Journal Information
Vol. 39. Issue 6.
Pages 339-340 (June 2020)
Share
Share
Download PDF
More article options
Vol. 39. Issue 6.
Pages 339-340 (June 2020)
Editorial comment
Open Access
High blood pressure in pediatric care: Early diagnosis and treatment can reduce the risk of cardiovascular events in adulthood
Pressão arterial elevada em cuidados pediátricos: o diagnóstico precoce e a terapêutica podem reduzir o risco de eventos cardiovasculares na idade adulta
Visits
1993
Marília Loureiro
Serviço de Cardiologia Pediátrica, CMIN-Centro Hospitalar Universitário do Porto, Porto, Portugal
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text

The prevalence of high blood pressure (BP) in children has increased considerably as sedentary lifestyles and weight/obesity problems have grown in children.1 High BP is very likely to continue throughout childhood and adolescence, leading to premature cardiovascular events in adulthood. There is an urgent need to identify children at risk and offer them early intervention.1,2

Pediatric hypertension is difficult to identify accurately. Variations in surveillance strategies, diagnostic definitions and BP assessment methods account for epidemiological inaccuracies.

In children and adolescents, the prevalence of high BP is estimated to be between 2-5% and the prevalence of prehypertension between 4-15%. Several authors have established a relationship between body mass index and blood pressure levels, with a statistically significant higher prevalence (11-30%) of elevated BP in overweight and obese children and adolescents.2,3

The Portuguese National Child and Youth Health Program recommends the assessment of BP in all children over the age of three at routine doctor appointments. BP should be measured under the age of three in the presence of risk factors or diseases associated with high blood pressure.

Ambulatory blood pressure monitoring (ABPM) should be measured in pediatric patients with a likely diagnosis of high BP, since values obtained over 24 hours have higher reproducibility and a better correlation with target organ damage. ABPM also enables white coat BP or masked high BP to be studied, the latter being associated with progression to sustained high BP.4

In 2008, the American Heart Association (AHA) issued the first consensus recommendations for performing and interpreting ABPM in children. They have been updated several times and all advocate more frequent use of ABPM in children and adolescents with suspected high BP.5,6

ABPM should be interpreted according to percentile tables, such as those produced by the European Hypertension Society (updated in 2016).7 ABPM is the gold standard to confirm the diagnosis of high BP, particularly in overweight and obese children and adolescents with cardiovascular risk factors.

One of the most valuable parameters when evaluating children with high BP is arterial pulse wave velocity (PWV). This is a non-invasive method that characterizes arterial stiffness and predicts adverse cardiovascular events. PWV is essential in the study of the pediatric population with high BP.8 In the June issue of the journal, E. Cilsal presents a study of 30 children with newly diagnosed high blood pressure, highlighting the importance of early diagnosis and the highly probable relationship between high BP and cardiovascular diseases in adulthood. The author reports that the onset of cardio-vascular damage can be at a young age with an increase in left ventricular mass, progressing to left ventricular hypertrophy. This small series gives further insight into the subject and describes the analysis of heart rate variability, which showed decreased parasympathetic activity in children with high BP.9 Further studies are necessary.

All children with ABPM-confirmed high blood pressure should undergo echocardiography to screen for congenital heart disease as a potential underlying cause, including coarctation of the aorta, and to assess left ventricular mass and cardiac output.10

Early detection of high BP in children is paramount and preventive measures need to be established. As stated by the AHA in 2016, it is only by promoting cardiovascular health in all children that can we decrease the risk of cardiovascular disease in adulthood.11

Conflicts of interest

The author has no conflicts of interest to declare.

References
[1]
E.T. Monego, P.C.B.V. Jardim.
Determinants of risk of cardiovascular diseases in schoolchildren.
Arq Bras Cardiol, 87 (2006), pp. 37-45
[2]
D.R. Ewald, L.A. Haldeman.
Risk factors in adolescent hypertension.
Glob Pediatr Health, 3 (2016), pp. 1-26
[3]
J. Maldonado, T. Pereira, R. Fernandes, et al.
An approach of hypertension prevalence in a sample of 5381 Portuguese children and adolescents. The AVELEIRA registry “Hypertension in children”.
Blood Press, 20 (2011), pp. 153-157
[4]
H. Andrade, A. Pires, N. Noronha, et al.
Importance of ambulatory blood pressure monitoring in the diagnosis and prognosis of pediatric hypertension.
Rev Port Cardiol, 37 (2018), pp. 783-789
[5]
E. Urbina, B. Alpert, J. Flynn, et al.
Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment. A scientific statement from the American Heart Association, Atherosclerosis Hypertension, and Obesity in Young Committee of the Council on Cardiovascular Disease in the Young and the Council for High Blood Pressure Research.
Hypertension, 52 (2008), pp. 433-451
[6]
J.T. Flynn, E.M. Urbina.
Pediatric ambulatory blood pressure monitoring: indications and interpretations.
J Clin Hypertens, 14 (2012), pp. 372-382
[7]
E. Lurbe, E. Agabiti-Rosei, J.K. Cruickshank, et al.
European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents.
J Hypertens, 34 (2016), pp. 1887-1920
[8]
A. Redington, E.J.T. Sarkola, C. Manlhiot, et al.
Pressure changes evolution of the arterial structure and function from infancy to adolescence is related to anthropometric and blood pressure changes.
Arterioscler Thromb Vasc Biol, 32 (2012), pp. 2516-2524
[9]
E. CILKSAL.
In newly diagnosed hypertensive children, impaired arterial stiffness and reduced heart rate variability parameters were significantly increased and related with non-dipping blood pressure pattern.
Rev Port Cardiol, 39 (2020), pp. 331-338
[10]
E.M. Urbina, B. Mendizabal, R.C. Becker, et al.
Association of blood pressure level with left ventricular mass in adolescents.
Hypertension, 74 (2019), pp. 590-596
[11]
J. Steinberger, S.R. Daniels, N. Hagberg, et al.
American Heart Association Atherosclerosis Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Functional Genomics and Translational Biology; and Stroke Council. Cardiovascular health promotion in children: challenges and opportunities for 2020 and beyond: a scientific statement from the American Heart Association.
Circulation, 134 (2016), pp. e236-e255
Idiomas
Revista Portuguesa de Cardiologia (English edition)
Article options
Tools
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.