Everything You Should Know About High Blood Pressure In Children

If you thought high blood pressure only affected older people, you’ll be surprised to learn that it can affect everyone, including children. In fact, according to the 2017 American Academy of Pediatrics clinical practice guidelines, approximately 1 in 25 people aged 12–19 years suffer from high blood pressure.¹

If untreated, high blood pressure in children can continue to adulthood and lead to life-threatening conditions like kidney disease, heart failure, and stroke. Read on to discover everything you should know about high blood pressure in children.

What's high blood pressure for a child?

Blood pressure is a measurement of the force of your blood against your blood vessels. Under normal circumstances, the heart pumps blood at a moderate pressure, allowing the vessels to widen and contract to ensure enough blood flow.

For people with hypertension, their blood pushes too hard against their blood vessels and could cause damage to their organs, blood vessels, and the heart itself.

In adults, diagnosing high blood pressure requires the doctor to check and compare systolic and diastolic numbers.² With children, diagnosing blood pressure levels is different, although the same testing process applies. The doctor will consider the child's height, weight, and sex to determine whether they have high blood pressure. 

There's no specific high blood pressure range for children. Any reading that's above the 95th percentile for children of the same height, sex, or age as your child can be regarded as high blood pressure.

According to American Family Physician, for children aged 13 years or older, a high blood pressure reading can be concluded if their systolic value is 120–129mm Hg and their diastolic level is below 80mm Hg. This is similar to what is considered high blood pressure in adults.³ The following readings show how doctors determine the level of high blood pressure in children:

• A reading between the 90th and the 95th percentile is regarded as pre-hypertension

• A reading between the 95th and the 99th percentile is regarded as stage 1 hypertension

• Anything above the 99th percentile is regarded as stage 2 hypertension

What causes high blood pressure in children?

High blood pressure in children can be one of the following:

• Primary hypertension: High blood pressure with no known cause

• Secondary hypertension: High blood pressure with a specific cause

Some of the causes of secondary hypertension in children include:

Kidney disease

Chronic kidney disease can cause high blood pressure. The kidneys remove excess water and waste products from the body, thereby regulating your blood pressure, so any damage to these organs can lead to high blood pressure. 

According to a 2017 study published in the International Journal of Nephrology and Renovascular Disease, chronic kidney disease and high blood pressure are intimately linked.⁴ They could cause detrimental effects on the kidneys if left untreated.

Prescription medicines

Particular prescriptions and over-the-counter medication can cause temporary or permanent high blood pressure in children. Some medicines are also known for interfering with medication that lowers high blood pressure.

Medications that can raise your child's blood pressure include:

Pain medications

Pain medicines like ibuprofen (e.g., Advil), piroxicam, and indomethacin can cause high blood pressure in children. These pills are anti-inflammatory medications and are known to raise blood pressure.⁵ It's recommended that your child's blood pressure is taken regularly to discuss suitable pain medication that doesn’t raise their blood pressure.

Cold medicine

Cold medicines, especially certain decongestants, can cause high blood pressure.⁶ These drugs make it harder for blood to flow freely, raising your blood pressure. Some common cold medications that can lead to high blood pressure include phenylephrine and pseudoephedrine.

Antidepressants

Antidepressants work by altering how your body responds to brain hormones like dopamine, serotonin, and norepinephrine to affect your mood. These chemicals can lead to high blood pressure. Some of the antidepressants known to raise blood pressure include:

• Tricyclic

• Fluoxetine

• Monoamine oxidase inhibitors

Illegal drugs

Illegal drugs or substance use can affect the central nervous system. The central nervous system regulates critical regulatory systems responsible for blood pressure, respiration, and heart rhythm.

In an article published in the American Journal of Medicine, drug-induced hypertension can occur in different ways, including:⁷

• Interfering with drugs meant to lower your blood pressure

• Causing high retention of sodium or fluid volumes

• Activating the sympathetic nervous system

• Affecting the arteriolar smooth muscles that regulate blood flow

Thyroid disorders

Thyroid disorders can cause high blood pressure when the thyroid secretes too much or too little thyroid hormones.⁸ Hyperthyroidism can force the heart to work harder than usual, increasing your blood pressure as a result.

Other endocrine glands that can cause high blood pressure include:

• Adrenal glands: When your adrenal glands produce too much cortisol, aldosterone, or other hormones similar to adrenaline, they might cause high blood pressure

• Pituitary glands: The production of hormones in the thyroid and adrenal glands are associated with the pituitary gland. When the pituitary gland sends excess signals to these glands, it can lead to high blood pressure.

• Parathyroid glands: Excess parathyroid hormone production can also cause high blood pressure

• Pancreas: The pancreas makes insulin. High blood pressure can result from high insulin levels or insulin resistance.

Mental health

Mental health issues, particularly stress, signal a surge of hormones which can temporarily cause high blood pressure. While there's no significant proof that stress can cause long-term high blood pressure, how young people react to stress can lead to high blood pressure.

Behaviors that are a reaction to stress, like eating unhealthy foods, excessive consumption of alcohol, and smoking are the leading causes of high blood pressure.

