Under pressure: For kids with hypertension, the time to make changes is now

This article was written by Megan Haverman and originally appeared in the Portland Monthly 2016 Kids’ Health Annual magazine.

While in the past high blood pressure in children has usually been considered a secondary symptom of something else, like kidney or heart disease, today children, like adults, are increasingly experiencing issues associated with being overweight.

According to Jennifer Huang, M.D., a pediatric cardiologist at OHSU Doernbecher Children’s Hospital, “It’s becoming more and more common for kids to have hypertension or high blood pressure even without the primary causes.” And every year this number goes up.

Hyperlipidemia, a condition defined as a high presence of fats circulating in the blood, frequently accompanies high blood pressure and is associated with obesity. “Some children have the disease because it’s familial,” explains Dr. Huang, “but most of the kids coming in are significantly obese.”

The good news is that children with hypertension aren’t condemned to a life of high blood pressure. When lifestyle is modified before adulthood, blood pressure can be “cured” in kids – as long as those changes are maintained.

“Change is easier with kids than adults,” Dr. Huang says, “but if you look at the kids with hypertension and hyperlipidemia, their parents have hypertension and hyperlipidemia because they already have that lifestyle.”

Dr. Huang says she and her colleagues – such as Laurie Armsby, M.D., also a pediatric cardiologist – can work to assist parents trying to alter their children’s lifestyle through a more holistic program, including children’s gym activity and consultation with a dietician.

Medication can also be helpful for controlling blood pressure, though the diuretics used as a primary line for adults aren’t the go-to for children. Pediatricians often prefer ACE inhibitors, which target the kidneys as they adjust blood pressure through many different hormones and markers.

“It’s a feedback loop. When you have high blood pressure a long time, your kidneys become intolerant to that, and they react the same way as someone with normal blood pressure,” Dr. Huang clarifies. ACE inhibitors work by blocking one of these kidney hormones to help lower blood pressure, stabilizing the feedback loop. Younger children have lower blood pressure targets than older children, and the scale varies based on age and height percentile.

But just like high blood pressure in adults, hypertension in children often displays no symptoms and is found during routine screenings. “In a cardiology clinic we check blood pressure with every visit,” Dr. Huang says, noting the contrast with a standard wellness checkup: “Especially with younger children, they’re not getting their blood pressure checked on their primary care visit.”

Parents who suspect hypertension – or simply want reassurance that their child doesn’t have a problem that needs addressing now – should ask their pediatrician to break out the blood pressure cuff.

If you’re concerned about your child’s blood pressure, talk to your pediatrician or call (503) 346-0640 to reach the pediatric cardiology program at OHSU Doernbecher.