Kids and blood pressure: What every parent should know

hypertension in children

We tend to associate hypertension with older age, but the truth is that anyone can develop high blood pressure — even kids. In fact, pediatric hypertension occurs in 2 to 5 percent of kids and is one of the top five chronic diseases in children, according to the American Academy of Pediatrics. While an elevated blood pressure reading may seem alarming, it isn’t always a sign of a more serious disease. Here’s what every parent should know about blood pressure in kids.

It’s a routine test.

“Your child’s primary-care provider should check their blood pressure at every routine well-child visit for kids age 3 and older, and more often in kids with certain risk factors, such as obesity and diabetes,” says Dr. Corinna Rea, a pediatrician in Boston Children’s Primary Care at Longwood. If your child’s clinician skips this test, be sure to request it.

Stress could be to blame.

Just as adults can experience elevated blood pressure readings during doctor visits, the stress of the medical environment can cause pressure to rise in some kids. But that’s not a reason to discount the reading, says Rea. Instead, your child’s provider should perform two additional measurements during the same visit. If pressure is normal by the third reading, no further action is necessary.

If blood pressure stays elevated, your child’s doctor may consider additional testing with an ambulatory blood pressure monitor, a portable device that records blood pressure every 20 to 30 minutes over a 24-hour period. Based on those results, your child could be referred to specialty care.

There are two main types of hypertension.

In primary hypertension, elevated blood pressure doesn’t seem to be caused by some other underlying medical condition. It’s more common in older children and teens, often appears to be related to obesity and is usually treated with lifestyle measures such as diet and exercise.

On the other hand, secondary hypertension stems from an underlying medical condition, such as kidney disease, blood vessel anomalies, endocrine disorders, heart problems and even use of certain medications. If your child’s physician suspects that their high blood pressure may be due to an underlying condition, they may refer you to a nephrologist, preventive cardiologist or other specialist, says Dr. Deborah Stein, co-director of the Center for Midaortic Syndrome and Renovascular Hypertension.

Testing determines treatment.

Based on your child’s risk factors and other symptoms, the specialist will perform further evaluation of the problem, including blood and imaging tests. The results of these tests help determine which class of blood pressure medication, if any, is recommended. Some causes of renovascular hypertension, such as midaortic syndrome, may eventually require surgery or other interventional procedure.

Regardless of the treatment, the specialist should work with your child’s provider for optimal care, says Dr. Michael Ferguson, the Center’s other co-director and director of the Renal Hypertension Program. “Kids with secondary hypertension need a collaborative team of pediatricians, specialists and even school nurses that communicate well with each other,” he explains. “We want to work with primary care providers to monitor treatment and help kids stay healthy.”

Learn about the Renal Hypertension Program, the Center for Midaortic Syndrome and Renovascular Hypertension and Boston Children’s Primary Care at Longwood.