World hypertension days Hypertension prevention is often very important in children too

More and more children and adolescents suffer from hypertension due to being overweight. For this reason, on the occasion of World Hypertension Day, cardiologists are calling for pediatricians to increase their blood pressure control. This is too rare, because hypertension is considered to be an old-age disease.

More and more children and adolescents have high blood pressure because they are overweight. A European guideline therefore requires paediatricians to monitor blood pressure during check-ups. A co-founder justified the step at a symposium of the German Hypertension League e.V. DHL® at the 123rd Annual Congress of the German Society for Internal Medicine in Mannheim.

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High-pressure diseases, also called hypertension, were earlier rare in children. "As a rule, children with congenital diseases of the heart and the blood vessels or the kidneys were affected", reports Professor Dr. med. med. Elke Wühl, Senior Physician of the Pediatric Nephrology Section at the Center for Pediatric and Adolescent Medicine of the University Hospital Heidelberg. "Treating hypertension in these cases has long been routine. Lowering blood pressure can often prevent further organ damage, "continues the expert, who specializes in the treatment of kidney disease in children. For several years, however, the number of children whose blood pressure without underlying disease has increased is increasing. The cause is then often too high a body weight: "Every fourth child with obesity suffers from high blood pressure," says Professor Wühl, a member of the commission hypertension in children and adolescents of the high pressure league. In overweight children, the proportion is about seven percent. But also normal-weight children can get hypertension.

The European Society of Hypertension (ESH) has therefore last year revised its guidelines for the treatment of high-pressure diseases in children and adolescents. It is confirmed that paediatricians and family physicians should control the blood pressure of all children and adolescents. "From the age of 3, this should be done at every medical presentation," said Professor Wühl. In younger children, blood pressure measurement is usually only necessary for risk factors such as premature birth or congenital heart disease and kidney disease.

Diagnosing hypertension in children and adolescents is not easy. The pediatrician needs special blood pressure cuffs, whose width and length must be adapted to the upper arm of the children. Blood pressure is lower in children and adolescents than in adults. Professor Wühl explains: "A value of 120 to 80 mm Hg, which is optimal for adults, is just normal for a 12-year-old, too high for a 6-year-old, for a 3-year-old is a severe hypertension and at an emergency for a newborn. "The guideline of the ESH therefore contains tablets that show the blood pressure limits for the different ages. From the age of 16 then the recommendations for adults, where the upper limit is 140 to 90 mm Hg apply.

In the case of obese children, the treatment is initially based on a lifestyle change. The goal is a weight loss of one to two kilos a month. This means more sport and a healthy diet. Professor Wühl explains: "Children should refrain from excessive sugar intake and soft drinks as well as limit the intake of fat and salt." Highly recommended fruits, vegetables, and fiber. In addition, at least 60 minutes a day sport. Outside the school, children should spend less than two hours a day sitting.

"When the children lose weight and do sports, usually normalizes the blood pressure," reports Professor Wühl. If this fails, doctors should not be afraid to prescribe medicines. Most high-pressure medicines are well tolerated and as effective in children and adolescents as they are in adults. If the blood pressure is not controlled, threatened already in adolescence first consequential damage. These include thickening of the heart muscle and blood vessels, which may be harbingers of vascular calcification. That hypertension develops over time is rare. "Blood pressure changes in adolescents continue into adulthood," says Professor Wühl. Experts call this a "tracking phenomenon".