HTN in Child or Teen? Retake Blood Pressure
Node Smith, ND
Hypertension or Take 2 on Blood Pressure for Teens and Children?
According to a recent study, nearly a quarter (25%) of children and teens initially screened in primary care offices may have hypertension, however far less of these initial readings are confirmed when blood pressure is repeated.1 The study was conducted by Kaiser Permanente and released recently in the Journal of Clinical Hypertension. The study, and subsequent publication, is meant to highlight the importance of taking a second blood pressure reading when the first is elevated in patients between the ages of 3 and 17.
Best Practice: Taking a Second Reading when First Reading is High
It isn’t extremely common for a pediatrician to diagnose hypertension in a child, however it does happen, and it is occurring more often. Taking a second reading when a first reading is high is being advocated as a best practice in this patient population.
BP Increases in Children are Multifactorial
Increases in blood pressure in children can be caused by numerous factors, including a child’s anxiety. Also, what is considered high blood pressure in children is different from what is considered high in an adult population, just like pulse and respiratory rate. For instance, the normal range for a preschooler’s (3-5 years) blood pressure is 89-112(systolic) and 46-72(diastolic). This means that a blood pressure that is considerably “normal” for an adult of 130/80 could be considered very high for a child. Blood pressure will also vary depending on height, weight, and gender which are all things to consider in a child population.
Hypertension & BP Study
The study looked at almost 800,000 patients over a 4-year period and showed that among Kaiser Permanente patients ages 3-17 years, about 25 percent had at least one blood pressure reading that was considered in the hypertensive range, but under half of that number would have been classified as hypertensive upon further readings. In general, the percentage of youth with sustained hypertension over time is likely to be under 3 percent according to the study.
Repeated Readings are Key
According to Corinna Koebnick, PhD, MSc, of the Kaiser Department of Research, and elevated first blood pressure in a child is very common, and repeated readings are key to identifying hypertension in pediatric care. Many practitioners may be missing hypertension in their child patients by not confirming with a second reading.
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Node Smith, ND, is a naturopathic physician in Portland, OR and associate editor for NDNR. He has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp-out where naturopathic medicine and medical philosophy are experienced in nature. Four years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.