From Our 2008 Archives
Child Heart Disease Risks on the Rise
Early Prevention Efforts for Hypertension and Obesity Needed to Stave Off Epidemic of Heart Disease
Reviewed By Brunilda Nazario, MD
Oct. 10, 2008 (New York) -- The rate of premature heart disease among obese teens is set to triple, and the increasing prevalence of high blood pressure in children is a major culprit, experts warned at a news conference sponsored by the American Society of Hypertension.
"The presence of child obesity results in higher rates of high blood pressure," which is a major risk factor for stroke and heart attack, said Bonita Falkner, MD, a professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia. "This is a problem that is not going to magically go away, and it puts children at risk for premature cardiac events at an earlier period in their adult lives."
The statistics are staggering. Seventeen percent of children are obese and 20% are overweight, which means that about 12 million children under age 18 are overweight or obese, Falkner says.
As it stands, 3.5% of children have high blood pressure and another 3.5% have pre-hypertension, meaning that they are at risk of developing high blood pressure in the future.
There is no magic number that defines high blood pressure in children. Instead, a child's sex, age, and height are used to determine age-, sex- and height-specific systolic and diastolic blood pressure percentiles. Pediatricians typically begin to measure blood pressure when a child turns 3 as part of a standard well visit.
Metabolic Syndrome Risks
What should concerned parents and pediatricians do to ward off this potentially devastating health crisis?
"If we have a child with obesity plus high blood pressure, that is a child that we should have further evaluated for other risk factors such as cholesterol, sleep apnea, or sleep disturbances and if they have a family history of diabetes, they may need further screening of [blood sugar] metabolism," Falkner said. Obesity and high blood pressure are two components of metabolic syndrome, a cluster of risk factors that increases the risk of heart attack, stroke, and diabetes.
"They just need one more risk factor and they have the syndrome," she says.
Treating children with essential high blood pressure (high blood pressure that is not caused by another disease or condition) starts with lifestyle changes. This means "trying to modify diet, increase physical activity, and if they are overweight, controlling their weight," Falkner says. "In children with more severe hypertension and no response to a reasonable period of lifestyle changes [who have] evidence of organ injury [from the high blood pressure], medication is indicated."
The same drugs that are used to treat adults with high blood pressure are also used in these children. These drugs do have side effects, Falkner says, and "we are very concerned about the side effects of these drugs and up until the last 15 years we have been doing this blind without data on children."
Early Intervention Is the Key
Obesity and high blood pressure go hand-in-hand, and experts agree that is a lot easier to prevent obesity from occurring than it is to reverse it.
George Bakris, MD, the director of the Hypertensive Diseases Unit at the University of Chicago School of Medicine and president-elect of the American Society of Hypertension, says the situation is analogous to ignoring a roof that has just sprung a leak.
"If you know you have a leaky roof, but it's not bothersome, you [may] blow it off, then a rainstorm comes and the house is a swimming pool," he says. "This would never have happened if you took care of [the leak] earlier."
Bakris proposes a government "bailout" of the obesity/high blood pressure crisis in children.
"It takes a village," he says. "A community effort needs some government support behind it or it won't work." He says the government needs to step up efforts to fund physical education programs in schools, for example.
SOURCES: American Society of Hypertension news conference, New York City, Oct. 10, 2008. Bonita Falkner, MD, professor of medicine and pediatrics, Thomas Jefferson University, Philadelphia. George Bakris, MD, director, Hypertensive Diseases Unit, University of Chicago School of Medicine in Chicago; president-elect, American Society of Hypertension.
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