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300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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Clinical Services (Preventive Cardiology Clinic):
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High Blood Pressure (Hypertension)
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Most people do not realize that high blood pressure, an epidemic problem affecting more than 50 million adults in the United States, can affect children. In fact, it is believed that in many cases, high blood pressure in adults has its roots in childhood. Although in the past high blood pressure has been uncommon in children, steady increases in rates of childhood obesity (which can elevate blood pressure) means more kids are at risk for high blood pressure.
High blood pressure is a dangerous condition that in adults is a major risk factor for heart attack and stroke. If your child has high blood pressure, an early intervention program offered by the Preventive Cardiology Clinic may help prevent heart disease in the future.
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Blood pressure is the pressure exerted on your blood vessel walls. Hypertension is a medical term used to describe blood pressure that is elevated above a predetermined normal range of pressure. Over time, high blood pressure can damage blood vessels and vital organs such as the kidneys, brain and heart.
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The majority of adolescents and children over 6 years of age with hypertension have a family history of hypertension and/or are overweight. Some children have underlying medical conditions causing hypertension, such as kidney diseases, disorders of the endocrine system or blood vessel abnormalities. In children with underlying causes of high blood pressure, 8-10 percent have problems in the arteries and veins that supply the kidney. These problems, and congenital abnormalities of the kidney, are more common causes of hypertension in infants.
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Most people are familiar with the blood pressure cuff and stethoscope that physicians and nurses use to measure blood pressure. Blood pressure exams are routinely administered during visits to the doctor. But many do not fully understand what the measurement means.
Blood pressure is measured in millimeters of mercury (mm Hg) on a sphygmomanometer. When a health professional places the cuff around your arm and inflates it, the main artery in your upper arm (the brachial artery) is compressed, which means that the artery walls are closed. With the artery compressed, no sound is heard through the stethoscope placed over the artery. As air is released from the cuff, a thump will be heard. At that moment, the health professional records the number on the sphygmomanometer.
This number represents the systolic pressure, or pressure exerted with a heartbeat. Systolic pressure is the top number in a blood pressure reading. When the sounds disappear, the diastolic pressure, or pressure exerted as the heart rests, is recorded. Diastolic pressure is the bottom number in a blood pressure reading.
Blood pressure can be measured by several different methods, including an automated method. This is more convenient, but may be less accurate and may over estimate true blood pressure. If the readings are high, your doctor may recheck your blood pressure using the sphygmomanometer.
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If high blood pressure is suspected after a single measurement is obtained, other measurements must be taken on three separate occasions before a diagnosis of hypertension can be made. That is because blood pressure constantly fluctuats. It changes along with activity level, temperature, medications, emotions and stress. While there is a single accepted normal range for blood pressure for adults, the range of normal varies in children based on several factors. Hypertension in children is therefore defined as blood pressure greater than the 95th percentile for age, gender and height measurements.
In general, children with blood pressure between the 90-95th percentile are classified as having "pre-hypertension," which means they are at risk for developing hypertension as they get older. Adolescents with blood pressure above 120/80 mm Hg also are considered to have pre-hypertension.
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If your child has hypertension, the Preventative Cardiology team will develop a plan for your child that involves a combination of healthy eating, exercise, medication (in some cases) and routine monitoring.
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In children who are overweight, the best way to lower blood pressure is to lose weight. This is accomplished by increasing activity and decreasing caloric intake. The staff at the Preventive Cardiology Clinic realizes these kinds of changes are difficult to make and will work with you and your child reach the appropriate weight loss goals.
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Regular physical activity is just as important as healthy eating for obtaining a healthy weight and healthy life. A common misconception among parents of children with hypertension is that exercise should be restricted. In fact, regular physical activity may actually lower blood pressure, particularly in individuals who are overweight.
In addition, regular exercise helps burn fat, lowers LDL cholesterol and lowers triglycerides. Ultimately it reduces the risk of heart disease and some cancers. As part of a plan to lower blood pressure, the Preventive Cardiology Clinic staff will help you and your child with an exercise schedule that involves at least 30-60 minutes of vigorous aerobic exercise at least five days a week. In some cases, your doctors may recommend your child avoid lifting of free weights.
Exercise that meet this criteria can include organized sports or participation in other organized activities that promote exercise, such as dance, gymnastics or ice skating Some children may prefer to exercise on a treadmill or exercise bicycle in front of the television.
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Several studies have found that in adults, high blood pressure can be reduced by incorporating an eating plan called Dietary Approaches to Stop Hypertension. This is a heart healthy diet rich in fruits, vegetables, low fat dairy products and reduced saturated fat intake.
The same studies found that reducing sodium intake contributed to lowering blood pressure readings. At the Preventive Cardiology Clinic, you will be counseled in ways to incorporate this eating plan into your child's lifestyle, and will be encouraged to have your whole family adopt healthy eating measures.
