Consultant pediatrician with the University of Abuja Teaching Hospital, Dr. Iember Ajanaku, talks about hypertension in children and how to manage it with TOLUWANI ENIOLA
Most people think that hypertension variously defined by medical experts as abnormal high blood pressure affects only the old. These days, the condition also affects children. What is the reason for this?
There is now more awareness that hypertension can occur in children from the newborn age to adolescence. With certain diseases that affect children, there is need for frequent measurement of blood pressure in children when they are seen in health facilities. Hypertension now affects children because lifestyle factors such as obesity, physical inactivity, consumption of food high in salt, fats and sugar (fast foods), as well as smoking and alcohol consumption, which cause hypertension in adults, are becoming increasingly more common with children. Prevalence of hypertension in Nigerian children ranges from three to eight per cent obtained from different localities.
Can you state the causes of hypertension in children?
Hypertension is classified as either primary or essential hypertension, where there is no underlying cause, or secondary hypertension where there is an underlying cause. Essential hypertension occurs more frequently in adults, while secondary hypertension is seen more frequently in children. Causes of secondary hypertension include renal (kidney) diseases such as renal artery stenosis, acute glomerulonephritis and chronic kidney disease. Other causes include coarctation of the aorta, childhood tumours such as nephroblastoma and neuroblastoma, endocrine disorders such as congenital adrenal hyperplasia. Others include cushing’s syndrome and hyperthyroidism, drugs such as steroids, some nasal decongestants/ cough syrup, caffeine and recreational drugs such as alcohol, tobacco, and cocaine. Sleep disorders such as obstructive sleep apnoea can also cause hypertension. Less frequently, essential hypertension may be diagnosed in children, especially in adolescents.
Which of the causes is most prevalent in Nigeria?
The most commonly reported cause of hypertension in Nigerian children is renal disease. The kidneys are very important in ensuring blood pressure remains normal. Children may be born with abnormalities of the kidney or the vessels supplying the kidney, which affect the normal function of the kidneys. Complications of some bacterial infections such as acute glomerulonephritis and urinary tract infections impair kidney function. The abnormal kidney function results in hypertension.
Hypertension can affect children aged 0–5 years, including newborns. In very young children, the causes may be due to congenital abnormalities of the kidneys or the blood vessels supplying the kidneys which the children are born with, or bacterial infections which affect the kidney. Children who are given toxic substances such as toxic herbal medications in a bid to treat common childhood febrile illnesses may also sustain kidney damage with subsequent development of hypertension.
How do hypertensive pregnant mothers influence their babies’ growth?
In hypertensive mothers, blood supply to the foetus through the placental vessels is compromised, thus reducing the oxygen and nutrients being supplied to the foetus. This result in undernutrition, and intrauterine growth restriction occurs, where the foetus is smaller than it should be. This places the foetus at risk of developing certain disorders at birth.
What are the problems of babies born to a hypertensive mother?
Problems of babies born to hypertensive mothers include low birth weight, prematurity, perinatal asphyxia where the baby does not cry at birth and requires extensive resuscitation, persistent pulmonary hypertension of the newborn where the child has difficulty breathing and low blood glucose.
What are the other common medications that can trigger hypertension in children?
Herbal mixtures such as ‘agbo’ can cause hypertension, as alcohol is frequently used in the preparation. Some may also contain herbs and roots that may contain substances that can elevate blood pressure, as it often unclear what the constituents of such herbal mixtures are.
What are the behavioural and lifestyle changes needed for hypertensive babies to recover?
There is weight loss or control for obese or overweight children. Others include dietary modification to reduce intake of foods high in fats, sugar and salt (fast foods), increasing physical activity by reducing the time spent watching television or playing video games and introducing age-appropriate exercise. Babies who are exclusively breastfed (where the baby takes only breast milk for the first six months of life) are less likely to develop hypertension later in life. Studies have found that babies who are exclusively breastfed are less likely to become obese, which is a risk factor for developing hypertension, as breast milk contains less calories and proteins which limits weight gain in infants. Babies who are exclusively breastfed are also able to better self-regulate their feeds, limiting the risks of overfeeding. Breast milk also contains lower sodium (salt) levels than formula feeds, which impacts positively on blood pressure levels.
