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High Blood Pressure in Children
Hypertension, also known as persistent high blood pressure, is a medical condition that affects not only adults but also children. It is a serious health concern that should not be taken lightly, as it could lead to a host of other health problems if left untreated. In this article, we will explore the causes and symptoms of high blood pressure in children and the treatment options for high blood pressure in children.
What is Hypertension?
Hypertension is a medical condition characterised by persistent high blood pressure in the arteries. Blood pressure is the force of blood pushing against the walls of the arteries when the heart pumps blood. A person’s blood pressure is measured in millimeters of mercury (mmHg) and is given as two numbers represented as a fraction, such as 120/80mmHg. Systolic pressure (the first number) is the pressure in the arteries when the heart contracts. Diastolic pressure (the second number) is the pressure when the heart relaxes.
How Common is Hypertension in Children?
High blood pressure is becoming increasingly common in children. According to the American Heart Association, about 2-5% of children, especially adolescents, have hypertension, which means they have a blood pressure reading that is greater than the 95th percentile for their age, sex, and height1.
High blood pressure is also reported as a growing problem in Singapore, and with a higher incidence of high blood pressure among children. In 2018, the pediatric endocrinology division of the National University Hospital’s diagnosis of pediatric hypertension doubled to one per month, as compared to five years ago2.
High blood pressure in children is a serious condition that could have long-term health consequences. If a child has high blood pressure, he/she is at an increased risk of heart disease, stroke, and kidney damage later in life3. Therefore, it is essential to have your child’s blood pressure measured regularly.
Normal Blood Pressure for Kids
The regular blood pressure reading for adults is typically below 130/85mmHg. In children, regular blood pressure varies depending on their age, gender, and height, and is often identified by the child’s doctor.
In general, blood pressure in children is classified as shown below:
| BP Category | Age <13 years old* | Age 13 years old | |
| Systolic BP | Diastolic BP | ||
| Normal | <90th percentile for age, sex and height | <120mmHg | <80mmHg |
| Elevated | 90th-<95th percentile for age, sex and height | ≥120-129mmHg | <80mmHg |
| Stage 1 Hypertension | ≥95th percentile-95th percentile plus 11mmHg | 130-139mmHg | 80-89mmHg |
| Stage 2 Hypertension | ≥95th percentile plus 12mmHg | ≥140mmHg | ≥90mmHg |
*And up to the BP levels for children ≥13 years of age.
Adapted with permission from Pediatrics. Copyright © 2017.
Signs and Symptoms
Hypertension is often called the “silent killer” because it typically does not have any symptoms. However, in some cases, children may experience headache, seizure, vomiting, chest pain, palpitations, or shortness of breath3.
Causes
Hypertension in children and adolescents could be caused by a variety of factors3, including:
Obesity
Overweight or obesity is one of the most significant risk factors for hypertension in children. In 1976, a mere percentage of 1.4 Primary 1 pupils were overweight or obese; thirty years later in 2006, this number jumped to 12.7%. The rise in childhood obesity may likely be the reason for the increasing trend in high blood pressure diagnosis2.
Family history
Children who have a family history of hypertension are more likely to develop the condition.
Poor diet
A diet high in sodium, processed foods and sugary drinks could contribute to high blood pressure.
Lack of exercise
Regular exercise is essential for maintaining a healthy weight and reducing the risk of hypertension.
Chronic kidney disease
Children with chronic kidney disease have an increased risk of developing high blood pressure.
Sleep apnoea
Sleep disorders such as sleep apnoea cause interrupted breathing during sleep, and this in turn causes high blood pressure.
Complications
Hypertension in children could lead to a variety of complications in their adulthood, and these include:
- Heart disease – Hypertension could lead to an enlarged heart, coronary artery disease, heart attack or heart failure.
- Stroke – Hypertension could increase the risk of stroke, which is a medical emergency that may cause permanent brain damage.
