Have you noticed that many diseases have become younger, such as hypertension? Previously, it was thought that hypertension was the preserve of the middle-aged and elderly, but now many children are being diagnosed with “hypertension”, which is called “childhood and adolescent hypertension”.
In fact, a survey shows that the prevalence of hypertension in children worldwide is on the rise, and the reported prevalence varies from place to place due to differences in geography, race, diagnostic criteria, measuring devices, measurement methods and study subjects.
The prevalence of hypertension in children is also found to be on the rise in China. The prevalence of hypertension gradually increases with the age of children, and the prevalence of hypertension is higher in overweight and obese children, and the prevalence is higher in boys than in girls, and the prevalence is higher in the northern regions than in the southern regions, and there is a growing trend year by year.
1.How to detect hypertension in children and adolescents as early as possible?
First of all, there is a family history of hypertension in children and adolescents, and secondary causes are common.
The symptoms of manifestation are mostly atypical, often found during physical examination, and the clinical manifestation is different from that of adults. Some children may have no symptoms, and some also show headache, but the specificity is not strong, and they may even be mistaken for other systemic diseases.
However, if the child has these manifestations: such as developmental delay, nausea, vomiting, easily agitated and angry, not lively, visual impairment, etc., parents should pay attention and should go to the hospital for clear diagnosis and treatment in time.
2.What are the dangers of hypertension in children and adolescents?
As children and adolescents with hypertension usually show mild to moderate elevation of blood pressure, no self-perception and symptoms, generally not easy to detect, so it is easy to develop into adult hypertension, causing a variety of target organ damage, and seriously affect the growth and development of children and adolescents.
The most common target organ damage in children with hypertension is left ventricular hypertrophy, and the higher the child’s obesity and blood pressure level, the more severe the left ventricular remodeling.
Atherosclerosis
Atherosclerosis, another common target organ damage in children with hypertension.
Ambulatory blood pressure monitoring and pulse wave velocity testing and noninvasive vascular testing in children and adolescents with elevated blood pressure reveal the presence of large artery endothelial dysfunction and increased carotid artery intima and intima-media thickness.
In addition, cognitive dysfunction is a common complication of hypertension in children and adolescents.
In short, as reminded earlier, parents should pay more attention to their children, find “abnormalities” as early as possible and see a doctor as soon as possible, and once diagnosed, actively treat them according to the doctor’s recommendations.
3.Measurement and diagnostic evaluation of blood pressure in children and adolescents
In order to avoid the adverse effects of hypertension on children, parents and doctors need to be aware of the diagnostic and evaluation criteria for hypertension in children and adolescents, so that early diagnosis can be followed by timely treatment.
However, accurate measurement of blood pressure in children and adolescents is a prerequisite to confirm the diagnosis of hypertension. Compared with adults, there are more factors affecting the measurement of blood pressure in children and adolescents, so it is very important to choose the correct measurement method and avoid the influence of interfering factors.
The standard blood pressure data for children and adolescents are based on the results of the auscultation method, and the oscillometric blood pressure monitor can be used for blood pressure screening of children and adolescents.
Blood Pressure Monitoring
How can high blood pressure in children and adolescents be detected early?
Doctors recommend that children and adolescents over the age of 3 years (including 3 years) should have their blood pressure monitored during annual physical examinations, and that children and adolescents with risk factors for hypertension should have their blood pressure measured at each visit; other healthy children and adolescents should have their blood pressure measured once a year.
Children under 3 years of age who are at risk of developing hypertension, such as premature birth, low birth mass infants, other neonatal complications requiring intensive care, and congenital heart disease, need to have their blood pressure measured at each health checkup.
Because children are growing and developing, blood pressure varies somewhat between ages, and there is no absolute dividing line between normal blood pressure and hypertension, the diagnostic criteria for hypertension in children vary greatly worldwide.
The following diagnostic criteria have been adopted successively by various countries.
– Simple practical criteria: ≥120/80 mmHg in school-age children (6-13 years old) and ≥140/90 mmHg above 13 years old.
– WHO criteria: ≥135/85 mmHg for children under 13 years of age and ≥140/90 mmHg for those 13 years and older.
– Mean±standard deviation method: exceeding 2 standard deviations above the mean value of the same age and sex children and adolescents group was considered as hypertension (domestic).
– Diagnostic criteria using percentile values as cut-off points: that is, the 90th, 95th, and 99th percentile values of blood pressure cohort data of children and adolescents of the same sex, same age group, and similar height in the reference population, i.e., P90, P95, and P99 as cut-off points, with blood pressure values ≤P90 as normal blood pressure, >P90 blood pressure values ≤P95 as high blood pressure, >P95 blood pressure values ≤P99 as hypertension, and blood pressure values > P99 is severe hypertension (stage II).
In addition, the diagnosis of hypertension in children and adolescents requires attention to the assessment of.
– Assess the authenticity of blood pressure levels and perform hypertension grading.
– Identify the primary and secondary causes of hypertension.
– Detect and assess target organ damage and its extent.
– Assess the presence of other comorbidities such as diabetes mellitus.
4. Once a child is diagnosed with childhood and adolescent hypertension, how should he or she be treated?
The overall goal of treatment for hypertension in children and adolescents is to control blood pressure levels.
This will not only reduce the risk of target organ damage in childhood and adolescence, but also reduce the risk of hypertension and its associated cardiovascular disease in adulthood.
The first recommendation is to use lifestyle interventions to lower blood pressure.
For example, the diet should include more fruits, vegetables, low-fat dairy products, whole grains, fish, poultry, nuts and lean meats, and limit the intake of sugar and desserts and sodium.
Physical activity and increased physical activity should also be encouraged in children with hypertension, but in children with left ventricular hypertrophy and/or grade 2 hypertension, however, the child’s participation in competitive sports and/or high-intensity training should be limited.
Increasing physical activity
Second, treatment should be initiated with a single medication for persistent or symptomatic hypertension that is ineffective with lifestyle interventions, grade 2 hypertension without clear modifiable factors (e.g., obesity) or chronic kidney disease, or hypertension (regardless of grade) that accompanies diabetes treatment. Preferred medications include angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers (CCB), or thiazide diuretics.
In pediatric adolescents with comorbid chronic kidney disease, proteinuria, or diabetes mellitus, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are recommended first, unless absolutely contraindicated.
Other antihypertensive agents may be considered for children with hypertension in whom 2 or more recommended medications are ineffective.
References
[1]Expert Committee on Hypertension of the Professional Committee on Prevention and Rehabilitation of Cardiovascular Diseases in Integrative Chinese and Western Medicine of the Chinese Association for the Promotion of Traditional Chinese Medicine Research, Beijing Hypertension Prevention Association, Chinese Hypertension Alliance, Center for Vascular Health Research, Peking University School of Medicine. Expert advice on the key points of clinical diagnosis and treatment of special types of hypertension. China General Medicine. 2020;23(10):1202-1228.
[2] Qin YS. Overview of research on hypertension in children and adolescents[J]. China Clinical New Medicine,2016,9(9):837-841.
[3]Geng X. Characteristics of hypertension in children and adolescents and nursing interventions[J]. Medical Information,2013(27):376-376.