N° 75 | February 2013

Management of blood pressure in children

Elevated Blood Pressure (BP) has been recognized as an important health issue in the pediatric population over the past three decades. The majority of data indicate that average BP levels and prevalence of hypertension have risen substantially among children and adolescents. This tendency is evident not only in the United States but also in Asia, Europe and Latin America. Obesity and other lifestyle factors such as physical inactivity and high calorie, high salt intake and fast food are thought to be responsible. Hypertension in children is viewed now as a significant risk factor for the development of cardiovascular disease in adulthood.

Risk factors of hypertension in children

The most comprehensive analysis of potential anthropometric, prenatal, environmental, and familial risk factors for high BP was performed recently by Simmonetti et al.1 as part of a screening project in 4.236 preschool children in Germany.

  • Correlation between BP and BMI
    Obese children displayed significantly higher BP than lean children.
  • Prenatal risk factors
    • Children born pre-term or with low birth weight showed significantly higher systolic BP than children born at term or children with birth weight above 2,500g.
    • Children exposed to maternal smoking during pregnancy displayed significantly higher systolic BP than unexposed children, and children of mothers with pregnancy-related hypertension showed significantly higher systolic and diastolic BP.
  • Parental and environmental risk factors Children of hypertensive parents showed higher BP than children of normotensive parents. Similarly, BP was higher in children of obese parents than in children of nonobese parents. A lower parental educational level was significantly associated with higher systolic BP of the offspring. Children exposed to parental smoking at home had higher systolic and diastolic BP than unexposed children. The amount of maternal cigarette consumption correlated linearly with systolic BP.

How to lower blood pressure without use of blood pressure medications?

  • By eating fruits more than twice per day
    Damasceno et al.2 examined the associations of BP with fruits, vegetables, and fruit juice consumption among a random sample of 794 adolescents from 12 private schools in northeast Brazil. Regular consumption of fruits (more than twice per day) was associated with lower systolic and diastolic BP, whereas consumption of vegetables was associated with a significant decrease in systolic BP only.

    The relationships between childhood lifestyle risk factors and adulthood Pulse Wave Velocity (PWV) have been evaluated in 1.622 individuals of the Cardiovascular Risk in Young Finns Study followed up for 27 years since baseline3. Decreased vegetable consumption was an independent predictor of high PWV in adulthood when adjusted for lifestyle or traditional risk. The number of lifestyle risk factors (the lowest quintile for vegetable consumption, fruit consumption, physical activity and smoking) in childhood was directly associated with PWV in adulthood. These findings suggest that lifetime lifestyle risk factors, with low consumption of fruits and vegetables in particular, are related to arterial stiffness in young adulthood.

  • By practicing physical activity at a moderate intensity level in everyday life
    The Greek adolescents study analyzed data from 496 students aged 12–17 years who submitted information on the frequency and duration of physical activity and the amount of time spent in sedentary activities4. As expected, heart rates were significantly lower as the level of activity rose. However, intense physical activity was associated with higher systolic BP and pulse pressure, with positive correlations. The authors concluded that physical activity should be practiced at a moderate intensity level in everyday life.

    Maggio et al.5 performed a follow-up study of 20 young adolescents who participated in the randomized controlled trial of the effect of physical activity on cardiovascular risk factors. The authors showed that even two years after stopping the trial, the reduction in BP was maintained. In addition, arterial intima – media thickness, Body Mass Index (BMI) z-score, and body fat remained stable two years after stopping the physical activity program. These results were more prominent in the patients that decreased their BMI during the exercise program.

  1. Simonetti GD, Schwertz R, Klett M, et al. Determinants of blood pressure in preschool children: the role of parental smoking. Circulation 2011; 123:292– 298.
  2. Damasceno MM, de Araujo MF, de Freitas RW, et al. The association between blood pressure in adolescents and the consumption of fruits, vegetables and fruit juice: an exploratory study. J Clin Nurs 2011; 20:1553–1560.
  3. Aatola H, Koivistoinen T, Hutri-Kahonen N, et al. Lifetime fruit and vegetable consumption and arterial pulse wave velocity in adulthood: the Cardiovascular. Risk in Young Finns Study. Circulation 2010; 122:2521–2528.
  4. Tsioufis C, Kyvelou S, Tsiachris D, et al. Relation between physical activity and blood pressure levels in youngGreek adolescents: the Leontio Lyceum Study. Eur J Public Health 2011; 21:63–68.
  5. Maggio AB, Aggoun Y, Martin XE, et al. Long-term follow-up of cardiovascular risk factors after exercise training in obese children. Int J Pediatr Obes 2011;6:e603 e610.
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