October 7, 2013
News Review From Harvard Medical School -- Blood Pressure Screening Questioned for Kids
There's not enough evidence to say whether testing and treating children for high blood pressure is a good idea, a panel of experts says. The new report comes from the U.S. Preventive Services Task Force. This is a government-appointed panel that provides advice on preventive care. The task force looked at research on kids and blood pressure published in the last 10 years. The group said it's hard to predict which children will have high blood pressure as adults. There's also not enough research on whether treating kids with high blood pressure will improve their heart health as adults. And there's been little research on whether blood pressure medicines are safe and effective for long-term use by children. The task force said more research is needed. Meanwhile, we do know some things that kids can do to stay healthy, the task force said. They can eat a nutritious diet, stay active and keep weight in a normal range. The journal Pediatrics and the journal Annals of Internal Medicine published the study online. HealthDay News wrote about it October 7.
By Henry H. Bernstein, D.O.
Harvard Medical School
What Is the Doctor's Reaction?
We all have had our blood pressure checked at some time. High blood pressure (hypertension) is when the force of blood pumping against blood vessel walls is too strong.
High blood pressure is most common in adults. It usually does not cause symptoms. Yet high blood pressure still affects the body over time. Adults with it are at risk for long-term health problems, especially heart disease.
Kids can have high blood pressure, too. Between 1% and 5% of children have high blood pressure. The numbers are much higher for children who are obese (11%). Are these kids on track to have the same health problems as adults?
The U.S. Preventive Services Task Force studied all the latest research on high blood pressure in children and teens. It just published its update online in the journal Pediatrics. The task force was looking for answers to the following questions:
- How well do blood pressure machines work on children and teens?
- Are children and teens with high blood pressure more likely to have:
- High blood pressure as adults?
- Heart disease as adults?
- How well does treatment lower their blood pressure?
- Will treating high blood pressure cut their risk of heart disease as adults?
- What are the harms of testing children and teens for high blood pressure?
- What are the harms of treating their high blood pressure?
Based on these studies, the task force reports that there still is not enough evidence to fully answer these questions. The task force could not say for sure whether doctors should test children and teens for high blood pressure.
Yet many groups still recommend regularly checking blood pressure in children and teens. They include:
- American Academy of Pediatrics
- National High Blood Pressure Education Program
- National Heart, Lung and Blood Institute
- American Heart Association
- Bright Futures (a national children's health promotion program)
The new report points out what is done now around the country. Blood pressure is measured in children between 3 and 18 years at every checkup in the doctor's office. The doctor lists the blood pressure measurement as normal, pre-hypertension or high blood pressure. Then advice is given to help children and teens stay healthy.
What Changes Can I Make Now?
Your child should have his or her blood pressure checked every year. This should start at the age of 3. It is a normal part of routine checkups, just like measuring height and weight.
If your child has high blood pressure, the doctor will discuss how to treat it. Most of the time, the doctor will recommend that your child:
- Exercise more
- Eat fewer salty foods
- Lose weight, if he or she is overweight or obese
If these changes do not work, the doctor might give your child a medicine to lower blood pressure.
Obesity is the biggest factor that increases the risk of high blood pressure in children and teens. It is important for all children (and adults) to eat healthy foods and exercise.
The American Academy of Pediatrics recommends "5210 for Healthy Active Living":
5: Eat at least 5 servings of fruits and vegetables every day.
2: Limit screen time (TV, video games, computer) to 2 hours or less per day.
1: Get 1 hour or more of physical activity every day.
0: Drink fewer or no sugar-sweetened drinks. Try water and low-fat milk instead.
What Can I Expect Looking to the Future?
Expect your doctor to keep checking your child's blood pressure every year.
High blood pressure is becoming more common in children. This is most likely because there are more overweight children than ever before.
Testing and treating children and teens for high blood pressure now should prevent serious health problems later. We cannot be sure until more research is done. Likely research topics include:
- Which blood pressure machines work best in children?
- What are the top screening ways to find children who truly have high blood pressure?
- What happens to children with high blood pressure after they become adults?