Hypertension in Children: Symptoms, Diagnosis, and Effective Treatment Methods

Symptoms and Treatment of Hypertension in Children

Blood pressure is defined as the total pressure or force exerted by blood flowing through blood vessels. Blood pressure levels that are higher than they should be indicate high blood pressure, or hypertension. Hypertension in children and adolescents is also referred to as “pediatric hypertension.” Although hypertension is more common in children over 12 years of age, it is a condition that can also be encountered in younger children in some cases. While a diagnosis of hypertension in adults can be made through specific measurements, interpreting blood pressure values in children is difficult. Tables specifically used for children that include gender, age, and height characteristics can provide information about hypertension. Family history, problems during birth and in the mother, and dietary patterns are taken into account in the diagnosis of hypertension.

In individuals with hypertension, blood exerts too much pressure on the blood vessels, which can damage the blood vessels, heart, and other organs. Organs commonly affected by hypertension include the heart, kidneys, and eyes. Therefore, timely diagnosis and treatment of hypertension are of critical importance. Untreated hypertension is likely to continue to pose a danger to children in their later lives. Blood pressure should be measured and monitored at every examination for children over 3 years of age.

What is Hypertension in Children?

Hypertension is when the pressure exerted by blood on the arteries is above ideal values. The diagnosis of hypertension in children aged 13 and over is made in the same way as in adults. Abnormally high blood pressure is examined in three categories: elevated blood pressure, stage 1 (mild) hypertension, and stage 2 (severe) hypertension. Hypertension assessment in adolescents aged 13 and over is performed as follows:

120/ < 80 to 129/ < 80 mmHg is elevated blood pressure

130/80 to 139/89 mmHg is stage 1 hypertension

≥140/90 mmHg is stage 2 hypertension

For younger children, hypertension is defined as having blood pressure values greater than the 95th percentile of other children of the same gender, age, and height.

There are 2 main causes of hypertension in children:

Primary hypertension

Secondary hypertension

Primary hypertension is high blood pressure that is not due to an obvious cause. It is the most common type of high blood pressure in children. Children who are over 6 years old, overweight, and have a family history of hypertension are usually in this group. Treatment specifically targeting excess weight helps reduce the likelihood of hypertension.

Secondary hypertension is high blood pressure caused by another underlying condition. The most common causes of secondary hypertension are usually kidney and renovascular (affecting the renal vessels) diseases. Structural kidney diseases such as glomerulonephritis and obstructive uropathy account for approximately 34-79% of hypertension cases. In addition, congenital heart diseases, obstructive sleep apnea, hormonal imbalances such as hyperthyroidism, medications such as corticosteroids, and genetic mutations such as Liddle syndrome are among other causes of secondary hypertension.

What Are the Symptoms of Hypertension in Children?

Hypertension in children often shows no symptoms, but certain symptoms may be seen in severe cases. Hypertension in children is usually discovered during routine check-ups. If your child has risk factors for hypertension, regular blood pressure monitoring may be necessary. For example, the risk of hypertension is considered in the presence of obesity, physical inactivity, excessive sodium or salt consumption, and a history of genetic hypertension. Although hypertension in children often does not show symptoms, some symptoms of a hypertensive crisis that requires emergency medical treatment are as follows:

Headache

Nausea and vomiting

Shortness of breath

Palpitations

Chest pain

Tinnitus (ringing in the ears)

Nosebleeds

Double or blurred vision

Seizures

The appearance of one or more of these hypertensive crisis symptoms emphasizes the need for emergency medical help. An untreated hypertensive crisis can lead to life-threatening situations.

What Are the Diagnostic Methods for Hypertension in Children?

In the evaluation of hypertension in children, a detailed history and a comprehensive clinical examination are first obtained. Information regarding pregnancy, birth weight, fetal growth, maternal hypertension, and the presence of postnatal infections is reviewed. Subsequently, the breastfeeding and weaning period, food preferences, daily salt intake, and fast food habits are questioned. In addition to nutrition, information is obtained about physical activity during the day, screen exposure, and sleep problems. A history of depression, stress, and anxiety in children is taken into account. The doctor should be informed about the presence of hypertension and kidney disease, especially in the family.

During the physical examination, the child's weight, height, BMI, and head circumference are measured. General appearance, such as syndromic facies seen during growth and development periods, is evaluated. Muscle weakness, joint swelling, abdominal masses, skin rashes, and abnormal conditions in other organs are checked. Shortness of breath, murmurs, skin pallor, pulse rate, and differences in blood pressure provide information about the general condition of children.

