NEW YORK (Reuters Health) - Despite recommendations to check children’s blood pressure, pediatricians may often skip it, a U.S. study suggests. Using government survey data, researchers found that pediatricians failed to take kids’ blood pressure at about one-third of routine check-ups between 2000 and 2009. The American Academy of Pediatrics and the National Heart, Lung and Blood Institute both recommend that children have yearly screenings for high blood pressure, starting at age 3. So it’s surprising that blood pressure checks were not done at so many preventive care visits, according to Daniel J. Shapiro, a medical student at the University of California, San Francisco who led the new study. What it all means for kids’ health is not clear. But the findings are important because high blood pressure and “pre-hypertension” could have health consequences for kids in the long run, said Dr. Margaret Riley, an assistant professor of family medicine at the University of Michigan who was not involved in the study. “High blood pressure in children can lead to changes in the child’s heart and blood vessels, and puts them at increased risk for heart disease and strokes as they get older,” Riley said in an email. Between two and five percent of U.S. kids and adolescents have high blood pressure, previous studies have found. When a young child has high blood pressure, Riley noted, it may be because of an underlying medical condition, like kidney disease. So blood pressure checks can sometimes help catch a serious health problem. Shapiro’s team did find that doctors were more likely to measure blood pressure during check-ups where they diagnosed a child as being overweight or obese. During those visits, they checked blood pressure 84 percent of the time. The numbers also improved over time, the researchers report in the journal Pediatrics. In 2001, blood pressure was taken during 51 percent of all routine check-ups; by 2009, it was 71 percent. “Over this time period, providers may have become more aware of the recommendations of various professional organizations,” Shapiro said in an email. Not everyone says that children should have their blood pressure routinely checked. The U.S. Preventive Services Task Force (USPSTF) - an expert panel with federal support - currently has no advice for or against it. But since “new evidence” has emerged in recent years, the panel is currently updating its recommendations. The new findings are based on data from two annual government surveys of doctors’ practices and emergency rooms. When the researchers looked at all pediatric visits - which would include visits for an illness or injury - doctors checked kids’ blood pressure only one-third of the time. If a child is ill, in pain or crying, Riley noted, a doctor might not want to check blood pressure because it could be “falsely elevated.” On top of that, she said, the child’s height and weight would have to be measured - since doctors need that information to know whether a child’s blood pressure is normal. But even during routine check-ups, Shapiro’s team found, pediatricians only measured children’s blood pressure two thirds of the time. “In my clinical practice, parents frequently inquire about their child’s height and weight,” noted Dr. Anisha Patel, an assistant professor of pediatrics at the University of California, San Francisco and the senior researcher on the study. But rarely do parents ask about their kids’ blood pressure, Patel said in an email. “Parents should ask their child’s physician if the blood pressure was measured, and if so, if it was a concerning reading.” Riley agreed. “If a parent takes their child to the doctor and no blood pressure is taken,” she said, “they should speak up and advocate for their child to get this simple screen that may significantly impact their health.” If a child does have elevated blood pressure, the doctor should take repeat measurements to make sure it’s truly high. A one-time “high” could just reflect anxiety, Patel said. A child with persistently high blood pressure might need diet changes or more exercise, especially if he is overweight, Patel noted. But if those blood pressure readings are very high, she said, parents may need to see a specialist to uncover any medical condition that could be causing the problem. There are five blood pressure stages: normal and four specific stages of hypertension, which range from very treatable to urgent.  People with a blood pressure range of 90 to 120 systolic and 60 to 80 diastolic have normal blood pressure, says Dr. Wong. A systolic reading below 90 signifies low blood pressure. Elevated Blood PressureA blood pressure reading of 120 to 129 systolic and less than 80 diastolic signifies elevated blood pressure and, thus, a higher probability of developing hypertension. “As blood pressure elevates, there is increased workload on the heart and arteries,” says Dr. Desai. “This results in [the] thickening of the heart muscle (hypertrophy), which can lead to heart failure. It also results in [the] micro-tearing of the artery wall, leading to cholesterol deposition (atherosclerosis). This leads to [the] narrowing of the vessel and further elevation of blood pressure.” Hypertension Stage IHypertension Stage I is defined by a systolic reading of 130 to 139 and a diastolic reading of 80 to 89. Dr. Wong says while doctors initially treat this stage of hypertension by suggesting a healthier lifestyle—eating more vegetables and whole grains, using less salt, increasing physical activity and controlling stress—medications may be needed if blood pressure falls in this range on multiple readings over a period of time in people with other cardiovascular risk factors. Dr. Wong adds that, per 2017 ACC/AHA guidelines, adults with Hypertension Stage I should consider medication after three to six months of nonpharmacologic therapy. There’s also a risk of atherosclerosis—thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery—if it isn’t treated. Risk factors for atherosclerosis may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity and eating saturated fats. Hypertension Stage IIHypertension Stage II is marked by a systolic reading of at least 140 and diastolic reading of at least 90. It’s generally treated with a mix of medications and a healthy lifestyle prescription, says Dr. Wong. Still, this stage of hypertension is more serious than the former and should be watched carefully. Hypertensive CrisisA hypertensive crisis is an emergency situation and occurs when the systolic blood pressure reading exceeds 180 and the diastolic reading exceeds 120. “Immediate organ damage can occur and emergency treatment should be sought if there are symptoms of stroke, headache, visual changes, dizziness, chest pain or shortness of breath,” says Dr. Wong. |