What are the symptoms of high blood pressure in children?

Symptoms of high blood pressure in children vary depending on the stage of the condition. 

Children and teens with stage 1 high blood pressure may not show any signs unless identified by the doctor during routine checkups.

Children with stage 2 hypertension might experience the following symptoms:

• Double vision

• Headaches

• Chest pain

• Breathing problems

• Abdominal pains

• Vision loss

An infant with stage 2 hypertension might show different symptoms like vomiting, irritability, and not feeding properly.

How is high blood pressure in children diagnosed?

Diagnosing blood pressure in children is quite complicated. Your child's doctor will conduct a series of tests to accurately confirm the diagnosis of high blood pressure.

The doctor will ask about the child's medical history, family history of blood pressure issues, and nutrition levels. They will then conduct a physical exam and take your child’s blood pressure.

While measuring the blood pressure, the doctor should ensure that the child is rested and not agitated, maintain a quiet environment, and use the right cuff size. They might measure the blood pressure twice to guarantee accurate results.

To arrive at an accurate diagnosis of high blood pressure, the doctor should record any higher-than-normal readings during at least three separate visits.

Once the doctor confirms that your child has high blood pressure, they will conduct further tests to determine whether it's primary or secondary hypertension. These tests can also help determine whether other conditions are causing your child's high blood pressure. These tests include:

• A blood test to check your child's kidney function, cholesterol levels, and triglyceride levels

• Urinalysis or urine sample test

• Echocardiogram to check the heart's blood flow and structure

• Ultrasound to evaluate your child's kidneys

Finally, the doctor might also recommend ambulatory monitoring to confirm a diagnosis of high blood pressure.⁹ The doctor will give your child a blood pressure monitor to wear for 24 hours, including while sleeping or performing various activities.

This test is suitable for ruling out blood pressure that might have risen temporarily, especially if your child is nervous at the doctor's office, a condition referred to as ‘white coat syndrome’.¹⁰

How do you treat high blood pressure in children?

Treating high blood pressure in children is similar to treating it in adults. By working closely with your doctor, you can find a suitable treatment process that works best for your child.

There are some common treatment options that your doctor may recommend.

Following the DASH eating plan

Dietary Approaches to Stop Hypertension (DASH) works by lowering daily sodium levels in your diet to about 2,300mg. By further lowering your daily sodium intake to 1,500mg, you can reduce your blood pressure even more.

The DASH diet includes several types of foods containing nutrients that can help you lower your blood pressure, including magnesium, calcium, and potassium.¹¹

Your doctor will recommend the following as part of your child's DASH diet:

• Plenty of vegetables, fruits, and low-fat products

• Whole grains, nuts, vegetable oils, seeds, and beans

• Cut back on your salt usage, sugary drinks, sweets, and red meat

• Limit alcoholic beverage intake (more relevant to older teens)

Medication

If your child has stage 2 hypertension, the doctor might recommend blood pressure medication. Some effective medicines that the doctor might prescribe are:

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors relax the blood vessels by blocking the production of chemicals that narrow them. This helps your child's blood flow through the blood vessels more easily, reducing blood pressure.

Angiotensin II receptor blockers

Like ACE inhibitors, this medication can help your blood vessels relax, allowing your child's blood to flow more freely.

Calcium channel blockers

These medications work by relaxing your child's blood vessels and can slow down the heart’s contractility (ability to contract). This will eventually lower the child’s blood pressure. 

Diuretics

Diuretics, or water pills, help your child's kidneys remove sodium and water, reducing their blood pressure as a result.

Your doctor should tell you how long your child must stay on the medication, based on how they respond to treatment. The doctor might suggest treating other medical conditions associated with high blood pressure.

Lifestyle and home remedies

Treating high blood pressure through lifestyle changes can also work for children as it does for adults. Such changes should be seen as a treatment option to complement medication, helping the medication to work better.

Some lifestyle changes you can adopt are:

Controlling your child's weight

If your child is overweight, working on achieving a healthy weight and maintaining it as they grow can help lower blood pressure.

Encouraging participation in physical activity

At least 60 minutes of moderate to vigorous physical activity a day can help to lower your child's blood pressure.

Limiting screen time

One thing that discourages children from exercising is spending time on screen. The best way to compel them to exercise is by reducing screen time and ensuring that they spend more time in active play.

When should you take your child to a doctor due to high blood pressure?

Your child's blood pressure should be assessed during routine doctor's appointments. The best age to start monitoring your child's blood pressure is three years old.

However, if your child has a congenital condition that has a high risk of raising blood pressure, such as premature birth, congenital heart disease, or low birth weight, you should schedule routine checkups sooner.

If you're concerned about certain high blood pressure risk factors like obesity, talk to your doctor as soon as possible.

The lowdown

High blood pressure is common in children but is highly controllable. However, failing to take relevant measures can cause life-threatening complications that can carry on to your child's adulthood.

It's recommended to seek immediate medical care if you start noticing any of the symptoms described in this article. At the same time, introducing medication and lifestyle changes can help lower your child's blood pressure to the optimum level.