- Kidney damage – Hypertension could damage the kidneys over time, leading to chronic kidney disease.
- Vision loss – Hypertension could damage the blood vessels in the eyes, leading to vision loss or even blindness.
Treatment
If and when a child is diagnosed with hypertension, the treatment to control high blood pressure3 may involve lifestyle changes and medication, which include:
A healthy diet
- Adopt the Singapore Heart Foundation’s Heart Smart Eating Plate by having more fruit and vegetables (1/2 plate), whole-grains (1/4 plate) and lean protein (1/4 plate).
- Reduce intake of sodium, refined grains, fatty and processed meats.
An active lifestyle
Regular physical activity could help reduce blood pressure and maintain your child’s weight. The Health Promotion Board encourages children and adolescents between the ages of 7 – 17 years to accumulate an average of 60 minutes in moderate to vigorous-intensity aerobic activity per day, and a variety of vigorous-intensity aerobic activities, muscle-and-bone-strengthening exercises at least 3 times a week5.
Healthy weight
Ensure your child’s weight is within the healthy range; refer to the charts below for the recommended weight.
BMI for Age Percentiles (6 – 18 years – Boys)⁶
| Age (Years) | Severely Underweight (<3rd perentile) | Underweight (3rd-<5th percentiles) | Acceptable Weight (5th-<90th percentiles) | Overweight (90th-<97th percentiles) | Severely Overweight (≥97th percentile) |
| 6 | ≤12.8 | 12.9-13.1 | 13.2-18.8 | 18.9-21.4 | ≥21.5 |
| 7 | ≤13.0 | 13.1-13.3 | 13.4-19.8 | 19.9-23.0 | ≥23.1 |
| 8 | ≤13.2 | 13.3-13.6 | 13.7-20.9 | 21.0-24.6 | ≥24.7 |
| 9 | ≤13.5 | 13.6-13.8 | 13.9-21.8 | 21.9-26.0 | ≥26.1 |
| 10 | ≤13.8 | 13.9-14.1 | 14.2-22.7 | 22.8-27.3 | ≥27.4 |
| 11 | ≤14.1 | 14.2-14.5 | 14.6-23.6 | 23.7-28.3 | ≥28.4 |
| 12 | ≤14.4 | 14.5-14.8 | 14.9-24.3 | 24.4-29.2 | ≥29.3 |
| 13 | ≤14.7 | 14.8-15.1 | 15.2-25.0 | 25.1-30.0 | ≥30.1 |
| 14 | ≤15.0 | 15.1-15.4 | 15.5-25.5 | 25.6-30.6 | ≥30.7 |
| 15 | ≤15.3 | 15.4-15.8 | 15.9-26.1 | 26.2-31.2 | ≥31.3 |
| 16 | ≤15.6 | 15.7-16.1 | 16.2-26.5 | 26.6-31.7 | ≥31.8 |
| 17 | ≤15.9 | 16.0-16.3 | 16.4-27.0 | 27.1-32.1 | ≥32.2 |
| 18 | ≤16.1 | 16.2-16.6 | 16.7-27.4 | 27.5-32.4 | ≥32.5 |
BMI for Age Percentiles (6 – 18 years – Girls)⁶
| Age (Years) | Severely Underweight (<3rd perentile) | Underweight (3rd-<5th percentiles) | Acceptable Weight (5th-<90th percentiles) | Overweight (90th-<97th percentiles) | Severely Overweight (≥97th percentile) |
| 6 | ≤12.6 | 12.7-12.8 | 12.9-18.3 | 18.4-20.5 | ≥20.6 |
| 7 | ≤12.8 | 12.9-13.1 | 13.2-19.1 | 19.2-21.8 | ≥21.9 |
| 8 | ≤13.1 | 13.2-13.4 | 13.5-20.1 | 20.2-23.1 | ≥23.2 |
| 9 | ≤13.4 | 13.5-13.7 | 13.8-21.0 | 21.1-24.4 | ≥24.5 |
| 10 | ≤13.7 | 13.8-14.1 | 14.2-21.9 | 22.0-25.6 | ≥25.7 |
| 11 | ≤14.1 | 14.2-14.4 | 14.5-22.7 | 22.8-26.6 | ≥26.7 |
| 12 | ≤14.4 | 14.5-14.8 | 14.9-23.4 | 23.5-27.5 | ≥27.6 |
| 13 | ≤14.8 | 14.9-15.2 | 15.3-24.0 | 24.1-28.3 | ≥28.4 |
| 14 | ≤15.1 | 15.2-15.5 | 15.6-24.6 | 24.7-28.9 | ≥29.0 |