Hypertension in children is diagnosed differently than in adults because blood pressure values change as the child grows. Hypertension in children is defined as having blood pressure greater than the 95th percentile of other children of the same age, gender, and height. Several measurements are taken before a diagnosis of hypertension is made because situations such as stress can cause high blood pressure. A sphygmomanometer is used to check blood pressure, and blood pressure values are taken more than once. Blood pressure should be measured at every clinical visit.

What Are the Treatment Methods for Hypertension in Children?

Hypertension is a treatable and preventable condition. The main treatment options for hypertension are lifestyle changes and medication use. Helping children reach a healthy weight, consume healthy and nutritious foods, and engage in regular physical activity helps lower high blood pressure. Furthermore, these changes help reduce the risk of cardiovascular diseases that may occur in later life. Some practices that can be implemented in the treatment of hypertension include:

Consuming adequate amounts of fresh vegetables and fruits, legumes, whole grains, and nuts

Limiting the consumption of fast food containing high amounts of fat, salt, and sugar

Choosing foods and drinks with low sodium/salt content

Reducing fruit juice consumption due to its high sugar content

Engaging in physical activity or exercise every day

Ensuring adequate and quality sleep

Parents acting as role models by choosing healthy snacks

Avoiding cigarettes and secondhand smoke by the family and children.

The dietary treatment for hypertension is known as the DASH diet and emphasizes healthy food and drink choices. It supports increased physical activity with low sodium intake. In addition to dietary treatment, stress management practices such as breathing exercises and meditation help lower blood pressure. When blood pressure cannot be lowered through lifestyle changes, your doctor may recommend hypertension medications. Treatment usually starts with the lowest dose and requires regular follow-up. Each medication may have specific side effects, and families are informed about this. In the presence of obesity or excess weight, losing weight is recommended.

Frequently Asked Questions

Hypertension is seen in children just as it is in adults. There are many causes of hypertension in children. Among these causes, obesity, diabetes, having one or more individuals with hypertension in the family, premature birth, and low birth weight increase the risk of hypertension. Additionally, maternal smoking and alcohol use, stress, diabetes and hypertension, excessive salt use, and unhealthy eating habits are factors that can increase the likelihood of hypertension in infants and children.

It is observed that some diseases that develop during the neonatal and infancy periods also increase the likelihood of hypertension. Diseases such as renal artery thrombosis, renal vein thrombosis, hormonal disorders, medications, and aortic disorders are factors that can lead to hypertension in early childhood. Hypertension is often a silent disease and may not show symptoms. During severe hypertension or a hypertensive crisis, complications such as loss of consciousness, palpitations, chest pain, and vomiting are seen. However, no symptoms may be seen for early diagnosis. Regular doctor check-ups should be provided for the diagnosis of hypertension in children. Furthermore, eliminating the presence of risk factors for hypertension is one of the most effective methods in reducing the risk of hypertension. Changes in nutrition and physical activity or medication treatment are ideal options for managing high blood pressure. However, persistent high blood pressure or untreated high blood pressure negatively affects children, especially their hearts, brains, and kidneys. Untreated hypertension can continue into adulthood and cause damage to other organs. The damages that hypertension can cause are commonly as follows:

Heart failure

Heart attack

Kidney failure

Stroke

Blindness

Aneurysms in blood vessels

Hypertension is mostly controllable and treatable. However, neglected hypertension causes organ damage in children and adults. Therefore, regular follow-up and check-ups are essential. There are very few studies on the relationship between postnatal hypertension and growth. According to the data, children with hypertension and diabetes, especially after the age of 7, are shown to be heavier and taller than other children. The body measurements of children with only hypertension are generally at average values. However, in women with hypertension, sufficient blood cannot be provided to the placenta during pregnancy. For this reason, low birth weight and growth restriction may be seen in addition to premature birth. In cases of severe hypertension, the situation must be brought under control, and doctor follow-up is important.

Hypertension, which can develop in children without showing any symptoms, is a value that needs to be monitored. If you suspect hypertension in your child or if they have hypertension, please contact a relevant healthcare institution. You can visit our Pediatric Cardiology department, where our expert doctors are located and where the necessary tests, examinations, and required equipment are available for the necessary procedures.

If you suspect hypertension in your child, visit our expert Pediatric Cardiology department without delay. Ensure your child takes a step toward a healthy future with early diagnosis and correct treatment. You can fill out the form below to get more information or to schedule an appointment.