From the Guidelines
Elevated systolic blood pressure in pediatric patients is commonly caused by obesity, kidney disease, heart defects, endocrine disorders, and certain medications, with obesity being the most prevalent cause. The definition of elevated blood pressure in children is systolic or diastolic blood pressure persistently above the 95th percentile, as stated by the American Heart Association 1. According to the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure, secondary forms of hypertension are more common in children and in individuals with severe hypertension 1. Some of the key causes of hypertension in children include:
- Obesity, which affects approximately 30% of overweight children due to increased body mass and metabolic changes
- Kidney diseases like glomerulonephritis, renal artery stenosis, and polycystic kidney disease, which disrupt fluid and electrolyte balance
- Congenital heart defects, particularly coarctation of the aorta, which can cause significant hypertension
- Endocrine conditions such as hyperthyroidism, Cushing's syndrome, and pheochromocytoma, which alter hormone levels that regulate blood pressure
- Medications including corticosteroids, decongestants, certain antidepressants, and stimulants used for ADHD, which can elevate blood pressure It is essential to conduct a thorough evaluation, including physical examination, laboratory tests, and sometimes imaging studies, to determine the underlying cause of hypertension in children before initiating treatment 1. Lifestyle interventions, such as active dietary counseling and physical activity prescriptions, should be recommended for all children with hypertension, with pharmacological therapy instituted for higher levels of BP or if insufficient response to lifestyle modifications occurs.
From the Research
Common Causes of Elevated Systolic Blood Pressure in Pediatric Patients
The common causes of elevated systolic blood pressure (hypertension) in pediatric patients can be attributed to several factors, including:
- Family history of hypertension 2, 3
- Obesity 2, 4, 5
- Minority race/ethnicity 2
- Physical inactivity 2, 4
- High dietary intake of sodium 2, 4
- Poor sleep quality 2
- Genetic disorders 3
- Renal disease 3
- Endocrine disorders 3
- Cardiovascular abnormalities 3
- Perinatal factors 4
- Socioeconomic factors 4
- Ethnic blood pressure differences 4
Risk Factors and Associations
These factors are associated with an increased prevalence of elevated blood pressure and hypertension in children and adolescents. Additionally, a linear relationship between systolic blood pressure and target organ damage has been observed, indicating that even currently considered normal blood pressure levels could increase the risk of target organ damage in childhood 2.
Lifestyle and Treatment Factors
Lifestyle changes, such as adhering to the Dietary Approaches to Stop Hypertension diet, and pharmacologic treatment using angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are effective methods for reducing blood pressure and target organ damage in children with hypertension 2, 6.