| 15 | ≤15.4 | 15.5-15.8 | 15.9-25.0 | 25.1-29.4 | ≥29.5 |
| 16 | ≤15.7 | 15.8-16.1 | 16.2-25.4 | 25.5-29.7 | ≥29.8 |
| 17 | ≤15.9 | 16.0-16.3 | 16.4-25.7 | 25.8-30.0 | ≥30.1 |
| 18 | ≤16.1 | 16.2-16.5 | 16.6-25.9 | 26.0-30.3 | ≥30.4 |
Medication
Medication may be prescribed to help lower a child’s high blood pressure. The medication may include:
- Angiotensin-converting enzyme (ACE) inhibitors – The medication helps relax the blood vessels, making it easier for blood to flow through the body.
- Angiotensin receptor blockers (ARBs) – ARBs work similarly to ACE inhibitors by relaxing blood vessels.
- Calcium channel blockersThe medication helps relax the muscles of blood vessels and reduces the heart’s workload.
- Diuretics – The medication helps the body eliminate excess sodium and fluid, reducing a child’s blood pressure.
Conclusion
In a nutshell, high blood pressure is a serious medical condition that severely afflicts children as much as it does adults.
At the Singapore Heart Foundation, we believe that inculcating healthy habits in children helps prevent the onset of these risk factors later in life. As such, we have the Heart Health Programme @ Schools to educate and empower the young in the prevention of cardiovascular diseases; the programme especially inculcates the understanding of blood pressure reading.
It is important for parents and caregivers to be aware of the risks and symptoms of hypertension in children, and to work with their child’s doctor to prevent and/or treat the condition. Regular blood pressure checks are recommended for children, especially those with a risk of hypertension. By taking steps to make lifestyle changes in children, we help them achieve better overall health and reduce the risk of complications in adulthood.
References
- Falkner, B., Gidding, S. S., Baker‐Smith, C. M., Brady, T. M., Flynn, J. T., Malle, L. M., South, A. M., Tran, A., & Urbina, E. M. (2023). Pediatric primary hypertension: an underrecognized condition: A scientific statement from the American Heart Association. Hypertension, 80(6). https://doi.org/10.1161/hyp.0000000000000228
- Lai, L. (2018, October 15). Growing problem of kids with high blood pressure. The Straits Times. https://www.straitstimes.com/singapore/health/growing-problem-of-kids-with-high-blood-pressure
- High blood pressure in children – Symptoms & causes – Mayo Clinic. (2021, July 30). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/symptoms-causes/syc-20373440
- A healthy food foundation – for kids and teens. (n.d.). https://www.healthhub.sg/live-healthy/a%20healthy%20food%20foundation%20-%20for%20kids%20and%20teens
- HealthHub. (2021). Singapore Physical Activity Guidelines For Children & Youths (7-17 years) [Report]. https://ch-api.healthhub.sg/api/public/content/79fc840bf1e64234846b6f56929654a2?v=01dcc67c
- Health Promotion Board. (n.d.). Healthy Weight Healthy Children; Healthier child, Brighter future. https://ch-api.healthhub.sg/api/public/content/6388cea4f0834765a4383ce7dbbf7124?v=5208ce49
