High blood pressure and children: Early treatment offers hope

High blood pressure (hypertension) in childhood sets the stage for a lifetime of serious health problems. If your child has high blood pressure, healthy lifestyle changes may be the key to better health. And the earlier your child adopts healthier habits, the more likely the habits will take hold — and prevent future chronic health problems. In some cases, medication to control blood pressure is needed as well.

What causes high blood pressure in children?

High blood pressure in younger children is often related to secondary or reversible factors such as heart or kidney disease or adrenal gland disorders. In older children — especially those who are overweight — the precise cause of high blood pressure is often unknown.

What are the categories of blood pressure in children?

A blood pressure reading has two numbers. The first, or upper, number measures the pressure in your child's arteries when his or her heart beats (systolic pressure). The second, or lower, number measures the pressure in your child's arteries between beats (diastolic pressure). Normally, blood pressure readings in children vary based on sex, age and height. The readings are classified by percentile, much the way height and weight are charted in relation to average percentiles.

*Percentiles are based on your child's sex, age and height.

How is high blood pressure in children treated?

High blood pressure is treated similarly in children and adults, typically starting with lifestyle changes.

• Weight control. If your child is overweight, losing the excess pounds or maintaining the same weight as he or she gets taller can lower blood pressure. Rather than singling out your child, focus on healthy lifestyle choices for the whole family.
• Healthy diet. Encourage your child to eat a healthy breakfast. Provide plenty of fresh fruits and vegetables. Trade white bread, rice and pasta for whole-wheat varieties. Limit the amount of sodium in your child's diet. Don't keep sugary snacks or drinks in the house.
• Physical activity. Most children need at least 30 to 60 minutes of physical activity a day. To promote physical activity, limit your child's time in front of the television or computer — no television before age 2, and no more than two hours of "screen time" a day after age 2. Set a good example by joining in the fun. Ride your bikes together, play catch or walk to the park.

What about medication?

As is true for many adults, some children have trouble committing to lifestyle changes significant enough to make a difference in their blood pressure — especially since the most effective changes require commitment from the child's entire family. For a few, successful lifestyle changes don't control high blood pressure adequately.

Enter blood pressure medication, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers and diuretics. Some blood pressure medications relax blood vessels. Others slow the nerve impulses that travel through the heart or rid the body of excess sodium and fluid.

Your child's doctor may want to give lifestyle changes enough time to take effect before recommending medication. Often medication can be postponed for several months. But some children need medication sooner, including those who have:

• Other medical conditions, such as diabetes, heart disease or kidney disease
• Severe high blood pressure
• Complications related to high blood pressure

How long is medication needed?

Each child's need for blood pressure medication is unique. If a child's high blood pressure is caused by obesity, losing excess weight may eliminate the need for medication. In other cases, treating any underlying conditions effectively controls blood pressure. Other children may need blood pressure medication indefinitely.

What risks do blood pressure medications pose for children?

Although little is known about the long-term effects of blood pressure medication on a child's growth and development, research supports the safety of these medications during childhood. Depending on the specific drug, various side effects are possible, including dry mouth, dizziness and fluid retention.

In fact, resistance to taking medication is often the most troubling aspect of treating high blood pressure in children. With some high blood pressure medications, the risks of stopping and starting the medication erratically may be far greater than any risks associated with taking the medication consistently over the long term. And without medication, a child's blood pressure may not be well controlled.

What does the future hold for a child with high blood pressure?

If blood pressure is elevated when your child is young, the odds are quite high that it'll be elevated in adulthood — putting your child at risk of potentially life-threatening conditions, such as stroke, heart failure and kidney disease. But if it's caught early and controlled, your child can enjoy a lifetime of good health.