Heart disease remains the leading cause of death among adults in the United States, but now experts are looking at kids’ health to determine who is most at risk of developing cardiovascular disease in the future.
Updated guidelines that classified more children with elevated blood pressure are better at predicting which children may develop heart disease as adults, a new study finds.
A report in the American Heart Association’s journal Hypertension evaluated the 2017 American Academy of Pediatrics (AAP) guidelines. Prior to the 2017 update, the standards had not been since 2004.
“Based on our results, the guidelines are pretty accurate at identifying individuals who go on to have adult hypertension or other indicators of heart disease risk,” Dr. Lydia A. Bazzano, senior author of the study and associate professor of epidemiology at the Tulane School of Public Health and Tropical Medicine in New Orleans, told Healthline. “That is actually a good thing because it allows parents and kids to make changes if needed that can benefit their health over a lifetime.”
Her review found that compared with children with normal blood pressure, those reclassified as having elevated or high blood pressure were more likely to develop adult high blood pressure, thickening of the heart muscle wall, and metabolic syndrome — all risk factors for heart disease, explained.
The study Bazzano used followed 3,940 children for 36 years and provides useful follow-up data.
According to Bazzano’s review, the newer guidelines would identify 11 percent of participants as having high blood pressure, compared to 7 percent using the 2004 guidelines. Also, 19 percent of children with high blood pressure under 2017 guidelines developed thickening of the heart muscle during the follow-up period, compared with 12 percent of those considered to have high blood pressure according to the 2004 guidelines.
The new guidelines also mean that not all children classified with high blood pressure will require medication for the condition.
The 2017 guidelines set parameters for cutoffs based on children of normal weight; the older guideline included overweight and obese children, which skewed the cutoffs to a higher threshold. The update enables a more precise classification of blood pressure levels according to age, sex, and height.
“This change is more in line with adult hypertension guidelines,” Bazzano explained.
More children may be diagnosed as hypertensive, but it can also encourage better health awareness and reduce future heart disease risk, according to a released by the U.S. Centers for Disease Control and Prevention.
There were some limits to the research, as it doesn’t record actual heart attacks and strokes the children followed had in adulthood. The children studied were also from one community in Louisiana, and may not reflect the nation as a whole.
For most children with high blood pressure, lifestyle changes are the leading treatment. This includes avoiding excess salt in the diet, exercising regularly, eating well, and maintaining a healthy weight, Bazzano noted.
Dr. Joshua Samuels, a professor of nephrology and director of the hypertension program at the University of Texas Health Science Center at Houston, hopes parents remember that elevated and high blood pressure affects children as well as adults.
“You’ll never know that your kid has a BP problem unless it gets measured,” Samuels told Healthline. If your child is over the age 3, make sure the doctor takes a reading during routine well visits.
Children under 13 have different blood pressure thresholds than adults. For adults, anything at or under 120/80 is normal. Depending on a child’s weight, height, and sex, their levels vary. In general, children have lower blood pressure than adults. Doctors must use a specific calculation based on percentiles to evaluate what’s normal, elevated or high.
If your child has an elevated or high reading, a doctor should take it on two more occasions. Some children have elevated blood pressure from “white coat syndrome,” where being in the doctor’s office can cause stress and elevated blood pressure.
In those cases doctors may have an ambulatory monitoring device to gauge blood pressure readings for 24 hours. This enables them to tell if the child’s level falls when they are out of a medical setting, and if the elevated numbers are due to medical anxiety compared to a health ailment.
Other reasons for elevated or high blood pressure in children can be heart and vascular issues, kidney issues, or endocrine system issues. This is why ruling out white coat syndrome is so important. Doctors want to make sure they treat any underlying condition that causes elevated or high blood pressure. This way they can tell who needs medication for blood pressure compared to who does not.
“There are a lot of medications that are safe and effective at treating hypertension in children,” noted Samuels, who last year published a report on the 2017 guidelines.
Doctors typically try to manage lifestyle issues if the rise in blood pressure is related to weight.
While no study has shown that increased blood pressure in childhood leads to an early death as a result of cardiovascular issues as an adult, there is enough research to show that children with hypertension turn into adults with hypertension, which is a risk factor for cardiovascular issues, Samuels said. This is why it’s vital that parents are aware of any blood pressure issues in children.
“Under the new definition we’re better able to find kids at risk — we think that’s a precursor to later cardiovascular issues,” he noted.
“Blood pressure is important in children and adolescents and should be measured at routine healthcare visits,” Dr. Stephen R. Daniels, pediatrician-in-chief at Children’s Hospital Colorado.
Parents don’t need to keep a certain number in mind because the numbers can change as the child ages. Pediatricians must discern if blood pressure is not normal and help parents understand the reading.
“It’s good to have your child’s blood pressure checked so you can be aware if it may be high and help prevent heart disease in their future,” Bazzano added.