Following Up on Young Folks' Blood Pressure

Elevated blood pressure readings in children are not being followed up on as recommended

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Most children don’t have to deal with high blood pressure. For those young people who do get hypertension, though, detecting it early may help ward off other health problems in the future. About 1 to 3 percent of children in the US have hypertension (high blood pressure), according to estimates from the Centers for Disease Control and Prevention (CDC). If left untreated, high blood pressure can lead to damage of the heart, brain, kidneys and eyes. But if the problem is found early, children can control it and lead a healthy life.

A new study, however, has found that children with elevated blood pressure were unlikely to get the recommended follow-up blood pressure screenings. Although, those who did follow up were likely to have results that were normal.

"Have your child's blood pressure checked as part of an exam."

Matthew Daley, MD, a researcher at the Institute for Health Research at Kaiser Permanente Colorado in Denver, and colleagues discovered that only one out of five children with higher than normal blood pressure was rechecked within a month.

National Heart, Lung and Blood Institute guidelines recommend getting a repeat blood pressure check one to two weeks after the first elevated reading.

On the positive side, the study reported that blood pressure levels returned to normal in follow-up checks for most children who initially had elevated readings.

Investigators reviewed medical records of 72,625 children and adolescents ages 3 to 17 over a three-year period. These young patients had received blood pressure checks as part of their routine clinical care through Kaiser Permanente in Colorado and Northern California and HealthPartners of Minnesota.

About 8 percent of these children had elevated blood pressure during at least one visit. Of those with one elevated pressure reading, only 1.4 percent went on to develop childhood hypertension.

Children are only diagnosed as hypertensive after three consecutive pressure readings that are at or above the 95th percentile for their age, sex and height.

The study's authors noted that multiple readings are required to confirm high blood pressure because children may have high readings for a number of reasons, including excitement and nervousness at the doctor's office.

"Diagnosing hypertension during childhood is difficult because normal blood pressure for children changes as they age," said Dr. Daley in a press release. "It’s fairly common for children to have a single elevated blood pressure reading, but when their doctors repeat the test, it appears that most children won't actually have hypertension."

In a separate study published in July in the American Heart Association journal Hypertension, scientists reported that more children had elevated blood pressure than in the past. The research, led by Bernard Rosner, PhD, professor of medicine at Harvard Medical School, had found that the risk of elevated blood pressure among children and adolescents had risen 27 percent during a 13-year period. The investigators noted that weight gain and salt intake were the prime suspects in pumping up the pressure in those kids.

"High blood pressure during childhood can lead to high blood pressure in adulthood," said Dr. Daley in a statement. "And adult cardiovascular disease — including coronary artery disease and strokes — can have its origin in childhood, so diagnosing and controlling hypertension in children is important for their health later in life."

"It is true that we do see children with elevated blood pressures and that most resolve in the few minutes after the exam or at the next visit. However, elevated readings should be taken very seriously. As we have heard many times in the news obesity is on the rise in teenagers. Unfortunately along with this comes the complications of high blood pressure and type 2 diabetes. Both can cause organ damage resulting in heart, brain and kidney damage. Should there ever be an elevated blood pressure reading it should be repeated before the patient leaves the office and if it is still elevated a follow up appointment should be made in a week or so to monitor it," Dr. Thomas Seman, a physician at North Shore Pediatrics in Boston, Massachusetts, told dailyRx News.

"Should there be 3 consecutive visits with elevated blood pressures then the child should have a proper evaluation, be counseled on lifestyle changes and started on appropriate medication," said Dr. Seman. 

This study was published in August in Pediatrics.

The investigation was conducted by Kaiser Permanente Colorado Institute for Health Research as part of its ongoing child health research and was funded by the National Heart, Lung and Blood Institute at the National Institutes of Health.

Review Date: 
August 7, 2013
Last Updated:
August 13, 2013