With the change of social environment and lifestyle, the prevalence of hypertension in children is increasing year by year. Hypertension has an insidious onset and is known as the “invisible killer” of health, and is an important risk factor for coronary heart disease, heart failure, stroke, chronic kidney disease, and peripheral vascular disease. In order to ensure the healthy growth of the next generation, the diagnosis and treatment of hypertension in children should not be delayed.
I. Measurement of blood pressure
Parents, please note that when your child reaches the age of 3, it is necessary to regularly check blood pressure every year. While it is easy and quick to use an electronic sphygmomanometer, the “gold standard” is to use a mercury sphygmomanometer and a stethoscope (steps below).
1. Have the child sit still for 5 minutes before the measurement and take a sitting position (infants and children take a supine position).
2. Prioritize the measurement of the right arm.
3. Use a special cuff that matches the circumference of the child’s arm (there is a space between the cuff and the arm for the thickness of the stethoscope head), so that the cuff is at the same height as the heart.
4. placing the stethoscope head below the bottom edge of the cuff and above the brachial artery pulsation.
5. pressing the balloon so that the pressure rises rapidly to a level of 30 mmhg after the brachial artery pulsation has disappeared
6.The cuff is slowly deflated and the reading corresponding to the first beat sound when it appears is recorded as the systolic blood pressure (SBP), the reading corresponding to the disappearance of the beat sound is recorded as the diastolic blood pressure (DBP), and if the beat sound persists, the reading corresponding to its diminution is recorded as the diastolic blood pressure.
Medication, coffee consumption, smoking (or exposure to secondhand smoke) can cause an increase in blood pressure, so please repeat the measurement or seek professional advice if you have any of these conditions. Children who are found to have high blood pressure in a medical facility can have ambulatory blood pressure monitoring under medical supervision.
II. Diagnosis of hypertension in children
1. Latest version of diagnostic criteria
The “International criteria for high blood pressure percentile (P90, P95 and P99) in children”, published in Circulation in 2016, are the common criteria for the diagnosis of hypertension in children worldwide, with a table of percentile values showing the corresponding blood pressure in children of different ages, genders and heights The table of percentile values (P50th, P90th, P95th, and P99th) is used by parents to check their child’s blood pressure level. The diagnostic criteria state that
(1) normotension: SBP/DBP < p90th.
(2) Critical hypertension: SBP/DBP ≥ P90th and < p95th (or ≥ 120 p="" 80 mmhg).
(3) first-degree hypertension: SBP/DBP ≥ P95th and < p99th +5mmhg.
(4) secondary hypertension: SBP/DBP ≥ P99th+5mmHg.
It is worth noting that a single measurement of high blood pressure cannot diagnose hypertension, and at least 3 repeated measurements on different days (interval >1 week) are required.
2.Follow-up examination
In the diagnosis of hypertension, it is not enough to measure blood pressure alone, but a series of tests are needed to perform hypertension typing and to assess the involvement of organs throughout the body.
III. Clinical typing of hypertension
Clinically, hypertension can be divided into two categories: primary hypertension and secondary hypertension. The etiology of primary hypertension is unclear and may be related to genetic and environmental factors; the etiology of secondary hypertension is clear and common causes include renal disease, endocrine diseases (such as pheochromocytoma, cortisolism, primary aldosteronism), aortic constriction, and obstructive sleep apnea hypoventilation syndrome. For targeted treatment, clinical staging of hypertension is required. Parents are asked to assist the physician in taking a medical history, recording symptoms, and completing physical and laboratory examinations for.
1. any history of maternal smoking during pregnancy, history of low birth weight, history of breastfeeding
2. any family history of hypertension, family history of kidney disease, history of urinary tract infection
3, history of medication use.
4, height and weight.
5, eating habits, sleep conditions.
6, discomfort symptoms.
7, laboratory tests: thyroid function, parathyroid hormone, plasma renin, angiotensin, aldosterone, cortisol, renal ultrasound, renal vascular ultrasound, adrenal ultrasound, aortic MRI.
Target organ damage
Long-term hypertension can cause damage to arteries, heart, kidneys, brain, retina and other organs (called target organ damage). Routine urine, renal function, biochemistry, electrolytes, electrocardiogram, chest X-ray and echocardiogram can reflect the health status of target organs and provide the basis for setting the target of blood pressure reduction.
IV. Treatment of hypertension in children
The survey shows that primary hypertension is the majority among adolescents in China, while secondary hypertension is predominant in children before puberty. Several studies have shown that the risk factors of primary hypertension in children in China are overweight and obesity, so the treatment of such hypertension is based on lifestyle changes first and drug treatment second; the treatment of secondary hypertension in children is based on the primary disease. The target of blood pressure reduction depends on the level of blood pressure and target organ involvement.
1.Target of blood pressure lowering
(1) Children with uncomplicated primary hypertension and no target organ damage should have their blood pressure reduced to below P95th.
(2) Children with secondary hypertension, target organ damage and diabetes should have their blood pressure lowered to below P90th.
2.Non-pharmacological treatment
(1) Increase the amount of exercise and overcome the bad habit of being sedentary: cultivate children’s interest in exercise, aerobic exercise (such as jogging, cycling, walking) is the best form of exercise, physical activity for at least 60 minutes a day, and sedentary duration of no more than two hours.
(2) Develop healthy eating habits: increase the intake of fruits and vegetables, reduce total fat intake, and limit high-salt and high-sugar diets.
(3) Maintain an optimistic and positive state of mind.
Medication
When 1 or more of the following conditions occur, it is necessary to start medication intervention
(1) having obvious clinical symptoms.
2.Blood pressure levels reaching grade II.
3.Secondary hypertension.
4, the presence of target organ damage.
5, combined with diabetes mellitus.
6.Ineffective after 6 months of non-pharmacological treatment.
After the physician has formulated an individualized medication regimen, parents are asked to supervise their children to take the medication as prescribed, to keep track of blood pressure changes, and to monitor and report adverse reactions.
The following table shows the blood pressure percentile cut-off values based on sex, age and height.