Primary Pediatric Hypertension - Symptoms, Treatment, and Complications

Introduction

Increased blood pressure in childhood can be a major health risk for hypertension in the later stages of life. However, it is not definite that all children with high blood pressure will have high blood pressure as adults. Children with hypertension under the age of 13 are classified normatively or in comparison to blood pressure readings in a large group of children, as there are no outcomes data for this age group. Children under 13 have normal blood pressure ranges that differ by age, sex, and height. For children who are greater than 13 years of age, blood pressure is classified based on actual blood pressure values.

What Is Hypertension in Children?

Blood pressure that is at or above the 95th percentile for children of the same sex, age, and height is considered to be high blood pressure (hypertension) in children. Since changes in blood pressure are considered normal as children grow, there is not a straightforward target range for high blood pressure in all children. However, the definition of high blood pressure in teenagers (children of more than 13 years of age) is the same as it is in adults, which is a blood pressure reading of 130/80 millimeters of mercury or higher (mm Hg). In young children, high blood pressure is more likely to be caused by underlying medical conditions. For older children, high blood pressure can be the result of the same factors that cause hypertension in adults, like excess weight, poor nutrition, and a lack of exercise.

What Are the Types of Hypertension in Children?

There are mainly two types of hypertension:

Primary Hypertension - Primary hypertension develops on its own and has no known cause. Children aged six and older are more likely to experience the primary type of high blood pressure. The following are some risk factors for developing primary hypertension.

• Having obesity or being overweight.

• A history of high blood pressure in one's family.

• A high fasting blood sugar level or type 2 diabetes.

• A high cholesterol level.

• Consuming excessive salt.

• Being Hispanic or Black.

• Smoking (both active and passive smoking).

• Being inactive or sedentary.

Secondary Hypertension - Secondary hypertension has a known and identifiable cause, and if the cause is treated, hypertension may go away.

• Chronic kidney disease conditions.

• Polycystic kidney disorder.

• Heart disorders like excessive constriction of the aorta.

• Disorders of the adrenal glands.

• Increased thyroid function (hyperthyroidism).

• Artery stenosis, or narrowing of the kidney artery.

• Disorders of sleep, particularly obstructive sleep apnea.

• Decongestants, stimulants used to treat attention-deficit/hyperactivity disorder (ADHD), caffeine, nonsteroidal anti-inflammatory drugs (NSAIDs), and steroids are some drugs and medications that can cause secondary hypertension.

• Cocaine, Methamphetamine, and other similar drugs.

What Is the Pathophysiology of Primary Hypertension?

Like adults, the balance between vascular resistance and cardiac output (affected by myocardial contractility, heart rate, and vascular volume) determines blood pressure (affected by vascular structure and function). The sympathetic nervous system, sodium transport, the renin-angiotensin-aldosterone system, and other factors are also associated. In contrast to older adults, children, and younger adults are more likely to have hypertension due to cardiac output and volume status, but as people age, vascular structural changes with increased vessel wall thickness and stiffness (which increase vascular resistance) become more significant.

What Are the Signs and Symptoms of Primary Hypertension?

Symptoms of high blood pressure are uncommon in children. Nevertheless, the following are some warning signs and symptoms of a hypertensive crisis:

• Headaches.

• Seizures.

• Vomiting.

• Chest pain.

• An irregular, fluttering, or pounding heartbeat (palpitations).

• Breathing difficulty.

What Is the Treatment of Primary Hypertension?

Depending on the stage of hypertension, treatment for hypertension in children may involve a combination of weight loss, a healthy diet, exercise, and occasionally medication. It is best to refer children with stage 2 hypertension, stage 1 hypertension with symptoms, end-organ damage, diabetes, or renal disease to a specialist so that a more expedient and effective course of treatment can be started.

• Lifestyle Modification - Lifestyle changes include physical activities, diet modification, and weight management. Increased physical activity and healthy eating practices are the keys to weight loss in children. Lower blood pressure has been linked to diets that are higher in fruits, vegetables, legumes, low-fat dairy products, and less salt. A calorie restriction based on activity level, age, and sex should be part of any dietary changes as well. Also, limit the salt intake. Children between the ages of six and 17 should exercise for 30 to 60 minutes each day, or at least three to five days a week, in a moderate-to-vigorous manner.

• Medicinal Treatment - When lifestyle changes fail to sufficiently lower blood pressure within six months in children with high normal or borderline hypertension or stage 1 hypertension without symptoms or end-organ dysfunction, drug therapy is required. Drug therapy should typically start with a single drug at the low end of its dosing range and be increased every one to four weeks until blood pressure is under control, the upper end of the dosing range is approached, or side effects appear that impair the drug's use. If normal blood pressure has still not been reached, a second drug may be added. Drugs used for treating high blood pressure include calcium channel blockers, vasodilators, angiotensin-converting enzyme (ACE) inhibitors, etc.

What Are the Complications of Primary Hypertension?

If treatment is not started for high blood pressure in children, it is likely that they will have high blood pressure even in adulthood. The child may be at risk of the below-mentioned conditions if their high blood pressure persists into adulthood:

• Stroke.

• Heart failure.

• Kidney diseases.

• Coronary artery diseases.

Conclusion

Though there is a rising prevalence of hypertensive and prehypertensive children worldwide, pediatric hypertension remains undiagnosed. To define pediatric hypertension across all ethnic backgrounds, particularly among African-Americans and Hispanics, updated normative data on blood pressure (BP) that take ethnicity into account, in addition to age, sex, and height, are essential. The prevalence of childhood obesity has shifted the onset of metabolic syndrome to a younger age. Therefore, public health initiatives are required to lessen this burden. To assess the long-term impact of childhood obesity and dietary salt on adult cardiovascular morbidity and mortality, larger, controlled studies must be conducted. Because of the obvious theory of fetal programming of hypertension, studies evaluating the impact of interventions on complicated pregnancies and their offspring must also be reevaluated.