Hypertension in Children

Childhood hypertension has been on the increase worldwide. From 2000 to 2020, the incidence of high blood pressure in children and adolescents nearly doubled. Estimates are that about 1 in 25 children, ages 12-19, have hypertension, and 1 in 10 has prehypertension (elevated blood pressure but not yet high enough to classify as hypertension).

Child getting his blood pressure measured at the doctor's office.

What are the Causes?

Blood pressure ranges vary with age. For teens and adults, it is the same. As a child grows, blood pressure normally increases, so ranges change with increasing age.

Often, in practice, I would see a child with an elevated blood pressure after first arriving. This can often be attributed to nervousness about a visit (called white coat syndrome). We would then check the BP again at the end of the visit, and most times it was normal. If not, we would have them return for another check soon after. These steps are a good rule to follow.

In kids, an elevated blood pressure doesn’t typically cause symptoms, unless it is very high. The younger the child (under 6), the more likely a medical reason is found for abnormally high pressures. In older children, the causes are often similar to adult hypertension. This article focuses on primary or essential hypertension, meaning that no medical cause has been identified. Thus, I will focus on preventive causes since this blog is all about prevention.

The risk factors for primary hypertension include:

• Genetics or a positive family history

• Obesity or being overweight - this condition increases the incidence of hypertension by almost eight times over normal-weight kids

• Lack of exercise

• Too much salt intake

• Poor nutrition - excess ultra-processed foods

• Types 1 and 2 diabetes

• High cholesterol

• Being male, Black, or Hispanic

• Smoking or secondhand smoke exposure

Why Does This Matter?

High blood pressure in children increases their risk for heart and kidney disease. Hypertension is not benign. If it develops at a young age, it is likely to persist without intervention, putting them at risk for organ damage early in adulthood. Uncontrolled hypertension puts one at risk for heart attack, stroke, heart failure, and chronic kidney disease.

Too much salt in the diet, especially from too many ultra-processed foods, can cause high blood pressure.

What Can We Do?

Essential hypertension is largely preventable, especially in children.

Steps to take:

1. Ensure it is checked at your doctor’s visits. If initially high, check again, and again.

2. Maintain a healthy weight by

Limiting ultra-processed, fried, and fast foods 

Decreasing sugar intake, especially from sugar-sweetened beverages

Monitoring portions and serving sizes

Increasing fruit, vegetable, and fiber intake

3. Increase physical activity, making it a daily habit for at least 30 minutes; 60 minutes is even better

4. Limit salt intake by 

Limiting ultra-processed, fried and fast foods

Minimizing the use of salt at home in cooking and the use of the salt shaker. The maximum daily salt intake, according to the American Heart Association, is 2300 milligrams or 1 teaspoon total a day. The optimum intake is 1500 mg/day. This number is lower for younger ages. 

Look for labels with no salt, salt-free, unsalted, reduced sodium, sodium-free, low sodium, or lightly salted. 

These terms ensure the item has less salt content.

5. Avoid smoking, vaping, and secondhand smoke

6. Get adequate sleep and observe for snoring or sleep apnea

Young man covering his face from cigarette smoke. Smoking, vaping, and secondhand smoke exposure can lead to hypertension.

Protecting your child’s future health is the priority. The key to knowing how to do so is being informed.