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The following are tips for a heart healthy diet that will help to lower your child's overall cardiovascular risk:
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- Lower salt intake - Diets that contain no more than 1.2 grams of salt for 4-8 year olds, and 1.5 grams of salt per day for older children, may help to decrease blood pressure. Most children take in much more than this on a regular basis. Foods that are highly processed often contain large amounts of salt. Children with hypertension should also follow general recommendations for a heart healthy diet, such as the DASH diet.
- Lower saturated fat intake - Saturated fats (unhealthy fat that comes mostly from animal products) are known to raise LDL-cholesterol levels. To help lower LDL to an acceptable range, your child should consume 12-15 grams of saturated fat per day. That means limiting consumption of animal products, such as:
red meats and pork
- whole milk dairy products
- cheeses and butter
- the skin of poultry
- coconut oil, palm oil, palm kernel oil and cocoa butter
Avoid trans-fatty acids - Trans-fatty acids are artificial fats, created by scientists who, in the early 1900s, created margarine and shortenings as a cheap alternative to butter. They did so by a process called hydrogenation, which gives polyunsaturated fats attributes of saturated fats. For instance, when a healthy vegetable oil is hydrogenated, it solidifies, like a bad fat. The Institute of Medicine has deemed trans-fatty acids worse than saturated fats. The IOM found that, unlike LDL cholesterol, trans-fatty acids have no health value whatsoever. In fact, in addition to increasing LDL cholesterol, trans-fatty acids decrease HDL levels. Unfortunately, trans-fatty acids are found in many packaged snacks, such as crackers and cookies, as well as in the oils used to cook deep-fried restaurant foods. Food manufacturers are beginning to list, and soon will be required to list, trans-fats on food labels. Until then, check ingredients on food products and look for the words "hydrogenated" or "partially-hydrogenated," and avoid these foods.
Consume good fats - You may be surprised to learn that not all fats are bad. Two kinds of "unsaturated" or good fats, known as polyunsaturated or monounsaturated fats, can help lower LDL by raising the level of HDL in your bloodstream. Sources of monounsaturated fats include fish, certain types of vegetable oils, nuts and natural nut butters, and avacado.
Lower cholesterol intake - One way to lower bad cholesterol is to lower your intake of cholesterol from food. Cholesterol intake should be reduced to less than 200 mg of cholesterol per day. The four largest sources of cholesterol in the diet are liver, egg yolks, squid (calamari) and shrimp.
Increase dietary fiber - For adults, 25-30 grams of dietary fiber are recommended each day. Children can consume less. Dietary fiber can be found in fruits, vegetables, whole grain foods, beans and legumes. The fiber in these foods refers to a part of plants that your body cannot absorb and therefore has no caloric value. Still, fiber helps your body eliminate waste by bringing water to the colon and making waste softer and easier to eliminate. Soluble fiber in oats can increased bile acid excretion and help decrease cholesterol absorption into the blood. For important information about fiber and lists of food sources, see facts about fiber.
Reduce caloric intake - Children with hypertension are sometimes overweight or obese. A weight loss plan, in and of itself, should help decrease blood pressure. Strategies for limiting calories include reducing portion sizes and removing high-calorie snacks and junk foods from the home (see how to stock a healthy kitchen). Children with elevated triglycerides are advised to decrease intake of simple sugars and refined carbohydrates such as white breads, rice and potatoes, pasta, and sweet foods.
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Medication that lowers blood pressure is sometimes prescribed for children or adolescents who:
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- have severe hypertension that is causing organ damage.
- have severe hypertension that is causing symptoms. Most children with hypertension do not have symptoms. But in some severe cases, your child may experience dizziness, headaches or light-headedness.
- have hypertension secondary to another condition, such as a kidney disease.
- are not seeing results with diet modification and exercise.
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Medications that have been shown to lower blood pressure in children include:
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- Thiazide-type Diuretics - These drugs often are the first line of treatment in adults and are highly effective. They lower blood pressure by decreasing the amount of salt and fluid in the body.
- Agiotensin Converting Enzyme (ACE) Inhibitors - These drugs are widely prescribed for adults with high blood pressure. They effectively lower blood pressure by blocking a naturally occurring substance that constricts blood vessels, therefore helping blood vessels relax and dilate.
- Beta Blockers - Beta blockers work by decreasing heart rate, decreasing the amount of blood the heart pumps out per minute and relaxing blood vessels, which in turn reduces blood pressure.
- Calcium Channel Blocker or Angiotensin Receptor Blockers (ARBs) - These drugs reduce constriction of blood vessels, which makes blood flow more smoothly. ARBs also encourage the release of sodium and water into urine, which helps lower blood pressure.
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The information on this website should not be taken as medical advice,
which can only be given to you by your personal health care professional. |
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Copyright © Children's Hospital Boston. All rights reserved. |
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