Health: Children and High Blood Pressure

Kids Health

A new study published Wednesday in the Journal of the American Medical Association reveals a disturbing trend -- high blood pressure is on the rise in U.S. children as they've become increasingly overweight. With children already increasingly being diagnosed with an adult form of diabetes, the new finding is another indication that the nation's obesity epidemic may be predisposing a generation to diseases once found only in adults.

Jeffrey Cutler, MD, of the National Heart, Lung and Blood Institute -- who helped conduct the study -- will be online Wednesday, May 5 at 2 p.m. ET, to discuss the findings of the report and the factors leading to a rise in high blood pressure in kids and teens.

Submit your questions and comments before or during today's discussion.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

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Augusta, Ga.: Dr. Cutler: We congratulate you on the findings of your new study that highlight the need for interventions that are efficacious in lowering elevated blood pressure in adolescents. Please comment on the recently published findings by Barnes VA, Johnson MH, and Treiber FA. reporting impact of stress reduction via Transcendental Meditation on ambulatory blood pressure in African American adolescents. (American Journal of Hypertension 2004; 17:366-369).

Dr. Jeffrey Cutler: Thank you for your kind comments. I have not seen the report from Barnes et al. If you provide me with an e-mail address or other contact information, I will be glad to comment at a later time. (My e-mail address is cutlerj@nhlbi.nih.gov)

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Falls Church, Va.: My daughter is slightly overweight, but is active -- she plays sports. But then again she does tend to have a hard time limiting her food intake. Do I need to worry about her developing high blood pressure?

Dr. Jeffrey Cutler: Physical activity is very important in maintaining a healthy weight and a normal blood pressure. Your doctor or school nurse should be charting your daughter's weight over time against her height and age, compared with the norms of other children. If her weight is staying within the same percentile and is not in the highest percentiles, I would not be concerned about the amount she eats. However, all children should still have their blood pressure checked during physical exams.

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Overland Park, Kan.: Can the DASH diet help children to bring hypertension under control the way it can impact adults?

Dr. Jeffrey Cutler: The data are very limited and no trial similar to the DASH trials has been conducted in children. However, until this evidence deficit is addressed, a DASH-like diet is being recommended for children, based on extrapolation: lots of fruits and vegetables, low in fat especially saturated fat, rich in low fat dairy, high in fiber, etc.

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washingtonpost.com: The DASH Eating Plan, (National Heart, Lung and Blood Institute)

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Anonymous: Dr. Cutler: What is the percentage of total people with HBP? What is the percentage of children 0 - 18 with HBP? Thanks.

Dr. Jeffrey Cutler: We did not calculate those percentages, as it is more complicated to address in children than adults. The dividing line for high blood pressure depends on age, height, and gender. High blood pressure is defined at lower levels in children than adults. There are new tables just out to do these calculations (on the NHLBI web site).

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Clifton, Va.: How was the data for this report gathered?

Dr. Jeffrey Cutler: The National Health and Nutrition Examination Survey has been conducted by the Federal National Center for Health Statistics since the 1970s. Basically, using a complicated geographic sampling method, communities throughout the U.S. are chosen and large examination trailers go arounfd the country (now on a continuous basis). People of all ages who fall into the representative sample are first interviewed in their homes and then invited to come in to the trailer for an all-day exam. Data related to blood pressure is only a small part of the total exam. The data for this study were collected in 1988-94 and 1999-2000. Does that explain it?

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New Jersey: Are there any signs we can look for in our children if we suspect they might have high blood pressure?

Dr. Jeffrey Cutler: No, high blood pressure has no symptoms or signs unless there are complications (rare in children). The only way to detect it is with a blood pressure cuff and measuring instrument (called a sphygmomanometer).

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Farragut West, Washington, D.C.: I've read about the link between caffeine consumption and high blood pressure for African-American children.

Is there any link to caffeine consumption and high blood pressure for adults? Please don't make me give up my coffee!

