Hypertension | Research & Encyclopedia Articles

Also known as high blood pressure, a condition in which too much force is exerted by the blood as it travels through the body's arteries.

There are two types of hypertension: primary and secondary. Primary, or essential, hypertension is caused by external factors; secondary hypertension is related to an underlying disorder, such as a congenital heart defect or kidney disease. Factors that increase the risk of high blood pressure include age (the likelihood of hypertension increases with age), race (hypertension is two to three times more common in blacks than in whites), heredity, and being overweight.

About 60 million Americans have high blood pressure. Of this number roughly 2.7 million are children between the ages of six and 17. Secondary hypertension occurs in only about 10% of the diagnoses—in the majority of cases the condition has no known cause. However, serious hypertension in infants and young children is usually of the secondary variety. Secondary hypertension also occurs (although less frequently) in adolescents, in whom it can signal a hormonal imbalance, kidney disorder, or other condition. In contrast, primary hypertension is not unusual among adolescents and is also found, though infrequently, in children. Of the two types, secondary hypertension is easier to detect because the symptoms of the underlying condition alert the child and parents that something is wrong. Primary hypertension usually produces no symptoms, a fact that makes it important for children to have their blood pressure tested regularly starting at the age of three. Children and adolescents with high blood pressure have an increased risk of developing hypertension in adulthood.

Blood pressure in children is measured the same way as in adults—with the familiar inflatable cuff and meter known as a sphygmomanometer (although a special smaller cuff is used for children). Two figures are used to describe blood pressure. The top figure—known as systolic blood pressure—refers to the level of pressure when the heart contracts to circulate the blood. The lower number—called the diastolic pressure—is based on the reading when the heart is resting. The total pressure is the systolic over the diastolic pressure, expressed in millimeters of mercury (a typical blood pressure reading might be 120 over 80). High blood pressure in adults is defined as a reading higher than 140 over 90. The blood pressure of children is lower than of adults and steadily increases as the child grows older. For example, a normal reading for a three-year-old would be 98 over 64. High blood pressure is diagnosed in children if the average of three readings is higher than that for 90% of children in the same age group. Aside from age, size itself is a factor—larger children have higher blood pressure than smaller ones, whatever their age (a fact taken in account when their blood pressure is assessed). Children should not have their blood pressure taken when they are nervous or agitated. Adolescents should be careful not to ingest any stimulants, such as caffeine, nicotine, or alcohol, in the hours preceding a blood pressure reading.

When a child is found to have elevated blood pressure, blood and urine tests and kidney χ rays are commonly taken to rule out any underlying disorder. If the diagnosis is primary hypertension, common treatment measures include a program of increased exercise and dietary modifications to cut down on sodium, especially salt, which is abundant in many foods favored by young people, such as french fries, pizza, potato chips, hot dogs, and hamburgers. Some substitution of healthy snacks such as fruit can help reduce the amount of salt in the diet. If the child is overweight, dietary changes may focus on weight loss. Even a modest reduction in weight can help reduce blood pressure. If other measures do not sufficiently alleviate the hypertension, a medication may be prescribed, usually a diuretic which cuts down on water retention by increasing the amount eliminated through urination.

For a child with a family history of heart disease or stroke, careful monitoring of blood pressure and treatment of hypertension can help reduce the risk of these conditions. According to the National High Blood Pressure Education Program, the treatment of hypertension early in life can also reduce the risk of heart and kidney failure and promote longevity. It is recommended that children and adolescents with high blood pressure have their blood pressure checked twice a year.

Caris, Timothy N. Understanding Hypertension: Causes and Treatments. New York: Basic Books, 1986.

Rees, Michael K. The Complete Family Guide to Living with High Blood Pressure. Englewood Cliffs, NJ: Prentice-Hall, 1980.

Salander, James M. Hypertension: Reducing Your Risk. New York: Bantam, 1993.

