[MUST READ] Hypertension in children

Hypertension is a serious ailment which afflicts people of all races and across all age groups. Last week, we explored briefly the effects of this problem in the general population, the factors considered before treatment is undertaken and the efforts which must be made in order to prevent those consequences from happening. The number of text messages and emails that came in as a result of that essay prompted this one. It is being written partly to demonstrate that even children and also adolescents can suffer from this malady. It is a real problem and the number of those who have it is probably understated. 

Continue reading after the cut....

That recognition has prompted the formation of an association in the United States called the Society for the Prevention of Hypertension in Children. There are now similar organisations in the United Kingdom, France and elsewhere.

Unlike in the adults, there are no definite figures to determine what constitutes hypertension in children. In this population group, the diastolic pressure is given more prominence in helping to determine when blood pressure can be said to be high. The blood pressure in children is measured with more strictness. It should be taken with the children lying down or sitting up in a comfortable position with a relatively large cuff at the level of the heart. The cuff should occupy about two-thirds of the length of the arm. Any cuff smaller than that is likely to give falsely high blood pressure readings. In a modern practice, any examination of a child who is at least three years of age should necessarily incorporate these measurements.

Hypertension in children is an inverse proportion to that seen in adults. Most of the cases are due to some other problems existing elsewhere in the body so that most are called secondary hypertension. Of these, 95 per cent are due to kidney related problems. In this connection, diastolic blood pressure in children from three to 12 years should be less than 85 millimetres of mercury. From 13 to 18 years they should return diastolic figures of less than 90 millimetres of mercury. So that by the time an adolescent is 18 years of age, he could have blood pressure measurements that are similar to what is obtainable in a young adult. In some nations of the world, an 18-year-old is regarded as a man or a woman depending on their gender. This is of course, not to say that children less than three years of age cannot be diagnosed with high blood pressure. I have seen an infant boy who had a stroke with paralysis of one half of the body as a result of severe hypertension that resulted from an abnormality of his urinary tract.

Some of the problems which commonly make children prone to developing high blood pressure are as follow:

• Vascular diseases such as:

(a) Renal vein thrombosis in which a blood clot lodges in the renal vein.

(b) Coarctation of the aorta in which there is abnormal narrowing of the aorta such that there is hypertension in the upper part of the body and a low or normal pressure in the lower part.

(c) Renal artery stenosis which means an abnormal narrowing of the renal artery.

In all the causes of childhood hypertension enumerated above, the relevant operation to correct the abnormality usually also cures the hypertension.

• ) Kidney problems which include the following;

(a) Chronic glomerulonephritis which is an enduring inflammation of the functioning unit of the kidneys commonly as a result of a bacterial infection. This disease is characterised by the progressive loss of proteins and red blood cells over a long period of time.

(b) An obstruction to the normal outflow of urine such that the urine is not passed out properly. The ureters and the bladder enlarge over time as a result because of the build-up of pressure until even the kidneys become similar to balloons and unable to perform their functions. The most common cause of such an obstruction is called posterior urethral valves, an exclusively male child disease.

(c) Polycystic kidney which means collections of fluid-filled sacs all over the kidney that slowly replace normal kidney tissue and leave behind useless sacs unable to fulfil the role of those kidneys.

(d) Kidney dysplasia which means a normal looking kidney with the wrong component of cells. Such a kidney can of course, not function normally and hypertension could result over a short period of time.

(e) Tumours originating in the kidneys.

The lesions described in numbers 2 to 5 above are also correctible by specific operations which usually help is bringing the raised blood pressure under control.

• ) Disorders of the endocrine system such as in the following:

(a) Phaeochromocytoma which is a disorder characterised by restlessness, headaches and abnormal sweating.

(b) Neuroblastoma which is a tumour of the supra-renal gland where the body secretes adrenaline and nor-adrenaline. A cancer originating from that organ causes an uncontrolled synthesis and release of those substances and cause hypertension.

(c) Congenital adrenal hyperplasia which is a tumour of the adrenal glands that similarly produces different chemical substances that also would eventually cause hypertension.

(d) Cushing’s syndrome, which is related to the sustained exposure to the hormone cortical in high levels, caused often by the development of a tumour in the master gland, the pituitary. It is characterised by obesity, a moon-face appearance and the development of high blood pressure.

• Miscellaneous causes include the following:

(a) Drugs such as oral contraceptives are an important possible cause among teens who are sexually active.

(b) Tumours within the brain can produce a sustained pressure effect within the skull and thus result in a raised blood pressure.

When hypertension is sustained in a child or an adolescent without the relevant surgical and or drug treatment, consequences similar to those discussed in last Sunday’s article can also ensue. The major difference here in contrast to that seen in adults is that many of the causes of hypertension in children are eminently treatable. Results are best when these lesions are picked up early. However, once the long term changes of sustained hypertension occur, they are usually not reversible.

A child who is diagnosed with high blood pressure must have blood tests to determine how fit they are and how much useful kidney function remains. The urine must also be examined for evidence of infection and abnormal protein loss. Children who are hypertensive without suffering any of the above diseases must be placed on medications especially if they come from families where one or more persons are already known hypertensive. Obese and overweight children should exercise more, make efforts to cut down on their food intake and their weight. That combination will bring about control and perhaps cure.

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