Is there a cure for hypertension in babies?
In secondary hypertension, drugs to lower the blood pressure are given, while the underlying cause is being treated. It is expected that once the underlying cause is treated, the blood pressure should normalise. However, in some cases, hypertension could persist, necessitating long-term management with antihypertensives.
What are the challenges in attending to hypertension in children in Nigerian hospitals?
Blood pressure measurement in children requires the use of appropriate-sized cuffs corresponding to different age groups which are often not available. Some hospitals may lack personnel with the necessary expertise to manage such cases, and would need to refer these patients to an appropriate facility.
What is the biggest dilemma of doctors handling cases of hypertensive children?
Managing a child with hypertension can be quite challenging in our setting. Often, the parents find it hard to believe the child has hypertension, since there is poor awareness regarding its occurrence in children. The child may also require prolonged admission, several laboratory and radiological tests, and various medications, which may be expensive. The parents become impatient as they run out of money, and either request for discharge against medical advice or abscond, despite the child not being fit for discharge. Parents may also default at bringing their children to clinic regularly for follow up visits. These all contribute to complications such as chronic kidney disease developing in these children.
Can hypertension in children be misdiagnosed?
Hypertension can be misdiagnosed. When children are anxious or crying, their blood pressure may become elevated, and they may be misdiagnosed as hypertensive. Diagnosis is usually established following several (at least three) readings of elevated blood pressure when the child is calm. Use of faulty blood pressure measuring devices, as well as faulty technique and interpretation of measurements obtained, may also result in misdiagnosis.
What are the consequences of wrong diagnosis of hypertension in children?
If hypertension is erroneously diagnosed in a child, the child with normal blood pressure may be placed on antihypertensive drugs to lower the blood pressure, with resultant dangerous drop in the blood pressure, leading to fainting spells, dizziness, and generalised weakness. This may be fatal if not identified early.
What are the common misconceptions about hypertension in children?
The general misconception is that children are too young to have hypertension, since they do not have worries.
What can a hypertensive mother do to protect the child in her womb?
The hypertensive woman, who is pregnant, should see her doctor who will prescribe appropriate medication that will lower her blood pressure (antihypertensives) which are not harmful to the foetus. She should be regular with antenatal clinic attendance, where she and the baby will be closely monitored to prevent complications from developing.
Health facts on high blood pressure in children
Blood pressure is the pressure of blood against the blood vessel walls as the heart pumps. When someone has high blood pressure (hypertension), the heart and arteries have a much heavier workload. The heart has to pump harder and the arteries are under greater strain as they carry blood.
- Having high blood pressure puts someone at a higher risk for stroke, heart attack, kidney failure, loss of vision, and atherosclerosis (hardening of the arteries).
- The causes of high blood pressure in kids can differ, depending on a child’s age. The younger the child, the more likely the high blood pressure is linked to an illness.
- In babies, it’s usually caused by prematurity or problems with the kidneys (this is most common), lungs, or heart. These can include conditions like bronchopulmonary dysplasia (an immaturity of the lungs in premature babies) or coarctation of the aorta (a narrowing of part of the major blood vessel that carries blood away from the heart).
- While hypertension is far more common in adults, experts link childhood obesity to rising rates of childhood hypertension. In some cases it’s due to a problem with the kidneys or other conditions. If no specific cause is found, doctors call it “essential hypertension.”
- Some medicines (such as steroids or oral contraceptives) can lead to high blood pressure, as can using alcohol and illegal drugs.
- If it’s not treated, high blood pressure can damage the heart, brain, kidneys, and eyes. But when hypertension is caught early, monitored and treated, kids can lead an active, normal life.
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