Children and high blood pressure
If you are a parent, it’s probably something you have never even thought to ask your child’s doctor about. Yes, you’ve fretted over their growth percentile, their motor skills, their diet and what vaccines they should be getting. But chances are, you haven’t considered their blood pressure.
New research paints a worrying reality. High blood pressure in children and teenagers nearly doubled between 2000 and 2020, according to the largest study on the topic to date. The rate of hypertension in under 19s has risen from about 3% to over 6% in 2020, according to research that looked at 96 other large studies across the world and was published last week in the Lancet Child and Adolescent Health journal.
“It’s a dramatic jump,” says Rahul Chanchlani, a pediatric nephrologist at McMaster University in Canada who wasn’t involved in the research, but co-authored an accompanying comment piece.
The fact is that most children aren’t routinely screened for their blood pressure. The current guidance is conflicting. While the American Academy of Pediatrics recommends annual blood pressure measurement for children over three, other guidance in the US suggests the evidence is insufficient. In the UK, where I am writing this from, the national screening committee doesn’t even recommend blood pressure screening for adults, let alone children.
“People used to think that pediatric hypertension is completely benign – their children grow out of it as they grow older and they do not have any long-term consequences,” says Chanchlani. Studies in the last couple of years have refuted that, including research from Chanchlani and his colleagues that showed that high blood pressure in children can lead to conditions like long-term chronic kidney disease.
When a child walks into a doctor’s office, the practitioner is faced with multiple other priorities that seem more important – vaccination, nutrition, growth. “Blood pressure is last on their radar. So we need to change their perspective,” says Chanchlani.
Doctors might not even have the right cuffs and machines needed for children. And even if they do, in-office testing also has problems. The Lancet study showed that around 9.2% of children and teens are affected by conditions like masked hypertension, when routine screening doesn’t pick up their high blood pressure.
I asked Chanchlani if parents should be testing their child’s blood pressure at home if it wasn’t being routinely done at the doctor – and if it’s not always accurate there. Firstly, it’s not as simple as buying a monitor off Amazon, he says, with few at home versions for children available.
Where it might make sense is to do this in schools and pharmacists – places where kids might be getting vaccinations or other health checkups.
The bigger question though, is whether there needs to be a national screening program.
“Do we really need to check every single child’s blood pressure?” he asks. The alternative is to identify high-risk children like those with obesity that might benefit most from having their blood pressure checked. “I still don’t know the answer to this question,” he says.
But stay tuned. Researchers like Chanchlani are studying this and hope to have answers soon. — Ashleigh Furlong
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