Inactivity, diets high in sugar and salt and obesity are at the root of nine out of ten cases of high blood pressure in children and adolescents, according to a consensus paper from heart health experts published in the European Heart Journal, a journal of the European Society of Cardiology (ESC). The paper, which focuses on hypertension in children between the ages of 6 and 16, recommends that the whole family get back to health.
Inactivity, high sugar and salt diets and obesity are the basis for nine out of ten cases of high blood pressure in children and adolescents, according to a consensus paper from heart health experts published in European Heart Journal, a journal of the European Society of Cardiology (ESC). The paper, which focuses on hypertension in children between the ages of 6 and 16, recommends that the whole family get back to health.
“Parents are important agents of change in promoting children’s health behaviours,” said lead author Prof Giovanni de Simone from the University of Naples Federico II, Italy. “Very often hypertension and/or obesity run in the same family. But even when this is not the case, it is desirable that lifestyle changes involve all family members.”
Dietary recommendations for treating high blood pressure in children include an emphasis on fresh vegetables, fruits, and other high-fiber foods, limiting salt intake, and avoiding sugary drinks and saturated fat. Children and young people should get at least one hour of moderate to vigorous physical activity, such as jogging, cycling or swimming, every day and spend no more than two hours a day in sedentary activities. “Parents should monitor the time their children spend watching TV or using smartphones and suggest active alternatives,” de Simone said.
You must set realistic goals for weight, diet and physical activity, focusing on the areas that most need improvement. “Recording weight, eating habits and physical activity over time – but without becoming obsessive – can help young people and their families track progress towards their goals,” Professor de Simone said.
A “health reward system” is recommended. Professor de Simone said: “The ideal incentives are those that increase social support and reinforce the value of targeted behaviour, such as a family bike ride or a walk with friends.”
The document refers to obesity and hypertension in children as “insidious siblings” that gradually become a serious health hazard. Studies have shown that hypertension in children is becoming more common and that part of the increase can be explained by obesity, especially abdominal obesity. It is estimated that less than 2% of normal-weight children are hypertensive, compared with 5% of overweight children and 15% of obese children. Professor de Simone said: “The increase in hypertension in children is very worrying because it is associated with persistent hypertension and other cardiovascular problems in adulthood.”
The early diagnosis of arterial hypertension is essential to be able to manage it with lifestyle and, if necessary, medication. Even a single blood pressure reading by a doctor or nurse can identify children with high blood pressure, but a second visit is recommended for confirmation. De Simone stated that: “Screening should be done in primary care at least annually, regardless of symptoms. This is because hypertension in children, as in adults, is usually asymptomatic.”
When blood pressure readings indicate hypertension, a medical history and physical examination are necessary to determine potential causes and identify behaviors that can be changed. Information includes family history of hypertension and cardiovascular disease, birth weight and gestational age; lifestyle details, such as smoking, salt intake, alcohol consumption, exercise and leisure activities; and possible symptoms, including headache, nosebleeds, dizziness, visual disturbances, poor school performance, difficulty paying attention, shortness of breath, chest pain, palpitations, and fainting.
In the early stages, treatment of childhood hypertension must focus on education and behavior change. If blood pressure targets are not achieved, a single low-dose drug should be introduced. If one drug is ineffective, small doses of two drugs may be needed.
The authors encourage public health authorities to prioritize the prevention and management of hypertension in children and adolescents. For example, awareness campaigns about the risk of hypertension in young people and the positive effect of a healthy lifestyle that includes physical activity, a nutritious diet low in salt and sugar and not smoking. Other recommended actions include shielding children’s time from television and social media without promoting junk food or potentially harmful lifestyle habits.
de Simone G, Mancusi C, Hanssen H, et al. Hypertension in children and adolescents. Eur Heart J. 2022. doi: 10.1093/eurheartj/ehac328