High BP is not just an old-age problem. Childhood hypertension is on the rise, says Dr. Arvind Kasaragod.
While not much research has been done on ‘hypertension among children’, a few studies indicate that 17 per cent of adolescents in India have high BP. The reasons for this range from obesity and sedentary lifestyle to lack of awareness.
Hypertension is basically divided into primary hypertension when there is no identifiable cause, and secondary when there is a known cause. In children, hypertension is usually secondary to diseases of the kidney, heart, endocrine glands, blood vessels and due to medications.
Primary hypertension is more common in older children and adolescents and can exist with absolutely no symptoms till the organs are damaged. In addition, awareness of incidence and its consequences are lacking even among the medical fraternity.
In India it is not considered standard for paediatricians to measure BP in children. Further, those under the age of 12 are considered to be paediatric patients and those above 18 are considered adults. This leaves a large group of adolescents in a limbo with no one taking responsibility for their care. Finally, the belief that adolescents are generally healthy stymies any effort towards preventive healthcare. The screening of children for hypertension is recommended from the time they are three years old or earlier if they have risk factors as per international guidelines. An annual BP check after the third birthday is a good beginning. In fact it should be made mandatory for children to have their BP recorded at the time of entry to schools and colleges.
A multi-pronged approach is needed to find a solution to this problem. Untreated, this disease can lead to dysfunction of multiple organs leading to significant suffering and sometimes death. The cost of healthcare and well-being of the society will be significantly impacted if this is unrecognised and left untreated. Hence the need to collect local data is critical.
The medical community will need to address the issue of simplifying the definition and reach a consensus about the kind of BP apparatus. In fact pediatricians should be responsible for care of children till they are 18 years of age. The government should actively work towards informing the people about health issues that adolescents face. The media too plays a vital role in spreading awareness and should be roped into reach a larger audience.
In adolescents with primary hypertension, the focus should be on preventive health care and lifestyle modifications. In children with secondary hypertension, the focus should be on early identification of the cause and targeted therapy. Medication should be started one at a time and at the lowest dose possible. Patients who are resistant to standard doses can be treated with multiple drugs. As far as possible, combination drugs should be avoided unless they increase compliance.
The importance of weight loss in obese patients and maintaining ideal body weight in others must be stressed. A healthy diet with no added salt should be prescribed. Exercise should be encouraged at all ages. With a holistic approach, patients can lead a normal life if the disease is detected early and appropriate therapy is instituted.