Newly announced pediatric blood-pressure guidelines may result in more youngsters getting flagged for hypertension, but that will likely help more children and teenagers get started earlier on healthy lifestyle changes.
That's the take-away for parents on the new standards for identifying and treating high blood pressure in children and adolescents, published in the September issue of the journal Pediatrics. The recommendations and accompanying study are the work of a 20-person American Academy of Pediatrics (AAP) panel.
The new guidelines serve to simplify identifying concerning blood-pressure levels in kids, which can be more complex and involves more variables than adult diagnoses. The panel created user-friendly pressure tables that some doctors say will assist with diagnosis.
"We're really hoping the new tables and new classifications will make it easier for providers to recognize high blood pressure in children and implement the necessary next steps," said Joseph T. Flynn, one of the authors of the study and a professor of pediatrics at the University of Washington.
The panel's report, which included a review of more than 15,000 research articles, estimates that 3.5 percent of all children and teens have hypertension, compared with 1 or 2 percent estimated by early studies, said Flynn, who completed his pediatric training at St. Christopher's Hospital for Children in Philadelphia.
For many children, like their elders, hypertension often goes undiagnosed and untreated. Called "the silent killer," elevated or high blood pressure generally has no obvious symptoms but can be linked to various health concerns, including cardiovascular problems, later in life.
The new standards differ from the older ones in a few key ways.
Under the new guidelines, youths 13 or older have the same definitions of abnormal blood pressures as adults.
The new guidelines also remove overweight and obese patients when calculating the standard for normal blood pressure for children. That means young people will be identified as having elevated or high blood pressure at a lower threshold than previously recommended.
For example, a 10-year-old girl at the 25th percentile for height (about 54 inches tall) would previously be diagnosed with hypertension at a blood-pressure level of 117/77 or higher, Flynn said. Under the new guidelines, the same girl would now be diagnosed with hypertension at a blood-pressure level of 114/76 or higher.
This is helpful because children with elevated blood pressure will likely receive preventative or corrective lifestyle changes earlier than they would have in the past.
Additionally, children age 3 and older who are not obese or who do not have certain chronic conditions will have their blood pressure taken at annual wellness visits, rather than every time they are in a health-care setting, such as visits for vaccinations. That old practice resulted too often in false positives and unwarranted concern, according to the report.
For children who have repeated high pressure readings, the new report calls for a final high blood-pressure diagnosis by an ambulatory monitoring device worn by the child in real-life settings for 24 hours. Using the device can eliminate "white coat hypertension," or high pressure readings that may occur only in a doctor's office. These young patients are also recommended to receive an echocardiogram before they start any medications.
The new standards, made public late last month, are already receiving positive reviews.
"They raise awareness of the importance of getting regular blood-pressure checks for children and making sure children are a healthy weight and are eating healthy, appropriate foods," said Jen Caudle, a family physician and associate professor at the Rowan University School of Osteopathic Medicine.
Shobha Natarajan, codirector of the Hypertension and Vascular Evaluation (HAVE) Program at Children's Hospital of Philadelphia, said the new standards will help facilitate consistency and care quality across a range of health practices.
"These guidelines can be used by nurse practitioners in general care offices or they can be used by cardiologists," said Natarajan, who is also an associate professor at the Perelman School of Medicine at the University of Pennsylvania.
Some health leaders say the guidelines may prove especially significant for Hispanic and African American children, who tend to have higher rates of hypertension, as well as low-income children, who may be at risk in part due to limited access to healthy diets and activity.
April Douglass-Bright, head of the division of general pediatrics at Children's Regional Hospital at Cooper University Hospital, said she thinks the guidelines will result in more children being identified at risk for hypertension.