Inactivity, high-sugar, high-salt diets, and obesity cause nine out of ten cases of high blood pressure in children and adolescents. A recent research on hypertension in children aged 6 to 16 recommends that families improve their overall health.
The conclusions of the heart health specialists’ consensus report were published in the European Heart Journal, a journal of the European Society of Cardiology (ESC).
“Parents are significant agents of change in the promotion of children’s health behaviours,” said first author Professor Giovanni de Simone of the University of Naples Federico II, Italy. “Very often, high blood pressure and/or obesity coexist in the same family. But even when this is not the case, it is desirable that lifestyle modifications involve all family members.”
Dietary suggestions for managing high blood pressure in children include focusing on fresh vegetables, fruits, and other high-fiber meals, minimising salt intake, and avoiding sugary beverages and saturated fat. Every day, children and adolescents should engage in at least one hour of moderate-to-vigorous physical exercise, such as running, cycling, or swimming, and no more than two hours of sedentary activities.
“Parents should monitor the amount of time their children spend watching TV or using smartphones and suggest active alternatives,” said Professor de Simone.
Realistic goals should be set for weight, diet, and physical activity that focus on the aspects needing the most improvement. “Recording weight, eating habits and exercise over time — but without becoming obsessive — can help young people and their families to track progress towards their goals,” said Professor de Simone.
A “health-promoting reward system” is recommended. Professor de Simone said: “Ideal incentives are those that increase social support and reinforce the value of targeted behaviours, such as a family bike ride or a walk with friends.”
Childhood obesity and hypertension are referred to in the paper as “insidious siblings” that gradually become a severe health risk. Obesity, particularly abdominal obesity, has been linked to an increase in the prevalence of paediatric hypertension, according to research.
It is estimated that less than 2% of normal weight children are hypertensive, compared to 5% of overweight and 15% of obese children. Professor de Simone said: “The rise in childhood hypertension is of great concern as it is associated with persistence of hypertension and other cardiovascular problems during adulthood.”
Early diagnosis of elevated blood pressure is crucial so that it can be managed with lifestyle and, if needed, medications. Even one blood pressure measurement by a doctor or nurse can identify children with high blood pressure, but a second visit is recommended for confirmation. Professor de Simone said: “Screening should be performed in the primary care setting at least yearly, regardless of symptoms. This is because hypertension in children, as in adults, is usually asymptomatic.”
When blood pressure tests indicate hypertension, a medical history and physical examination are required to rule out probable causes and uncover modifiable behaviours. Details on lifestyle, such as smoking, salt intake, alcohol consumption, physical exercise, and leisure time activities; and possible symptoms such as headache, nosebleeds, vertigo, visual impairment, low school performance, attention difficulties, shortness of breath, chest pain, palpitations, and fainting are all provided.
Treatment of paediatric hypertension should begin with education and behaviour modification. If blood pressure targets are not met, a single low-dose medication should be administered. Small dosages of two medications may be required if one therapy is unsuccessful.
The authors urge public health organisations to prioritise hypertension prevention and management in children and adolescents. Campaigns to raise awareness of the risks of high blood pressure in young people, as well as the benefits of a healthy lifestyle that includes physical activity, a nutritious diet low in salt and sugar, and not smoking, for example. Other advised steps include setting aside time for youngsters to watch TV and use social media without promoting junk food or possibly harmful lifestyle behaviours.
