One year after recommending that children should be checked for high blood pressure starting at age 3, medical experts reviewed additional supporting evidence for the pediatric blood pressure guidelines at the American Society of Hypertension's Twentieth Annual Meeting (ASH 2005).
"Since our revisions were published last year, many physicians have requested additional information from us and appear to be using the guidelines," said Bonita Falkner, M.D., from Thomas Jefferson School of Medicine in Philadelphia, Pa, and lead author of the pediatric hypertension treatment guidelines published in Pediatrics in August 2004. "Now we have further evidence supporting our call for earlier blood pressure monitoring and more aggressive intervention to prevent this growing epidemic."
"When high blood pressure is detected at an early age, it is important to intervene to in order to prevent the cardiovascular damage that will occur in early adulthood." Dr. Falkner continued. "Children and adolescents with hypertension are unknowingly creating health problems that will be continually difficult to treat as they get older."
Dr. Falkner noted that recent studies suggest that the rising rates of childhood obesity seem to be directly responsible for a rise in blood pressure among children and adolescents in recent years. Furthermore, evidence suggests that higher blood pressure in adolescence is linked with signs of damage the heart and blood vessels later in life.
"Childhood obesity is one of the most important public health issues facing our country," said Dr. Falkner. "Recent research has shown that not only obesity is on the rise, but also its co-morbities such as hypertension, dyslipidemia, and early-onset type 2 diabetes, which we call metabolic syndrome."
Metabolic syndrome is defined as having three of the five risk factors for cardiovascular disease: obesity, high blood pressure, abnormal glucose tolerance, high triglicerides and low high-density lipoprotein. It is estimated that nearly 30 percent of obese adolescents already have developed metabolic syndrome, and many more are at risk. Dr. Falkner notes that many steps are in progress to help lower these rising prevalence rates.
"Efforts are underway by the National Heart, Lung and Blood Institute at the National Institutes of Health, the American Heart Association, and the American Society of Hypertension to help lower prevalence of high blood pressure, obesity and metabolic syndrome in children and adolescents," she said. "This year, the Institute developed a Palm application of our pediatric blood pressure guidelines to aid physicians in diagnosis and treatment of hypertension, and has been sponsoring programs that can lead to development of more effective treatments and prevention of childhood obesity."
Dr. Falkner and colleagues presented data at ASH 2005 reporting findings on Toprol-XL, a long-acting beta-blocker, that showed it is safe and effective in treating high blood pressure in children. Her study is one of many underway as a result of the Pediatric Research Equity Act of 2003, which is intended to support research on safety and efficacy of existing pharmacological treatments already on the market in children. Dr. Falkner warns, however, that while her research supports the use of antihypertensive therapy in children, lifestyle changes are the most critical factors in improving the health of our nation's children and adolescents, and should be primary in our treatment program.
"As pediatricians, we believe that changes in diet and exercise patterns are crucial to lowering overall prevalence of hypertension and obesity in children and adolescents. But, in young patients for whom exercise and diet modifications are not enough, we now have evidence suggesting that physicians have one more tool to help lower blood pressure and overall cardiovascular risk."