“How to treat a child with high blood pressure?”
My 12 year old daughter has high blood pressure and I don't understand it. I didn't even know children could have high blood pressure. How to treat a child with high blood pressure?
4 Answers
Children can have high blood pressure. There might be a cause that needs to be found. There are medicines to control it, but different ones work better for each person than others. Needs to be followed regularly.
That young you need to make sure kidneys and heart are normal You need to decrease salty foods and make sure she gets plenty of exercise. If she is overweight, she needs to cut back on calories. If it is still high, She may need medication.
Correction: high blood pressure new limits are 130/80.
Unfortunately, high blood pressure is no longer a disease of older people. Owing to lifestyle choices and high salt intake, the age of onset of the most common form of high blood pressure, also known as primary hypertension, is decreasing. We witness an unprecedented increase among children and adolescents.
First and foremost, and before worrying about causes and treatment, it should be shown that your daughter truly has high blood pressure. We are aware of a condition called white coat hypertension, which just means that your blood pressure may be high when you see a doctor. This is no true hypertension but rather a response to the sometimes anxiety provoking situation in a doctor's office and does not need any treatment. The diagnosis of white coat hypertension is made by 24-hour ambulatory blood pressure monitoring (ABPM). Unfortunately, this test is not widely available and a referral to a paediatric nephrologist may be necessary. Moreover, at least in most provinces of Canada, the government does not reimburse ABPM and sometimes physicians charge about $80 per test. This is unfortunate, however, it is really important to identify this condition as white coat hypertension can only be identified with this test and unnecessary treatment can be avoided.
The test is done through a device that measures the blood pressure every 15 minutes during the awake time and every 30 minutes during sleep and records this information which can later be downloaded into a computer. Based on gender and height specific reference intervals, the nephrologist or cardiologist interpreting the test can determine how much of the blood pressure is over the wake and sleep limits. The proportion of blood pressure over the limit is called blood pressure load. If more than 40% of the measurements are over the limits, there probably is hypertension. An ultrasound of the heart and an eye exam should follow to look for end-organ damage. If there is thickening of the left chamber of the heart or hypertension changes in the background of the eyes, the high blood pressure has likely existed for months. In those cases, treatment is indicated as high blood pressure is a silent killer which may lead to heart attacks and strokes and shorter life expectancy.
High blood pressure can occur at all ages, even in newborn, but it is rare in children compared to adults over the age of 40. In adults, most of the hypertension is lifestyle associated, especially due to the sugary drinks and high salt intake as well as obesity. In children and adolescents, a full workup is required. There are many different reasons and the workup may involve a cardiologist and a nephrologist. Narrowing in the aortic arch is one possible reason, or narrowing in the blood vessels of the kidney. It would be beyond the scope of this website to list all reasons, but some are weird and wonderful such as high blood pressure caused by black liquorice. In very few individuals with certain genetic conditions, consumption of liquorice can lead to dangerously high blood pressure and dangerously low potassium levels. (hypokalemia). However, all these rare conditions are not increasing, whereas the lifestyle associated high blood pressure now is seen more and more often in adolescents and even in younger children. Your cardiologist or nephrologist will choose lifestyle intervention and appropriate medications depending on the cause of the hypertension. Sometimes dietary changes, weight loss and exercise may suffice. It also depends on the severity of the elevated blood pressure or the stage of hypertension. I trust that your paediatrician has made the appropriate referrals to work up the high blood pressure of your daughter.
First and foremost, and before worrying about causes and treatment, it should be shown that your daughter truly has high blood pressure. We are aware of a condition called white coat hypertension, which just means that your blood pressure may be high when you see a doctor. This is no true hypertension but rather a response to the sometimes anxiety provoking situation in a doctor's office and does not need any treatment. The diagnosis of white coat hypertension is made by 24-hour ambulatory blood pressure monitoring (ABPM). Unfortunately, this test is not widely available and a referral to a paediatric nephrologist may be necessary. Moreover, at least in most provinces of Canada, the government does not reimburse ABPM and sometimes physicians charge about $80 per test. This is unfortunate, however, it is really important to identify this condition as white coat hypertension can only be identified with this test and unnecessary treatment can be avoided.
The test is done through a device that measures the blood pressure every 15 minutes during the awake time and every 30 minutes during sleep and records this information which can later be downloaded into a computer. Based on gender and height specific reference intervals, the nephrologist or cardiologist interpreting the test can determine how much of the blood pressure is over the wake and sleep limits. The proportion of blood pressure over the limit is called blood pressure load. If more than 40% of the measurements are over the limits, there probably is hypertension. An ultrasound of the heart and an eye exam should follow to look for end-organ damage. If there is thickening of the left chamber of the heart or hypertension changes in the background of the eyes, the high blood pressure has likely existed for months. In those cases, treatment is indicated as high blood pressure is a silent killer which may lead to heart attacks and strokes and shorter life expectancy.
High blood pressure can occur at all ages, even in newborn, but it is rare in children compared to adults over the age of 40. In adults, most of the hypertension is lifestyle associated, especially due to the sugary drinks and high salt intake as well as obesity. In children and adolescents, a full workup is required. There are many different reasons and the workup may involve a cardiologist and a nephrologist. Narrowing in the aortic arch is one possible reason, or narrowing in the blood vessels of the kidney. It would be beyond the scope of this website to list all reasons, but some are weird and wonderful such as high blood pressure caused by black liquorice. In very few individuals with certain genetic conditions, consumption of liquorice can lead to dangerously high blood pressure and dangerously low potassium levels. (hypokalemia). However, all these rare conditions are not increasing, whereas the lifestyle associated high blood pressure now is seen more and more often in adolescents and even in younger children. Your cardiologist or nephrologist will choose lifestyle intervention and appropriate medications depending on the cause of the hypertension. Sometimes dietary changes, weight loss and exercise may suffice. It also depends on the severity of the elevated blood pressure or the stage of hypertension. I trust that your paediatrician has made the appropriate referrals to work up the high blood pressure of your daughter.