		Systolic BP (mm Hg)							Diastolic BP (mm Hg)
Age	Height Percentiles*→ BP† ↓	5%	10%	25%	50%	75%	90%	95%	5%	10%	25%	50%	75%	90%	95%
*Height percentile determined by standard growth curves.
†Blood pressure percentile determined by a single measurement.
The blood pressure check is a routine part of most physical examinations. An estimated 2.7 million children between the ages of six and 17 have high blood pressure.
1	90th	94	95	97	98	100	102	102	50	51	52	53	54	54	55
	95th	98	99	101	102	104	106	106	55	55	56	57	58	59	59
2	90th	98	99	100	102	104	105	106	55	55	56	57	58	59	59
	95th	101	102	104	106	108	109	110	59	59	60	61	62	63	63
3	90th	100	101	103	105	107	108	109	59	59	60	61	62	63	63
	95th	104	105	107	109	111	112	113	63	63	64	65	66	67	67
4	90th	102	103	105	107	109	110	111	62	62	63	64	65	66	66
	95th	106	107	109	111	113	114	115	66	67	67	68	69	70	71
5	90th	104	105	106	108	110	112	112	65	65	66	67	68	69	69
	95th	108	109	110	112	114	115	116	69	70	70	71	72	73	74
6	90th	105	106	108	110	111	113	114	67	68	69	70	70	71	72
	95th	109	110	112	114	115	117	117	72	72	73	74	75	76	76
7	90th	106	107	109	111	113	114	115	69	70	71	72	72	73	74
	95th	110	111	113	115	116	118	119	74	74	75	76	77	78	78
8	90th	107	108	110	112	114	115	116	71	71	72	73	74	75	75
	95th	111	112	114	116	118	119	120	75	76	76	77	78	79	80
9	90th	109	110	112	113	115	117	117	72	73	73	74	75	76	77
	95th	113	114	116	117	119	121	121	76	77	78	79	80	80	81
10	90th	110	112	113	115	117	118	119	73	74	74	75	76	77	78
	95th	114	115	117	119	121	122	123	77	78	79	80	80	81	82
11	90th	112	113	115	117	119	120	121	74	74	75	76	77	78	78
	95th	116	117	119	121	123	124	125	78	79	79	80	81	82	83
12	90th	115	116	117	119	121	123	123	75	75	76	77	78	78	79
	95th	119	120	121	123	125	126	127	79	79	80	81	82	83	83
13	90th	117	118	120	122	124	125	126	75	76	76	77	78	79	80
	95th	121	122	124	126	128	129	130	79	80	81	82	83	83	84
14	90th	120	121	123	125	126	128	128	76	76	77	78	79	80	80
	95th	124	125	127	128	130	132	132	80	81	81	82	83	84	85
15	90th	123	124	125	127	129	131	131	77	77	78	79	80	81	81
	95th	127	128	129	131	133	134	135	81	82	83	83	84	85	86
16	90th	125	126	128	130	132	133	134	79	79	80	81	82	82	83
	95th	129	130	132	134	136	137	138	83	83	84	85	86	87	87
17	90th	128	129	131	133	134	136	136	81	81	82	83	84	85	85
	95th	132	133	135	136	138	140	140	85	85	86	87	88	89	89

		Systolic BP (mm Hg)							Diastolic BP (mm Hg)
Age	Height Percentiles* BP†	5%	10%	25%	50%	75%	90%	95%	5%	10%	25%	50%	75%	90%	95%
*Height percentile determined by standard growth curves.
†Blood pressure percentile determined by a single measurement.
1	90th	97	98	99	100	102	103	104	53	53	53	54	55	56	56
	95th	101	102	103	104	105	107	107	57	57	57	58	59	60	60
2	90th	99	99	100	102	103	104	105	57	57	58	58	59	60	61
	95th	102	103	104	105	107	108	109	61	61	62	62	63	64	65
3	90th	100	100	102	103	104	105	106	61	61	61	62	63	63	64
	95th	104	104	105	107	108	109	110	65	65	65	66	67	67	68
4	90th	101	102	103	104	106	107	108	63	63	64	65	65	66	67
	95th	105	106	107	108	109	111	111	67	67	68	69	69	70	71
5	90th	103	103	104	106	107	108	109	65	66	66	67	68	68	69
	95th	107	107	108	110	111	112	113	69	70	70	71	72	72	73
6	90th	104	105	106	107	109	110	111	67	67	68	69	69	70	71
	95th	108	109	110	111	112	114	114	71	71	72	73	73	74	75
7	90th	106	107	108	109	110	112	112	69	69	69	70	71	72	72
	95th	110	110	112	113	114	115	116	73	73	73	74	75	76	76
8	90th	108	109	110	111	112	113	114	70	70	71	71	72	73	74
	95th	112	112	113	115	116	117	118	74	74	75	75	76	77	78
9	90th	110	110	112	113	114	115	116	71	72	72	73	74	74	75
	95th	114	114	115	117	118	119	120	75	76	76	77	78	78	79
10	90th	112	112	114	115	116	117	118	73	73	73	74	75	76	76
	95th	116	116	117	119	120	121	122	77	77	77	78	79	80	80
11	90th	114	114	116	117	118	119	120	74	74	75	75	76	77	77
	95th	118	118	119	121	122	123	124	78	78	79	79	80	81	81
12	90th	116	116	118	119	120	121	122	75	75	76	76	77	78	78
	95th	120	120	121	123	124	125	126	79	79	8C	80	81	82	82
13	90th	118	118	119	121	122	123	124	76	76	77	78	78	79	80
	95th	121	122	123	125	126	127	128	80	80	81	82	82	83	84
14	90th	119	120	121	122	124	125	126	77	77	78	79	79	80	81
	95th	123	124	125	126	128	129	130	81	81	82	83	83	84	85
15	90th	121	121	122	124	125	126	127	78	78	79	79	80	81	82
	95th	124	125	126	128	129	130	131	82	82	83	83	84	85	86
16	90th	122	122	123	125	126	127	128	79	79	79	80	81	82	82
	95th	125	126	127	128	130	131	132	83	83	83	84	85	86	86
17	90th	122	123	124	125	126	128	128	79	79	79	80	81	82	82
	95th	126	126	127	129	130	131	132	83	83	83	84	85	86	86

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