Rise in Blood Pressure Among Children Cited

[Guest guest]

By Rob Stein

The increase in the number of American children who have become overweight

or obese in the past decade has been accompanied by a disturbing rise in

their blood pressure levels, researchers reported yesterday.

An analysis of data from nationally representative surveys of more than

5,000 children found for the first time that average pediatric blood

pressure rates nationwide have begun to inch up.

The increases may seem small -- 1.4 points in the top systolic reading and

3.3 in the bottom diastolic reading. But they are enough to sharply boost a

child's risk of developing high blood pressure, a major risk factor for

heart disease and strokes -- the nation's leading killers, experts said.

With an adult form of diabetes already being diagnosed in more and more

children, the new finding is another indication that the nation's obesity

epidemic may be predisposing a generation to diseases that in the past

primarily afflicted older adults, experts said.

" What we're doing is shifting this burden of disease to a younger age, "

said Barbara Alving, acting director of the National Heart, Lung, and Blood

Institute. " We see this new data as a wake-up call. It's time to pay

attention to this. "

Federal officials have begun revising the guidelines doctors use to

diagnose and treat high blood pressure in children and adolescents to spur

parents and physicians to screen children more aggressively and begin

treating signs of trouble early.

" The obesity-related rise in blood pressure among American children is a

serious health issue, " Alving said. " We need to take steps to reverse this

trend. "

The new guidelines, which will be released this summer, will for the first

time create a category of " prehypertension " for children. The document will

advise that children with prehypertension be put on a diet-and-exercise

regimen to lower their blood pressure.

If that fails, drugs should be prescribed. The exact blood pressure levels

that classify a child as having prehypertension or hypertension vary by

age, height and sex.

" We want to give our children the best possible start in life, " Alving

said. " That means ensuring they have a healthy blood pressure and weight. We

need to teach them to be physically active and to follow a heart-healthy

eating plan. Otherwise, we may be giving them an early start on heart

disease. "

In the new study, researchers examined data collected from 5,582 children

and adolescents between the ages of 8 and 17 during the government's ongoing

National Health and Nutrition Examination Survey between 1988 and 2000.

Over that time period, the average systolic blood pressure increased from

104.6 to 106 and the average diastolic pressure rose from 58.4 to 61.7, the

researchers reported in today's issue of the Journal of the American Medical

Association.

" What we're seeing is a shift in the whole blood pressure distribution in

children, " said Muntner of Tulane University, who led the study. " We

may be seeing an epidemic of hypertension in the future as these children

become adults. "

Studies have shown that just a one- or two-point increase in blood

pressure translates into a 10 percent increased risk of developing

hypertension as a young adult.

" There's a lot of evidence that high blood pressure begins in childhood,

and it's generally agreed that the strongest determinant of developing high

blood pressure in adulthood is high blood pressure in childhood, " Muntner

said.

Unlike with adults, there is not a single reading that constitutes the

threshold for high blood pressure for all children. Instead, normal blood

pressure varies depending on age, sex and height. For example, a 12-year-old

girl who is 4-feet-11 would be considered to have high blood pressure with

systolic reading of 123 or greater or a diastolic reading of 80 or greater.

The researchers did not analyze the data to determine whether more children

met the definition for high blood pressure at the end of the study period,

but Muntner said that was probably the case.

" Based on this data, the number of children with high blood pressure

probably has increased, " Muntner said.

While increasing weight undoubtedly is contributing to the rise, other

factors probably play a role as well, including a lack of physical activity

and possibly greater salt consumption from eating fast food and prepared

foods, experts said.

" One can be pretty sure that with the increasing role that fast food and

convenience foods play in the diet that kids are being exposed to more

salt, " said Cutler of the NHLBI, who helped conduct the study.

The findings should not necessarily alarm individual parents about their

children, but are cause for concern for the population overall, said

Rae-Ellen Kavey, chief of cardiology at Children's Memorial Hospital in

Chicago.

" On a national level, it is worrisome because the blood pressure of our

children is gradually trending up over time, just as the weight of our

children is gradually trending up over time, " said Kavey, speaking on behalf

of the American Heart Association.

Melinda S. Sothern, who treats overweight and obese children at Louisiana

State University's Health Sciences Center in Baton Rouge, said she is

already seeing children suffering severe health problems because of their

weight.

" I think that we're going to have a generation of children who are not

children. They're basically, because of the physiological and metabolic

sickness associated with carrying all that excess weight around, prevented

them from participating in childlike activities, " Sothern said. " They are

going to be very much physically and emotionally handicapped, and we're

going to have to pay for it as a nation. "