Top Things to Know: Pediatric Primary Hypertension: An Underrecognized Condition
Published: March 30, 2023
Prepared by Anne Leonard MPH, BSN, RN – National Senior Director Science and Medicine
- The overall prevalence of hypertension (HTN) during childhood is 2%-5%, with primary HTN being the leading type, especially in adolescence.
- The definition of pediatric HTN based on current pediatric guidelines (such as AAP), is systolic BP > 95th percentile and diastolic BP > 95% percentile. As a result of variability of BP measurements, BP levels > 95% percentile should be repeated on 3 separate visits, according to current guidelines.
- Children with hypertension are also more likely to become hypertensive adults linked with measurable target organ injury (including vascular stiffening) over time.
- Primary hypertension, the early phase of a condition, exists on a continuum across the life course, with higher BP exposure over time contributing to subclinical outcomes in childhood and young adulthood. These outcomes include heart failure, stroke, kidney failure and even death.
- Factors that predispose children and adolescents to HTN include overweight/obesity, suboptimal diet, suboptimal physical fitness, sleep disturbances and environmental stress. All play a role of risk factors for the development of primary hypertension in children.
- Other factors discussed in this statement that can cause HTN in children include:
- Family history of HTN in a parent or grandparent
- Abnormal birth history including prematurity, small for gestational age, maternal preeclampsia and eclampsia and assisted reproductive technologies.7.
- Kidney disease, type 1 and 2 diabetes and genetic syndromes associated with HTN (Williams syndrome, neurofibromatosis, Turner syndrome or tuberous sclerosis)
- Treatment with medications know to increase BP (stimulant medications, corticosteroids, calcineurin inhibitors).
- Barriers to proper monitoring of BP in children are discussed in this statement including current blood pressure monitoring and devices may not be optimal for children.
- This scientific statement discusses the recommended methods for accurately obtaining blood pressure measurements in the pediatric population.
- This statement discusses the public health implications of hypertension in children and the importance of addressing primordial prevention for healthier children.
- Clinicians should be aware of HTN in children and those at risk for HTN. Prompt detection and intervention can help maintain health over the life course.
Citation
Falkner B, Gidding SS, Baker-Smith CM, Brady TM, Flynn JT, Malle LM, South AM, Tran AH, Urbina EM; on behalf of the American Heart Association Council on Hypertension; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Kidney in Cardiovascular Disease; Council on Lifestyle and Cardiometabolic Health; and Council on Cardiovascular and Stroke Nursing. Pediatric primary hypertension: an underrecognized condition: a scientific statement from the American Heart Association [published online ahead of print Thursday, March 30, 2023]. Hypertension. doi: 10.1161/HYP.0000000000000228