Why doctors want children screened for high blood pressure from age seven

Children should be monitored for high blood pressure from the age of seven, according to new national guidelines aimed at reducing organ damage, heart attacks and stroke later in life.While high blood pressure has previously been perceived as a disease that affects adults, research has found that an estimated 22,000 to 44,000 Australian children live with significant hypertension.Miela Anderson, 17, has been treating her hypertension with blood pressure medicationLuis Enrique AscuiFactors including obesity, more babies surviving premature births, high salt intakes and low levels of physical activity are fuelling the rise in cases – most of which are undetected as many children don’t have symptoms.The clinical guidelines, which were developed by the Murdoch Children’s Research Institute and Edith Cowan University in partnership with Hypertension Australia, address a major blind spot in paediatric medicine.“There was a real gap,” said co-author Nick Larkins, a researcher at Edith Cowan University.“We didn’t have any guidance on paediatric hypertension so it gave the false impression that it was rare or not important.”The new guidelines, published in the Journal of Paediatrics and Child Health, recommend an initial screening when children are aged between seven and nine, and a follow-up screening between 13 and 15 years.These blood pressure checks would be conducted by GPs, with school nurses also potentially playing a role.Larkins said most cases of hypertension in children could be reversed by cutting down on processed foods, reducing salt intake and increasing physical activity.He said one-third of children with stage 2 hypertension develop a thickening of the heart muscle – an early sign of heart damage – that could be reversed within weeks of controlling their blood pressure.A small cohort of children would need blood pressure medication, he said.“If you get in early, the changes can be reversed,” Larkins said. “If you sit there with that pressure on your heart for 20 or 30 years, then eventually over time the changes become solidified, and once it gets scarring ... you can’t reverse all of that.”Miela Anderson is among a growing cohort of children who have high blood pressure. In her case, it’s linked to being born pre-term and having a kidney that doesn’t function.A newborn Miela in 2009.Pat ScalaThe 17-year-old was diagnosed with hypertension when she was 12 after experiencing frequent headaches and swollen hands. She was often out of breath and felt queasy.“I remember in my sports class we had to run around an oval and I couldn’t do it,” she said.The teenager, from Brunswick in Melbourne’s north, takes blood pressure medication every day to relieve her symptoms and otherwise lives a normal life. She hopes to embark on a gap year and then study marine biology when she finishes school.Miela was born at 26 weeks’ gestation, weighing just 788 grams, and spent 14 weeks at the Royal Women’s Hospital.Her father, Oli, said his daughter was incredibly stoic about her condition.“She has managed to handle this herself,” he said. “She gets a bit flushed and can get tired easily, but she took up running a couple of years ago. It’s amazing.”‘I remember in my sports class we had to run around an oval and I couldn’t do it.’Miela Anderson, 17Miela’s kidney specialist, Dr Tom Forbes from the Royal Children’s Hospital, said up to 25 per cent of children born pre-term develop elevated blood pressure, compared to 15 per cent of those born at full term.He said babies born prematurely might have underdeveloped kidneys with fewer filters. To compensate, the kidneys “call out” for more blood, forcing the body to retain extra water and driving up blood pressure.Forbes welcomed the new guidelines, which have been endorsed by the Royal Australasian College of Physicians, the Heart Foundation, Hypertension Australia, Kidney Health Australia, the Cardiac Society of Australia and New Zealand, and the Australia and New Zealand Paediatric Nephrology Association.“Paediatric medicine is changing,” Forbes said. “We are moving into a phase where more of the work we do is preventative. It’s important we start to screen children for high blood pressure because early detection and management is important to reduce long-term cardiovascular and kidney disease.”Children with untreated high blood pressure are more than twice as likely to suffer a heart attack or stroke by mid-adulthood.The new guidelines define high blood pressure as 120/80 mmHg or more for children aged between six and 11.Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.From our partners