Study suggests kids with hypertension more likely to have heart disease as adults; Ky. teens 3rd in U.S. in top risk factor, obesity

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By Melissa Patrick
Kentucky Health News

Just like adults, children can have high blood pressure. The only way to know is to check for it, and it's important because children with hypertension are more likely to grow up to be adults with heart disease -- the number one killer of adults in Kentucky. And in the biggest risk factor for heart disease, obesity, Kentucky high-school students are the third most likely in the U.S. to be obese.

"Children don't have a lot of symptoms with high blood pressure, so we don't know they have it until we check," said Dr. Donna Grigsby, chief of general pediatrics at UK HealthCare. " If they don't get it under control when they are young it's likely to persist into adulthood. . . . There are a lot of long-lasting consequences to living with high blood pressure that is not well-managed."

Untreated hypertension in adults can lead to heart disease, heart failure, vision loss, stroke and kidney disease.

Grigsby noted that the American Academy of Pediatrics issued new blood-pressure guidelines for children in 2017, and that diagnosing hypertension in children is a little trickier than diagnosing it in adults because it varies by a child's age, height and gender. She stressed that health-care providers have to do more than just take a child's blood pressure; they also have to interpret it.

A recent study in the American Heart Association journal Hypertension suggests kids with hypertension are at a higher risk of heart disease as adults.

Using data from nearly 4,000 children who were followed for 36 years, the study found that the newer guidelines classified 11% of children as having hypertension; the old guidelines classified 7%.

It also found that 19% of the children with high blood pressure according to the new guidelines had an enlarged heart (left ventricular hypertrophy, or LVH) as adults. Under the old guidelines, it was only 12%.

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A possible pitfall in the study was that all of the children in this study come from one community: Bogalusa, Louisiana, just across the Pearl River from Mississippi, a town of 12,000 with a 57% white and 41% population. Also, the study used no information about actual heart attacks and stroke.

Overall, the study found that 8% of the children who were reclassified to having high blood pressure under the new guidelines were more likely than those without hypertension to develop heart disease as adults; and the children who were reclassified to the lower blood-pressure categories with the new guidelines had similar results as those who had never been diagnosed with hypertension.

"Children who were reclassified to higher blood pressure categories based on 2017 guidelines were at increased risk of hypertension, metabolic syndrome and LVH in later life," the report says.

Metabolic syndrome is a group of risk factors that raises a person's risk for heart disease, stroke and diabetes. They include high blood pressure, excess fat around the waist, high blood-sugar levels, high triglyceride levels and low levels of good cholesterol, or HDL. Having any three of these risk factors produces a diagnosis of metabolic syndrome.

Grigsby said all children should start having their blood pressure checked at age 3, and children who are considered at higher risk of developing high blood pressure should have it done sooner, including those who were born prematurely or who have kidney or heart disease.

The Centers for Disease Control and Prevention reports that an estimated 1.3 million youth between the ages of 12 and 19 have hypertension under the new guidelines, which is about 4% of the population. For example, the CDC says that in a classroom of 30, one would have high blood pressure and about three more would have "elevated blood pressure," once called "prehypertension."

Kentucky-specific data were not available, but the primary risk factor for high blood pressure in children is obesity, and that's a real problem in Kentucky. According to the State of Obesity report, one in five, or 20.2%, of the state's high-school students are obese, the third highest in the country.

"The children that we worry about are the children who are overweight and obese because we know that is a big risk factor for having high blood pressure," Grigsby said.

She said high blood pressure in children is primarily treated with lifestyle changes, like decreasing screen time, increasing activity, and improving diets -- and these changes are most successful when the whole family makes them.

"Instead of diet and weight loss, we talk a lot about healthy lifestyles because this is a change that they are going to have to be able to sustain," she said.

The Kentucky Department for Public Health suggests the 5-2-1-0 prescription to significantly reduce childhood obesity, which says to eat five or more servings of fruits and vegetables each day; limit screen time to no more than two hours a day; be physically active for at least one hour a day; and drink zero sweetened beverages. The website offers free resources to help meet these goals.