Number of Children Diagnosed With High Blood Pressure May Rise Under New Guidelines

Simplified tables from American Academy of Pediatrics likely to raise detection rates

More U.S. children and teens are likely to be diagnosed and treated for high blood pressure because of new guidelines released by the American Academy of Pediatrics.

Approximately 3.5% of children and teens have abnormally high blood pressure or hypertension, which often goes unnoticed and untreated, the academy said.

"If there is diagnosis of hypertension, there are many ways we can treat it," said Dr. David Kaelber, who helped develop the guidelines. "But because the symptoms are silent, the condition is often overlooked."

When high blood pressure isn't addressed, it can lead to heart and kidney problems years later, the academy added. This is of special concern because the incidence of childhood high blood pressure has risen in the United States since 1988, although recently it has plateaued, the guideline authors noted.

Under the new, simplified tables, children will have their blood pressure measured against normal-weight children, so ideal readings will likely be lower than in the past. Obese or overweight kids—who were included under earlier guidelines—are more likely to have high blood pressure, possibly skewing recommended measurements.

As a result of this change, it's thought more children could be categorized as needing treatment. And that's a good thing, Kaelber's team said.

Dr. Joseph Flynn, who cochaired the guidelines subcommittee with Kaelber, explained that "by catching the condition early, we are able to work with the family to manage it, whether that's through lifestyle changes, medication, or a combination of treatments."

Noting the link between obesity and high blood pressure, the academy pointed out that lifestyle changes, such as diet and exercise, are the first-line treatment for high blood pressure. Physicians should prescribe blood-pressure-lowering medications if those behavioral changes don't reduce blood pressure, or if the child has another condition, such as kidney disease or diabetes, according to the guidelines.

But first, children with an elevated blood pressure reading should have 24-hour monitoring at home, the academy said. This will rule out the possibility of "white coat effect"—anxiety in the doctor's office that raises blood pressure.

Also, to simplify classification for doctors, the academy recommends adults and teens use the same blood pressure tables.

"These guidelines offer a renewed opportunity for pediatricians to identify and address this important—and often unrecognized—chronic disease in our patients," Kaelber said. "The easy part was developing the new guidelines. Now we begin the harder work of implementing them to help children and adolescents."

The guidelines were published online August 21 in the journal Pediatrics.

Source: HealthDay; August 21, 2017.