From the Guidelines
Elevated systolic blood pressure in pediatric patients is primarily caused by obesity, poor diet, lack of physical activity, and genetic factors, with secondary causes including kidney diseases, endocrine disorders, congenital heart defects, and certain medications. The causes of elevated systolic blood pressure in pediatric patients can be categorized into primary and secondary causes. Primary causes include:
- Obesity
- Poor diet high in sodium
- Lack of physical activity
- Genetic factors Secondary causes include:
- Kidney diseases (such as renal artery stenosis or glomerulonephritis) 1
- Endocrine disorders (like hyperthyroidism or Cushing's syndrome)
- Congenital heart defects (particularly coarctation of the aorta)
- Certain medications (including steroids, decongestants, and some ADHD medications) Environmental factors such as stress and sleep disorders can also contribute to elevated blood pressure 1. It is essential to identify the underlying cause of hypertension in pediatric patients to provide appropriate management and prevent long-term cardiovascular complications. According to the American Academy of Pediatrics, lifestyle modifications are the first-line approach for managing hypertension in children, including weight management, increased physical activity, and reduced sodium intake 1. If blood pressure remains elevated despite these measures, medications may be necessary, typically starting with ACE inhibitors, calcium channel blockers, or angiotensin receptor blockers at pediatric-appropriate doses 1. Early detection and management are crucial as childhood hypertension often continues into adulthood, potentially leading to cardiovascular complications. Regular blood pressure monitoring should begin at age 3 during routine check-ups, with more frequent monitoring for children with risk factors 1.
From the Research
Causes of Elevated Systolic Blood Pressure in Pediatric Patients
- The causes of elevated systolic blood pressure (hypertension) in pediatric patients are multifactorial, including:
- Overweight and obesity, which are strongly correlated with primary hypertension in children 2
- Family history of hypertension 3, 4
- Minority race/ethnicity 3
- Physical inactivity 3, 4
- High dietary intake of sodium 3, 4
- Poor sleep quality 3
- Perinatal factors, such as low birth weight 4
- Socioeconomic factors, such as limited access to healthcare and healthy food options 4
- Ethnic blood pressure differences 4
- Secondary causes of hypertension in children, such as renal parenchymal disease and renovascular disease, are more common in children than in adults 2
- Other factors, such as genetic aspects and familial aggregation, may also play a role in the development of hypertension in children 5
Risk Factors for Hypertension in Pediatric Patients
- Risk factors for hypertension in pediatric patients include:
Diagnosis and Treatment of Hypertension in Pediatric Patients
- Hypertension in children is often overlooked and should be screened for annually beginning at three years of age or at every visit if risk factors are present 6
- Accurate measurement of blood pressure is crucial for diagnosis, and ambulatory blood pressure monitoring should be performed to confirm hypertension in children and adolescents 6
- Lifestyle changes, such as weight loss, a healthy diet, and regular exercise, are the initial treatment for hypertension in children 2, 3, 6, 4
- Antihypertensive medications, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide diuretics, may be necessary for children with symptomatic hypertension, secondary hypertension, or persistent hypertension despite lifestyle changes 2, 3, 6