There's no doubt that American kids are getting fatter. But as the incidence of childhood obesity increases, so does that of another related condition: high blood pressure. Doctors estimate that there are now about 2 million U.S. kids and teens as young as 3 with hypertension, and a new study in the Aug. 22 issue of the Journal of the American Medical Association reports that many of these children go dangerously underdiagnosed.
Dr. David Kaelber, an internist and pediatrician at Children's Hospital Boston, and his colleagues at Case Western Reserve University Medical School analyzed the medical records of 507 hypertensive and pre-hypertensive children and adolescents in the Cleveland area. The children had visited doctors at least three times between June 1999 and September 2006 at a number of Ohio outpatient clinics. During that period, the records showed, 376 patients (74%) had never been properly diagnosed with high blood pressure.
It's a difficult diagnosis in kids, the study's authors say, since blood pressure can be affected by many factors, such as height, age and sex. In addition, doctors have to take into account the child's family history (heritability of hypertension is about 50%) and such risk factors as low weight at birth and whether the child is currently overweight. If hypertension isn't identified at a young age, it could go undiagnosed for years, eventually leading to organ damage and other health problems, like coronary artery disease, in adulthood.
Kaelber's study suggests that the right software program could analyze factors such as previous high blood pressure readings, height, weight and sex, then calculate children's risk of high blood pressure. "In theory, there's no reason why any electronic medical record [company] couldn't build a computer program, in the same way that we did, that is integrated at the point of care," says Kaelber. He hopes that electronic medical record companies or researchers will develop a system that could eventually function remotely, automatically analyzing medical data in electronic records, then sending e-mail or phone alerts to physicians when intervention is necessary. "This study starts to put a window on a potential paradigm shift on the role of the physician," Kaelber says.
In the meantime, parents can help the rate of diagnosis by asking the doctor to check their child's blood pressure regularly, along with weight and height. While only between 2% and 5% of U.S. children and teens are hypertensive, compared with 26% of adults, an estimated 1.5 million of these youngsters don't know they have high blood pressure. The American Heart Association and the American Academy of Pediatrics recommend screening children for hypertension starting at age 3, and even younger for children with risk factors such as low birth weight, congenital heart disease and longer than usual postpartum hospital stays. Breast-feeding in infancy has been found to lower a child's overall hypertension risk, along with changing the child's diet and reducing his or her weight.