Pediatric Pressure

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How do you treat a child with high blood pressure? The issue came up last week when a report published in the Journal of the American Medical Association showed, for the first time, that blood-pressure rates among children and teens across the U.S. have inched up over the past 15 years — a consequence of their growing girth. "The increase was seen in boys and girls, among whites, African Americans and Mexican Americans," says Paul Muntner, an epidemiologist at Tulane University in New Orleans and the study's lead author. "As these children become adults, they're more likely to develop high blood pressure, heart disease and stroke."

The reported jump may seem inconsequential at first: up 1.4 points, to 106 mm Hg, for systolic pressure and up 3.3 points, to 61.7 mm Hg, for diastolic. Indeed, that would normally not be a problem for an individual child. But we're talking about averages across the entire U.S. population. "Shifting the average by that amount is a big deal," says Dr. Stephen Daniels of the Children's Hospital Medical Center in Cincinnati, Ohio.

Figuring out if a child has hypertension is trickier than you might think. Because children's blood pressure naturally increases as they grow older and taller, doctors must refer to a standardized distribution chart. Readings at the 95th percentile and up indicate high blood pressure. New guidelines, scheduled to be released this summer, identify the 90th percentile to 95th percentile as prehypertension.

Most doctors prefer to treat high blood pressure in their younger patients with lifestyle changes first: getting them to lose weight, if necessary, and to step up their physical activity. Preliminary evidence suggests that caffeine — found in soda, coffee and some candy — may also boost blood pressure, particularly in African Americans. Daniels and his colleagues are just starting a study that looks at the effect on children and teenagers of a diet that has been shown to lower blood pressure in adults — one that emphasizes fruits, vegetables, whole grains and low-fat dairy. Blood pressure can jump high enough among youngsters, however, that diuretics and beta blockers — administered in doses appropriate to a child's size and weight — may be needed to bring it under control.