An alarming 74% of kids and teens
with high blood pressure aren't diagnosed, finds a study
in the August 22/29 issue of JAMA. Pediatric
hypertension, largely blamed on weight problems, can
pave the way for future health problems, including end-organ
damage. The finding is a troubling warning for Canada's
half-million overweight kids.
The US study looked at over 14,000
children and teens, and found some 500 with high blood
pressure. Their doctors were checking their blood pressure
during routine visits — as recommended by the American
Academy of Pediatrics — but only a quarter of the
500 HBP youths had been flagged as hypertensive.
"The problem with hypertension
is that it's nothing you can tell just by looking at
a child," says lead author Dr David Kaelber, a pediatrician
at Harvard Medical School. "They're not going to come
in with chest pains or headaches like an adult patient.
It's a silent and invisible disease." And so it flies
under the doc's radar.
TROUBLE
AHEAD
The fact that kids aren't likely to die from a heart
attack or kidney failure shouldn't lull physicians into
a false sense of security, Dr Kaelber warns. "The fear
is that it could actually be many decades before their
hypertension is diagnosed and properly treated, and
by then it's already done damage to their organs," he
says. Kids with high blood pressure grow into adults
with high blood pressure. They're also at risk of CVD,
kidney damage and atherosclerosis among other conditions.
So why aren't docs picking up on
the clues?
There's no easy answer, says Dr
Kaelber. "There are lots of abnormal ranges of blood
pressure for children," he says. "They're based on gender,
height and age. Even I can't remember all those values,
and I'm a board-certified pediatrician." Unlike adult
blood pressure, with its four manageable ranges of normal
and abnormal values, the ranges for kids and teens come
in a long chart, which docs are supposed to look up.
Most don't.
But that's not all. It takes three
abnormal readings for a kid to be properly labelled
as hypertensive. That means followup visits. "If I see
a child for a routine check-up and find that his blood
pressure is high, then I would see that child again
in several weeks to a month at the most and take another
reading," says Dr Kaelber. Kids and teens who are hypertensive
or even pre-hypertensive — those with borderline
high values — should be closely monitored until
their blood pressure is brought back under control.
Trouble is, the kids weren't getting the diagnosis in
the first place.
THE
FLAGGED FEW
But a quarter of the youths in the study did get their
diagnosis. And there seemed to be a trend as to why
they got flagged but others didn't. "Older and taller
kids were more likely to have their hypertension detected,"
says Dr Kaelber. The more adult-like the child is, the
closer the blood pressure range gets to that 120/80
adult normal value, which makes deviations easier for
a doctor to recognize.
An obvious weight problem also
increased a youth's chance of being diagnosed. "If the
child was overweight, and the doctor had figured that
out — which is not always as easy as it sounds
— then their hypertension was more likely to be
diagnosed," says Dr Kaelber. But studies have shown
that kids who are only a little overweight often escape
detection.
HOW
TO TREAT
Detecting high blood pressure early is vital in more
ways than one. "Sometimes, there are whole other medical
problems that may be causing the high blood pressure,"
says Dr Kaelber. "If you can figure out what the disease
is and treat it, then you've spared your patient future
complications."
Most kids will end up with primary
hypertension — the kind that's more likely lifestyle-related.
"For those young patients, the treatment starts with
lifestyle changes, like exercising more, eating healthy
and eating less salt for example," says Dr Kaelber.
The aim is to reduce their weight and for those teens
who smoke, it's important to get them to stop, he adds.
"If all of those things don't work within three to six
months, then you move on to medication, same as for
adults but with a different dosage." For more on how
to get kids to adopt more active lifestyles, see "Inactive
kids dance away the pounds" on page 14.
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