While pediatric hypertension is increasing in prevalence with the pediatric obesity epidemic, only one-quarter of children with hypertension are being diagnosed, according to a study published in the Journal of the American Medical Association.

August 21, 2007 (Insidermedicine) Hypertension has an estimated prevalence of between 2% and 5% and is a common chronic disease in children. Diagnosis of hypertension in children is complicated because normal and abnormal blood pressure values vary with age, sex, and height.

•    Both hypertension and prehypertension have become a significant health issue in children because of the strong association of high blood pressure with obesity and the marked increase in the prevalence of overweight children
•    Children over three years should have their blood pressure measured, and elevated blood pressure must be confirmed on repeated visits. Hypertension in children has been defined as blood pressure above the 95th percentile for age, sex, and height.
•    Therapeutic lifestyle changes are recommended for children and teens with hypertension, and if necessary, pharmacologic intervention

To determine the frequency of undiagnosed hypertension and prehypertension, researchers studied more than 14,000 children and teens for a seven-year period.

The criteria for hypertension were met by 4% of children, and nearly three-quarters of these cases were not previously diagnosed. Three percent had prehypertension, and only 11% of these were previously diagnosed.

Identifying elevated blood pressure in children with prehypertension or hypertension is important because of the increasing prevalence of pediatric weight problems, and requires identification and appropriate work-up. If it is not identified early, it may be years before it is detected, leading to end-organ damage.

Physicians should routinely screen all children for hypertension starting at three years, and confirm findings on repeat visits. In hypertensive children, lifestyle modifications are recommended, including weight loss, increased exercise, and dietary modifications. Antihypertensive drug therapy in children should be initiated when there is insufficient response to lifestyle modifications.

For Insidermedicine in Depth, I'm Maria Radina.