High blood pressure - the underestimated diagnosis
Goodbye cheeseburgers, crisps and cola! Since the paediatrician diagnosed Julian with high blood pressure, the ten-year-old has had to learn to eat healthier in order to lose weight. This is because being very overweight has led to high blood pressure levels in Julian. If these are not lowered, this can lead to long-term vascular damage to his organs and serious secondary diseases such as stroke, arteriosclerosis, heart attack or kidney failure.
What are the causes?
The development of high blood pressure, technically known as arterial hypertension, in children can have various causes: «On the one hand, organic causes such as heart disease or kidney disease can lead to high blood pressure in children,» says Professor Giacomo Simonetti, board member of the Swiss Society of Hypertension and head of the paediatric clinic at the regional hospital in Bellinzona and Valli. «This form of arterial hypertension has always existed. But it is comparatively rare.»
There has been an increase in so-called essential or primary arterial hypertension in particular. This is when no causal underlying diseases can be identified. «As a rule, overweight and obesity are responsible for this now much more common form of high blood pressure in children,» explains Simonetti. «However, certain medications such as the active ingredient methylphenidate for the treatment of ADHD, cortisone or liquorice can also cause children's blood pressure to rise.»
If blood pressure is not treated, diseases that are normally found in older patients can occur in young people.
If high blood pressure that develops at a very early age is not treated in time, it can cause serious damage to the blood vessels. And dangerous secondary diseases such as strokes, kidney, heart and circulatory diseases, which are normally only seen in older patients, can occur at a young age.
High blood pressure (unfortunately) doesn't hurt
What is particularly insidious about high blood pressure is that the disease is almost asymptomatic for a long time. «Children don't feel that their blood pressure is too high,» explains the paediatrician from Ticino. «High blood pressure doesn't hurt and causes hardly any other noticeable problems.»
As a result, parents often don't notice anything and it can happen that high blood pressure remains unrecognised and therefore untreated for a long time. «As part of a preventive check-up, routine blood pressure measurement is therefore recommended in Switzerland from the age of six,» emphasises Simonetti.
«However, children with an increased risk potential for high blood pressure, i.e. with kidney and cardiovascular diseases, a family history of hypertension, premature babies, ongoing cortisone and Ritalin treatment as well as overweight and obese children should always have additional targeted measurements.»
The same applies if unclear symptoms such as frequent nosebleeds and vomiting, persistent headaches and dizziness occur, which, in addition to other causes, may also indicate high blood pressure.
Why is it so difficult to diagnose children?
Diagnosing high blood pressure in children and adolescents is much more difficult than in adults. «For one thing, the doctor needs special blood pressure cuffs that are suitable for the different sizes of children's upper arms,» emphasises Simonetti. «Secondly, children's blood pressure changes quickly depending on the situation.» This is why three independent blood pressure measurements are always taken in children. «Only when all three values are above the norm can we assume that the values are elevated,» explains the paediatrician. «To be on the safe side, an additional 24-hour outpatient measurement is usually carried out.»
Diagnosing high blood pressure in children is not easy, especially because - unlike for adults - there is no fixed threshold value for high blood pressure in children. For example, the optimal blood pressure value for adults of 120 to 80 mmHg is just fine for a 12-year-old, but too high for a 9-year-old and an absolute emergency for an infant.
The limit values for high blood pressure in children must therefore be calculated individually depending on age, height and gender. For children up to and including the age of ten, the following rule of thumb applies: Years of age times two plus 100 for the upper blood pressure value and years of age times two plus 60 for the lower value. From 11 to 17 years of age, the lower value is calculated using the number of years of life plus 70.
A lifestyle change usually helps
Even though high blood pressure in children is a very serious condition, the disease can usually be treated well. In most cases, this is even possible without antihypertensive medication. «In the case of organic causes, the underlying disease must be treated first and foremost,» says Simonetti. «If obesity is the cause, a lifestyle change can bring good results.» Affected children and adolescents must learn to eat more healthily and with less fat.
«It is also important to reduce the previously high salt consumption.»
Professor Giacomo Simonetti,
To do this, children's entire diet often has to be turned on its head: away from high-calorie but low-nutrient fast food dishes and sweets in front of the TV and towards lots of vegetables and fruit, filling wholemeal products and low-fat animal protein sources in the form of dairy products, meat and fish.
«In terms of lowering blood pressure, it is also important to reduce salt consumption, which is often high,» says Simonetti. «In addition, drinks with a high sugar content should be avoided and thirst should be quenched with mineral water, juice spritzers and unsweetened teas.»
Children should also start to move more again. «This doesn't have to involve high-performance sport,» emphasises the paediatrician. «Light endurance sports such as walking, swimming or cycling are already very beneficial.» However, children need active support so that they can implement this lifestyle change and, above all, keep it up. There are many programmes, camps and groups with like-minded people in Switzerland that make this easier.
Local addresses can also be obtained from paediatricians. Above all, however, it is important that parents support the new lifestyle and, if possible, set a good example themselves. It's worth it, because with every pound that falls off, high blood pressure also falls.
Picture: iStock
What is high blood pressure?
- Blood pressure is the pressure that the blood exerts on the vessels as it flows through the arteries with each heartbeat.
- It is undulating and constantly fluctuates between two values, which are also determined during each blood pressure measurement:
- The upper value is the so-called systolic value. It indicates the highest pressure on the blood vessels when the heart contracts and pumps the blood into the artery.
- The lower value is the so-called diastolic value, when the heart relaxes to refill with blood and exerts the lowest pressure on the vessels.
- Both values are given in millimetres of mercury (mmHg). If these values permanently rise above a certain limit, this is referred to as high blood pressure.
Help with high blood pressure
Specialist association for obesity in childhood and adolescence (akj)
Lots of information and addresses of prevention and multi-professional structured therapy programmes for children and adolescents with overweight and obesity in Switzerland.
www.akj-ch.ch
Feel-OK
Child- and youth-orientated information on healthy eating (and other topics) with fun online tests for playful knowledge transfer such as the «fast food check» or the «food pyramid game».
www.feel-ok.ch
ZACK - Zurich obesity camp for children
Sports camps especially for overweight children and young people in the canton of Zurich, which take place during the school holidays.
sport.zh.ch
Laureus - Girls in Sport
Sports camp for girls aged 12 to 17 with the aim of having fun with sport without any pressure to perform.
www.laureus.ch
Modern, comprehensive obesity programmes are also offered by clinics such as:
University Hospital Zurich
www.endokrinologie.usz.ch/fachwissen/Ernaehrung-Adipositas-Fettstoffwechsel/Seiten/adipositastherapie.aspx
Inselspital Bern
www.endokrinologie.insel.ch/de/patienten-und-angehoerige/adipositas
Swiss Society for Nutrition
Recommendations for balanced eating and drinking for children with the Swiss nutritional disc
www.sge-ssn.ch/ich-und-du/essen-und-trinken/von-jung-bis-alt/kindheit
