed primarily by adolescents at risk. If necessary, other lifestyle changes are used that can help reduce blood pressure.
When the recommendations listed do not help or if blood pressure is measured in the range of moderate to severe, antihypertensive drugs can be used.
It is used in the case when the correction of nutrition and lifestyle did not give the desired results. The basic principles of the treatment of hypertension in children:
- First, prescribe drugs in a low dose, which, if necessary, increase every 2-4 weeks until reaching the target blood pressure.
- The second medication is prescribed if the blood pressure has not decreased to the desired level, despite the maximum dose of the first medication.
The following drugs have been approved for the treatment of hypertension in children by the FDA:
- ACE inhibitors (suitable for children 6 years and older, unless otherwise indicated)
The most commonly used captopril , which is assigned to babies every 6 hours, and older children every 8 hours. Also can be used lisinopril, benazepril (lozenzin), enalapril (Vasotec), fosinopril (monopril), ramipril.
- Angiotensin receptor blockers (suitable for children 6 years and older, unless otherwise indicated)
Lozartan, irbesartan (avapro), valsartan (diovan), olmesartan, candesartan are often used.
- Calcium channel blockers
The main representative of this group is amlodipine , which is prescribed in the appropriate dosage for children 1-5 years of age and older than 6 years. Additionally, if necessary, felodipine, nifedipine XR is used.
- Beta blockers (suitable for children 6 years and older)
They relate to second-line drugs, except that there are other indications (for example, prevention of migraine). In most cases, propranolol, metoprolol XL is used.
- Thiazide diuretics
Used in combination with other drugs. Hydrochlorothiazide, chlorthalidone may be given.
Additionally, depending on the evidence, clonidine (catapres) can be used, most often between the ages of 12 years and older.
Consequences of hypertension
High blood pressure increases the load on the heart, as it must push the blood through the blood vessels more strongly due to high pressure. When the heart needs to work harder, the pumping chamber (left ventricle) may begin to grow and thicken.
- If high blood pressure continues to go unnoticed or there is no treatment, the left side of the heart may gradually increase, that is, left ventricular hypertrophy develops. This is one of the risk factors for coronary heart disease and possibly a heart attack.
- Untreated hypertension can also damage the arteries in the kidneys, causing them to narrow and reduce the blood supply to the kidneys. As a result, this paired organ cannot function normally, which can lead to renal failure.
- Uncontrolled high blood pressure over time can also damage the arteries that deliver blood to the brain. Prolonged high blood pressure causes weakening of the walls of blood vessels and even their rupture, and this leads to hemorrhage in the brain tissue (stroke) . Sometimes the arteries narrow or block completely. In this case, the blood can not get into the brain, which contributes to the development of another type of stroke.
- Uncontrolled high blood pressure can also damage the eyes, causing the arteries to shrink and deform, thereby blocking the blood supply. Ultimately, this can lead to vision problems.
It is important to remember that heart attacks, kidney failure, and strokes from hypertension are rare in children and adolescents. However, the processes that lead to these problems are likely to begin in childhood. That is why children and adolescents should monitor their blood pressure with regular visits to the doctor.
Children usually do not suffer from life-threatening cardiovascular complications arising from high blood pressure. The negative effects of hypertension usually develop over many years. Detection of the disease at an early stage allows doctors to find suitable ways to solve this problem and reduce blood pressure.
Video: Mayo Clinic Minute: Kids with high blood pressure