Caring for children with high blood pressure

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Hypertension is known to be a common disease in the elderly, but few people know that hypertension is also relatively common in children. High blood pressure in children also needs to be cared for and treated in a timely manner, to limit its adverse effects on children's health. So how to care and treat high blood pressure in children?

1. Risk of hypertension in children

The percentage of children with high blood pressure is usually lower, only about 1%. However, this is still a completely possible disease if there are other underlying medical indicators (also known as secondary hypertension in children).
Children with severe hypertension or obvious symptoms are often secondary hypertension. On the other hand, the proportion of children with primary hypertension will increase in school age or adolescents with the prevalence of childhood obesity.
A screening study in the United States found that nearly 10% of adolescents had prehypertension and up to 2.5% of adolescents had hypertension. The obesity factor has a great influence on the incidence of the disease at the age of 2-5 years. Meanwhile, up to 20% of adolescents in the United States are obese and 10% of obese adolescents will develop high blood pressure.
In adults, hypertension is defined as blood pressure ≥ 140/90 mmHg at any age, sex, body size... This definition is functional based on the relationship between the index blood pressure with possible cardiovascular events. Since cardiovascular events that are the result of hypertension (myocardial infarction, stroke) are rare in childhood, the definition of childhood hypertension is therefore only systematic. enumeration rather than functionality.
NHBPEP - The US National High Blood Pressure Education Program Coordinating Committee has updated the definition, diagnosis and treatment of high blood pressure in children with a table of children's blood pressure values ​​by age and sex with different levels. 50, 90, 95, 99 percentiles of blood pressure readings (systolic and diastolic):
Normal child blood pressure is defined as when systolic and diastolic blood pressure is below the 90th percentile line by age, sex and height of the child; Blood pressure in a normal-high child (also called prehypertension) when mean systolic and/or mean diastolic blood pressure is between the 90th and 95th percentiles in infancy or blood pressure greater than 120/80 mmHg and below the 95th percentile for older children and adolescent subjects; Pediatric hypertension was defined as when the child's mean systolic and/or mean diastolic blood pressure was above the 95th percentile for age, sex, and height in the child. This is obtained in at least 3 different measurements; High blood pressure in children also has a special form of white coat hypertension when the blood pressure readings in the hospital or clinic are above the 95th percentile line but below the 90th percentile line. when measured in the hospital.

2. Identify the pathology of hypertension in children

2.1. How is primary hypertension in children identified? Primary hypertension can be seen in children and adolescents. High blood pressure or prehypertension are notable health problems due to the link between high blood pressure and overweight and obesity in children. The evaluation of children with primary hypertension should include risk factors such as obesity, low HDL-C, elevated triglycerides, and presence or absence of impaired glucose tolerance. ... Besides, sleep apnea syndrome is also associated with high blood pressure and overweight, so it is necessary to note more sleep problems in children.
2.2. Diagnosis of secondary hypertension in children Hypertension in children can be secondary to and related to a number of other conditions such as chronic kidney disease, renal artery stenosis, some cardiovascular diseases, disorders Adrenal dysfunction, hyperthyroidism, sleep disorders or due to the use of certain drugs... Especially, secondary hypertension is a disease more common in children than in adults.
Besides, children with hypertension have a strong correlation with obesity, so all cases of hypertension in children need to evaluate BMI during clinical examination.
To confirm the diagnosis of hypertension in children, doctors need to measure the blood pressure of the extremities. In addition, children with grade 2 hypertension or higher or a group of adolescents with symptoms suggestive of a cause for hypertension need a more comprehensive and thorough evaluation than other children.

3. Treatment of high blood pressure in children

Objectives of treatment of high blood pressure in children:
For children with primary hypertension and no complications of target organ damage, blood pressure should be controlled below the 95th percentile for age, gender and height; With hypertension in children with chronic kidney disease, diabetes, or end-organ damage, blood pressure readings should be below the 90th percentile for age, sex, and height. Treatment of high blood pressure in children with drugs:
Children with hypertension who have an indication to use antihypertensive drugs should start with a drug. The accepted classes of antihypertensive drugs in children include ACE inhibitors, blockers, beta-blockers, calcium channel blockers, and diuretics;
Recent studies have extended the recommendation to include some other antihypertensive drugs in children as well as appropriate doses;
At the beginning of treatment, the doctor should prescribe the drug with the lowest dose, then gradually increase it according to the child's response until the goal is reached;
In the case of using antihypertensive drugs in children with the maximum dose or unwanted effects, the doctor should appoint a second drug combination. The problem of drug combination depends on the mechanism of action. , 2 drugs need to complement each other such as ACE inhibitors and diuretics, vasodilators and diuretics or Beta blockers;
Another important issue in the treatment of high blood pressure in children is a plan to closely monitor blood pressure readings, complications of target organ damage, side effects of drugs, electrolyte testing. (if ACE inhibitors or diuretics are used) and other cardiovascular risk factors.

4. Pay attention to blood pressure monitoring when taking medicine, to avoid low blood pressure in children

Some causes can cause excessive low blood pressure in children such as:
Dehydration: Easy to happen in children who are sick, high fever, loose stools or excessive sweating. The above factors cause a decrease in intravascular volume and lead to hypotension in children; Certain medicines: Medicines can dilate blood vessels and cause low blood pressure in children; Anemia; Adrenal insufficiency ; Sudden change of position; Low blood pressure in children is no less dangerous than high blood pressure. If not detected and treated promptly, low blood pressure can cause damage to the nervous system and other important organs such as the heart, liver, kidneys...

5. Caring for children with high blood pressure

Weight loss, weight maintenance is the first measure to control and treat high blood pressure in children related to obesity. At the same time, maintaining an ideal weight will limit the risk factors that lead to high blood pressure. Weight loss measures may include:
Instructing children to practice appropriate and regular exercise; Limit an inactive lifestyle. Adjust nutrition, especially in the pre-hypertensive group. Specifically, the diet should reduce the amount of salt (about 1-2g/day for children 4-8 years old; 1.5g/day for older children), add fresh vegetables, foods rich in fiber and use healthy foods. fat-free milk.
In the high-risk group, blood pressure should be checked regularly and periodically. Ideally, blood pressure should be measured about 3 times per week.

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