Is my child at risk of hypertension? How often should blood pressure be checked? Does my child require evaluation for high blood pressure?

Dr. Paula Goel, Pediatrician & Adolescent Specialist

We usually assume that high blood pressure is a problem that affects adults, and not children. However, essential hypertension is quite common, and affects 2–3% of otherwise normal children. As most children do not show symptoms of hypertension, doctors recommend that blood pressure should be measured once a year in every child older than 3­years of age. In addition, screening of children younger than  3­yr­old is  advised in certain high­risk settings. Children who are obese, have obstructive sleep apnea (snoring,  frequent night­time awakening, mouth breathing) or whose parent(s) has/have hypertension, are at increase risk of essential hypertension and should definitely be screened for high blood pressure. Children with conditions associated with secondary hypertension, such as diseases affecting the kidneys, blood vessels, endocrine glands, heart or brain, or taking medications that might increase blood pressure, require regular screening.

If hypertension is confirmed, your child must be evaluated for the cause and consequences of high blood pressure. Certain tests are necessary to look at the effect of high blood pressure on the kidneys, heart, and eyes. An echocardiogram, detailed examination of the eyes, and blood tests are required. Even if essential hypertension is suspected, certain investigations are necessary to rule out secondary causes. Based on clues from history and physical examination, your physician will advise specific blood and urine tests. Your child would undergo an ultrasound of the abdomen to evaluate the kidneys and its vessels, and screen for other abnormalities.

The management of hypertension is guided by this evaluation, as the choice of drugs may vary by the cause. Specific and definitive management of the underlying disease may be possible in few instances

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