Hypertension symptoms & causes in

children
What is hypertension?
Hypertension means “high blood pressure.” This refers to how hard the blood is pushing against
the walls of the artery through which it flows—not how quickly it flows. In hypertension, the
level of pressure is higher than normal.

How is blood pressure measured?

Blood pressure is measured in millimeters of mercury (mm Hg). A typical normal blood pressure
in an adult is 120/80 mm Hg, or "120 over 80." The top number refers to the pressure when the
heart is pushing blood out through the arteries (systolic). The bottom number refers to the
pressure when the heart is at rest—“between beats” (diastolic).
It’s easy to tell whether an adult has hypertension, because there’s a standard set of
measurements:

 Normal blood pressure—systolic < 120 mmHg and diastolic < 80 mm Hg

 Pre-hypertension—systolic 120-139 mmHg or diastolic 80-89 mmHg
 Stage 1 hypertension—systolic 140-159 mmHg or diastolic 90-99 mmHg
 Stage 2 hypertension—systolic ≥160 or diastolic ≥100 mmHg

But it’s harder with children. That’s because there are no universal cut-offs as there are for
adults; instead, whether a child has hypertension depends on how his blood pressure
compares to his peers (determined by gender, height, and age).

 Pre-hypertension—90  to 95  percentile

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 Stage 1 hypertension—95  – 99  (plus 5 mm mercury)

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 Stage 2 hypertension—anything higher than 99  plus 5 mm mercury

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How common is hypertension in children?

Hypertension is becoming increasingly common in children and adolescents. A recent study that
looked at 15,000 adolescents found that nearly one in five had hypertension. And there’s reason
to believe that hypertension is vastly underdiagnosed in children, since:

 it can be difficult to measure in infants and young children

 it’s sometimes challenging to identify
 it’s often thought of as not something that really affects kids
The rise in the number of children with primary hypertension in the United States is thought to
correlate with the rise of obesity.

What complications are associated with hypertension?

While kids with hypertension are unlikely to have heart attacks and strokes, it still has significant
risks. Hypertension causes changes in the structures of the blood vessels and heart. Since
hypertension in children has historically been understudied, there isn’t a lot of data about exactly
what these changes mean. But we do know that in adults, hypertension increases the chance of
complications in the heart, blood vessels, and kidneys. There’s also compelling evidence that
some of these changes are seen in children with high blood pressure.
These changes affect:
Blood vessels—high blood pressure can damage blood vessels throughout the body, which
makes it harder for organs to work efficiently.
Kidneys—if the blood vessels in the kidneys are damaged, they may stop removing waste and
extra fluid from the body. This extra fluid can raise blood pressure even more.
Other organs—if left untreated, hypertension makes it harder for blood to reach many different
parts of the body, including the eyes and the brain, and can lead to blindness and strokes.

Can primary hypertension be prevented?

Pediatricians are making great efforts to prevent obesity and stem the tide of problems that
accompany it. We believe that promoting healthy lifestyle choices will help combat this trend
and will go a long way towards preventing primary hypertension in children (and keep adults
healthier, too).
Some things are being done—nutritional information is being made more readily available,
there’s one push to provide healthy options in schools and another to remove soft drinks from
them—but still, it often comes down to families making the right decisions. We are dedicated to
educating families to assist with appropriate dietary and activity choices to improve overall
health and reduce the risk of hypertension.

What is “white coat hypertension”?

“White coat hypertension” is when a child’s blood pressure readings are high at the doctor’s
office (mostly because she’s anxious, which can cause blood pressure to rise), but normal outside
of the office (for example at home or at school).
This is pretty common in kids. By some estimations, between 30 and 40 percent of kids who
have high blood pressure in the office actually have white-coat hypertension.
White coat hypertension is still a risk. Everyone’s blood pressure changes from time to time—
it’s lower when you’re asleep, for example—but if a child’s blood pressure continually rises
when she’s anxious (such as before a test), it can be sign of high blood pressure at other times
and potentially cause the same kinds of damage that standard hypertension causes.
White coat hypertension is diagnosed by taking the child’s blood pressure outside of the doctor’s
office. This can be done in different ways:

 Some parents feel comfortable doing it at home.

 Sometimes we make arrangements for a school nurse to check the child’s blood pressure.
 Your child’s doctor might recommend that she wear an ambulatory blood pressure
monitoring device—a blood pressure cuff attached to a small device that sits on her belt ,
and measures her blood pressure at regular intervals over the course of 24 hours. This
device is about the size of a deck of cards and is usually tolerated very well.

If your child is diagnosed with white coat hypertension, her doctor may still want to follow her,
since some children with white coat hypertension will develop actual hypertension in the future.

Causes of hypertension in children

1. Primary hypertension
Primary hypertension means that the hypertension does not seem to be caused by some other
underlyng medical condition. Many doctors think that the incidence of childhood or adolescent
hypertension has been rising along with the obesity epidemic. The majority of teens and children
over age 6 with hypertension have a family history of hypertension and/or are overweight.
2. Secondary hypertension
Secondary hypertension is caused by a known underlying medical condition. Of these, about

 80 percent of children have some kind of kidney disease or blood vessel abnormalities
 5 percent have an endocrinological disorder
 2 to 5 percent have heart disease

Hypertension in infants with hypertension almost always has a secondary cause. In addition,
premature infants have a higher incidence of hypertension.
Among kids with hypertension, especially those who are very young, secondary hypertension is
more common than primary hypertension. But among children who are older than 6 to 8 years
old, the ratio of primary to secondary hypertension is approaching 50/50.

Signs and symptoms of hypertension

Often, kids and teens with pre-hypertension or stage 1 hypertension won’t show any symptoms
at all. If your child has stage 2 hypertension, she might experience one or more of the following
symptoms:

 headaches
  loss of vision
 double-vision
 chest pain
 abdominal pain
 breathing problems

An infant with stage 2 hypertension may seem irritable, not be feeding properly, or vomiting.
Sometimes these infants are diagnosed with “failure to thrive.”