Health & Medicine

New blood pressure guidelines for children

Millions of young Americans with elevated blood pressure don’t know they have it. In August, the American Academy of Pediatrics published a much-simplified chart to help physicians readily determine whether a child’s blood pressure is within normal parameters.
Millions of young Americans with elevated blood pressure don’t know they have it. In August, the American Academy of Pediatrics published a much-simplified chart to help physicians readily determine whether a child’s blood pressure is within normal parameters. Getty Images/iStockphoto

Had Matthew Goodwin’s blood pressure been checked at age 3, when it should have been, he most likely would have been spared a medical emergency a year later. He spent two weeks in the pediatric intensive care unit while doctors tried to determine why his blood pressure had spiked off the charts following minor surgery.

Matthew turned out to have a congenital kidney disorder that caused severe hypertension and required surgeons to remove one of his kidneys and implant it in a new location, a procedure known as a kidney autotransplant. Now a 15-year-old honors student from Prairieville, La., Matthew takes pressure-lowering medication and adheres to a low-sodium diet loaded with fresh fruits and vegetables and no soft drinks.

Knowing his experience is not unique and that millions of young Americans with elevated blood pressure don’t know they have it, Matthew, who hopes to become a pediatric nephrologist, volunteers for the National Pediatric Blood Pressure Awareness Foundation, a nonprofit advocacy group his mother, Celeste Goodwin, created to educate parents and professionals about the importance of regular blood pressure checks in children and adolescents.

Boosting this effort, in August the American Academy of Pediatrics published a 74-page report updating its guidelines for screening and managing high blood pressure in youngsters. The report includes a much-simplified chart to help physicians readily determine whether a child’s blood pressure is within normal parameters.

Just as children’s blood pressure cannot be measured with a cuff meant for an adult-size arm, it also cannot be interpreted on an adult scale.

For children, the definition of normal blood pressure is not based on a simple reading of systolic over diastolic blood pressure, like 110 over 70 or 120 over 80. Rather, because normal blood pressure varies with a child’s age, gender and height, doctors typically needed to consult pages of charts to determine whether a patient’s pressure was normal or not.

Now, the new guidelines provide a short, easy-to-use table based only on a child’s gender and age, from 3 to 18, that doctors can readily consult and even hang in the office where they and parents can see it.

Study after study has demonstrated that elevated blood pressure is correctly diagnosed in less than one-quarter of the children who have it. For example, the largest study, published last year in the journal Pediatrics, covered more than 1.2 million patients ages 3 to 18. Electronic health records showed that 398,079 had their blood pressure measured at three or more visits. Of these, readings in 12,138 children met the criteria for hypertension and 38,874 for pre-hypertension (now called elevated blood pressure). But only 23.2 percent with hypertension and 10.2 percent with pre-hypertension were diagnosed as such and duly noted for follow-up in their health records.

Dr. David Kaelber, a pediatrician and internist at the MetroHealth System in Cleveland who directed the study and was co-chairman of the team that developed the new guidelines, said, “It’s great to have guidelines, but they’re only as good as the people who actually follow them.”

You may wonder why a diagnosis of high or elevated blood pressure in children is important. Although children don’t usually suffer the consequences of high blood pressure in the pediatric years, Kaelber said, unless treated, it can result in early heart attacks, strokes and kidney disease.

Elevated blood pressure in children predicts high blood pressure in adults, a leading risk factor for heart attacks and strokes. Already in young adults who’ve had elevated blood pressure as children, “you can see two kinds of cardiovascular damage,” Dr. Joseph T. Flynn, lead author of the new guidelines, said. “There is thickening of the left ventricle, the heart’s main pumping chamber, and thickening of blood vessel walls that is clearly tied to atherosclerosis and heart attacks in adults.”

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