High blood pressure in children often goes unnoticed at the doctor?s office, and many children go home without follow-up or treatment, suggests a study from the Johns Hopkins Children?s Center.
Researchers combed through six months of records detailing visits to the Children ?s Center outpatient clinic and found that of the 1,908 children who had their blood pressure measured, more than a quarter (518) had elevated blood pressure. Yet 91 percent (470) of those with elevated blood pressure went unrecognized, meaning the doctor didn?t follow up by taking a second measurement or by ordering further tests.
?If our findings extend beyond our clinic and indeed beyond Baltimore ? and we think they do ? this means that hundreds of thousands of children in this country might have high blood pressure and are not being followed or treated for it,? says lead author Tammy Brady, M.D., M.H.S., a kidney specialist at the Children?s Center.
If untreated, persistently elevated blood pressure, or hypertension, can lead to kidney damage, narrowing of the arteries (atherosclerosis) later in life and left-ventricular hypertrophy (LVH), a thickening or enlarging of the lower left chamber of the heart.
Pediatric guidelines say that any elevation in blood pressure measured in children on three consecutive visits is by definition evidence of hypertension.
In adults, blood pressure parameters are clearly defined. In children, however, doctors must factor in age, gender and height to determine whether the blood pressure is normal. To cut down on the cumbersome arithmetic, doctors at the Children?s Center are designing a computer program to do the calculations and alert providers if a child?s blood pressure is out of range. The program should be ready for testing by the end of the year.
Studies show that high blood pressure is found in up to 30 percent of overweight children and in about 5 percent of children of normal weight. In the study, children with high blood pressure with a lower body mass index (BMI) and no family history of heart disease were more likely to go unnoticed?possibly because a child of healthy weight doesn?t raise a red flag as much as an overweight child, researchers say.
?Overweight children are at higher risk, but high blood pressure can happen in anyone and rarely causes symptoms,? Brady says. ?The absence of signs is not a sign of absence, and we, as health care providers, must screen, monitor and treat all children, regardless of how healthy they appear and regardless of family history.?