More than one million youngsters in the United States have undiagnosed high blood pressure (hypertension) leaving them at risk for developing multiple organ damage later in life. Vital organs, such as the heart, kidneys, brain and eyes may suffer chronic and progressive damage. Many people have the wrong assumption that hypertension is an adult problem. Unfortunately, more and more children are affected by high blood pressure. It has been estimated that roughly two million U.S. youngsters have hypertension. Numbers are derived partly by the rising incidence of obesity, which is strongly linked to hypertension. In addition, salt intake, especially in African Americans and older children, may worsen this condition. Processed foods, junk food and foods from restaurants usually have an excessive amount of salt. The average American diet has over 4 grams of salt per day, while an optimal salt intake should be less than 2 grams or about 1-2 teaspoonfuls per day. An ideal diet should be high in potassium and low in sodium.
Most children with hypertension are obese and there is usually a family history of hypertension and obesity. In other words, this is not an isolated problem but a “family affair.” A kidney condition is found in a much smaller percentage of children.
The ideal approach would be to see the child or adolescent and go over family history and talk about diet, exercise and other related issues, including caffeinated soft drinks and junk food with excessive salt content. A repeat evaluation by a pediatric cardiologist and/or kidney specialist may be necessary, including a detailed physical exam, to rule out possible causes for the hypertension. Blood and urine tests, an electrocardiogram and even an echocardiogram may be necessary. The echocardiogram is an ultrasound study to evaluate the heart’s anatomy, function, size and left ventricular mass. It will help determine if the heart has already been affected by the high blood pressure. At least three measurements of high blood pressure are required in order to make a diagnosis.
Untreated hypertension can cause serious health problems. There is some evidence that it might contribute to early artery and heart damage in young patients. A person must not wait until he or she has a stroke to realize that it could have been prevented.
Potential treatments include anti-hypertensive medicine, although weight loss and exercise alone may do the trick for many children. The type of medicine to be used by the pediatric cardiologist depends on several factors including age, sex, degree of hypertension, associated risk factors (such as diabetes), race, and potential side effects.
Hypertension usually can be controlled but it depends on a group effort by the family to assure compliance in taking the medication, periodic monitoring of blood pressures while under treatment and keeping follow-up appointments. Many patients remain asymptomatic and feel that they can come off medications. That is why hypertension is one of the main “silent killers” in this nation. Although patients may remain completely asymptomatic they are not aware that the major organs may be greatly affected by the persistent and uncontrolled high blood pressure.
A diet high in sodium (the main ingredient in salt) is more common in African Americans than in other ethnic groups. Many African Americans are “salt sensitive.” Therefore, limiting sodium intake is advisable (see DASH diet).
A healthier diet certainly helps. Steps to take would be cutting down on sodium, using herbs, spices and lemon juice instead of salt; eating fewer fatty meats and whole-milk products (ice cream, butter, etc), and eating more fish, fruits, vegetables, whole-grain foods and low-fat milk products.
Things to avoid: The patient should avoid energy drinks and soft drinks, caffeine, salt, being overweight, smoking, stress and recreational use of steroids (for muscle build-up).
For more information please contact the National Heart, Lung and Blood Institute at www.nhlbi.nih.gov.