Jefferson Researchers Announce Recommendations on When to Test Blood Pressure in Young Children
Treatment Options and New ‘Prehypertension’ Category Also Identified
Children as young as 3 years old should have their blood pressure checked as part of their routine pediatric examinations,
according to new treatment guidelines presented at the American Society of Hypertension’s Annual Scientific Meeting in New
York City.
“The long-term health risks for hypertensive children and adolescents can be substantial. If left untreated, they pose a growing
public health challenge,” said Bonita Falkner, MD, Professor of Medicine and Pediatrics at Jefferson Medical College of Thomas
Jefferson University in Philadelphia, who chaired the national committee to develop the guidelines. “We want to update clinicians
on the latest scientific evidence.”
The guidelines are the results of the National High Blood Pressure Education Program Working Group and update previous guidelines
from 1996. The complete report is published in the August 2004 issue of
Pediatrics, the official journal of the American Academy of Pediatrics.
Determining Blood Pressure Standards More Precisely
In children and adolescents, the normal range of blood pressure is traditionally determined by body size and age. The guidelines
offer blood pressure standards that are based on gender, age and height, which, Dr. Falkner says, provide a more precise classification
according to body size and avoid misclassifying children who are very tall or very short.
The guidelines also encourage pediatricians to recommend diet, exercise and weight- control counseling for children who fit
into a new category known as “prehypertension.”
“The definition of hypertension remains the same,” Dr. Falkner explains.
“Prehypertension refers to an average systolic blood pressure or diastolic blood pressure that is greater than or equal to
the 90th percentile, but less than the 95th percentile in children. By adolescence, a blood pressure reading of greater than
120/80 is considered to be prehypertension.
“We know that elevated blood pressure levels in children and adolescents can be associated with obesity and risk factors for
diabetes and cholesterol disorders. These guidelines provide a kind of checklist to assist pediatricians in translating the
blood pressure numbers and in helping to recognize these potential problems.
“Once hypertension is recognized, pediatricians can begin providing treatment. Currently, it is estimated that from 1 to 3
percent of children and adolescents may have hypertension.”
Pediatricians often find that taking the blood pressure measurement of young children is challenging. It is important that
the blood pressure cuff used in a child is the correct size in order to obtain an accurate measure, Dr. Falkner stresses.
An elevated blood pressure should be confirmed on repeated visits before a physician characterizes a child as having hypertension.
Recommended Guidelines
Initially, the guidelines recommend therapeutic lifestyle changes such as dietary modifications, weight reduction, regular
physical activity and restriction of sedentary activity to help prevent increases in blood pressure in children and adolescents
over time. Dr. Falkner also recommends that physicians take a sleep history due to association of sleep apnea (temporary halting
of breathing during sleep) with overweight and high blood pressure. If these measures don’t prove to be effective, antihypertensive
drug therapy may be appropriate to control the blood pressure.
The American Society of Hypertension is the largest organization in the United States devoted exclusively to hypertension
and related cardiovascular diseases. It is committed to alerting physicians, allied health professionals and the public about
new medical options, facts, research finding and treatment choices designed to reduce the risk of cardiovascular disease.
