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More and more children and adolescents suffer from high blood pressure due to being overweight. For this reason, on the occasion of World Hypertension Day, cardiologists are calling for pediatricians to check blood pressure more intensively. This happens too rarely because hypertension is considered an illness in old age.
More and more children and adolescents have high blood pressure because they are overweight. A European guideline therefore demands that pediatricians check blood pressure during preventive examinations. A co-initiator justified the step at a symposium of the German Hypertensive League e.V. DHL® at the 123rd annual congress of the German Society for Internal Medicine in Mannheim.
Hypertension, also called hypertension, was less common in children in the past. "Children with congenital heart and blood vessel or kidney diseases were usually affected," reports Professor Dr. med. Elke Wühl, senior physician in the Pediatric Nephrology Section at the Center for Pediatric and Adolescent Medicine at the Heidelberg University Hospital. “Treating hypertension in these cases has been routine for a long time. Lowering blood pressure can often prevent further organ damage, ”continues the expert, who specializes in treating kidney disease in children. In recent years, however, the number of children who have high blood pressure without an underlying illness has been increasing. The cause is then often an excessive body weight: "Every fourth child with obesity suffers from high blood pressure," says Professor Wühl, member of the Hypertension Commission for Children and Adolescents of the Hypertension League. In overweight children, the proportion is around seven percent. Children of normal weight can also develop high blood pressure.
The European Society of Hypertension (ESH) has therefore revised its guidelines for the treatment of hypertension in children and adolescents last year. The requirement that pediatricians and general practitioners should control blood pressure in all children and adolescents is confirmed. "From the age of 3, this should be done with every medical presentation," says Professor Wühl. In younger children, a blood pressure measurement is usually only necessary for risk factors, such as after premature birth or for congenital heart diseases and kidney diseases.
Diagnosing high blood pressure in children and adolescents is not easy. The pediatrician needs special blood pressure cuffs, the width and length of which must be adapted to the children's upper arm. Blood pressure is lower in children and adolescents than in adults. Professor Wühl explains: “A value of 120 to 80 mm Hg, which is optimal for adults, is just normal for a 12-year-old, too high for a 6-year-old, for a 3-year-old it is severe hypertension and an emergency to a newborn. ” The ESH guideline therefore contains tables that show the blood pressure limits for different ages. From the age of 16, the recommendations for adults apply, for which the upper limit is 140 to 90 mm Hg.
In overweight children, treatment is initially carried out by changing the lifestyle. The goal is to lose weight by one to two kilos a month. This means more exercise and a healthy diet. Professor Wühl explains: "The children must avoid excessive sugar consumption and soft drinks and limit the intake of fat and salt." Fruits, vegetables and fiber are recommended. In addition, there is at least 60 minutes of exercise a day. Outside of school, children should spend less than two hours a day sitting.
"When the children lose weight and play sports, blood pressure usually normalizes," reports Professor Wühl. If this does not work, doctors should not be afraid to prescribe medication. Most high-pressure drugs are well tolerated and just as effective in children and adolescents as in adults. If the blood pressure is not checked, the first consequential damage threatens in adolescence. This includes a thickening of the heart muscle and blood vessels, which can be a harbinger of vascular calcification. It is rare for high blood pressure to grow over time. "Changes in adolescent blood pressure continue into adulthood," says Professor Wühl. Experts refer to this as the "tracking phenomenon".