Dr. Jeffrey Cutler: The link is quetionable for both children and adults. Very heavy coffee consumption (6 or more cups per day) appears to adversely affect risk factors for heart disease (including cholesterol), but less so if it is filtered rather than boiled, and most coffee makers use the filter method today.

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Washington, D.C.: Is the rate of adult high blood pressure also on the rise?

Dr. Jeffrey Cutler: It would have to be, although we did not report this rate, because there are new standards for high blood pressure in children just coming out. In children, they depend on age, height, and gender. The tables showing the levels have recently been posted on the NHLBI web site (www.nhlbi.nih.gov) under What's New. It is complicated enough that it would probably take a health professional to apply them.

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Rockville, Md.: Hello. I have a healthy 13 year old boy that is very active and fit, however, for the past several years his cholesterol has been elevated. His blood pressure is always fine.

Should I be worried and how can I get it down?

Thank you Dr. Cutler.

Dr. Jeffrey Cutler: The first thing to ask your doctor is whether the different types ("fractions") of cholesterol have been measured, as current recommendations suggest. If the total cholesterol is just a little high, it can sometimes be due to an elevation of HDL or so-called "good cholesterol", which is higher in very active people. If he has an increase in LDL or "bad cholesterol", some attention is needed. Unless your son has a genetic condition resulting in very high cholesterol, the key is diet not medication. The key to diet is limiting saturated fat, by watching the red meats, choosing reduced fat milk and other dairy products, certain oils and soft margarines instead of butter, lard, or other oils, etc. You can get more information from your doctor, the NHLBI web site (www.nhlbi.nih.gov) or the American Heart Association. And remember to make dietary changes as a family, because they will be more aceptable for your son and they are good for everyone!

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Washington, D.C.: The article mentioned a range of factors accounting for the rise -- lack of exercise, obesity, salty foods. Is there any one leading factor?

Dr. Jeffrey Cutler: Hard to say--they are interrelated. Overweight is probably number one, but hard to change. Physical activity is probably key to controlling the amount of weight gain, especially in children. There is some evidence that high salt diets underlie all of it, and if salt intake were sufficiently low, the others would not affect blood pressure, but weight and physical activity would still be important for many other health reasons, both heart-related and for other reasons (diabetes, cancer, gall bladder disease, osteoporosis, etc.)

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Silver Spring, Md.: Are adult blood pressure medications safe for children?

Dr. Jeffrey Cutler: In a word, yes, for the most part and as far as it has been studied. This question has been of concern for years, because of the lack of clinical trials in children. Due to extra incentives added to laws and regulations governing the FDA, there have been many more trials in children the past few years, and pediatricians and family practitioners can now prescribe with more confidence. The NHLBI Report coming out this summer on diagnosis and treatment of high blood pressure in children will provide much more information to physicians on this topic.

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Silver Spring, Md.: What do you think it will take for parents to really work on ensuring their child(ren) are at a healthy weight? Education, higher health insurance costs for risky behavior, subsidizing healthy foods, legislation requiring healthy foods and exercise in schools? Its very sad that some parents aren't placing a high priority on this, as evidenced by the increasing weight of children.

Dr. Jeffrey Cutler: That's a really important question, and I don't have solid answers, just opinion, although the NHLBI is doing some community-based research on some of these possibilites, such as linking schools more closely to community organizations providing after school opportunities for active pursuits for children. Education is important, but probably not sufficent. A financial penalty for parents of overweight children? I think it would be widely opposed and punishment seems like a last resort. Top down requirements for physical education and better menus in the schools? Yes, but they will need political support. Market solutions based on food prices? I can see improving availability and consumer appeal, which by increasing demand would probably bring down prices. Other solutions: neighborhoods better designed for an active life; controls on hours per day watching TV or sitting at a computer.

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Vienna, Va.: Does high blood pressure in children depend on diet, genetics or a missing enzyme/gene?

Dr. Jeffrey Cutler: We don't have a lot of information focused on children, but extrapolating from adults, it looks like both genetics and lifestyle are important, with diet and activity being most important. Plus we have not identified most of the genes as yet.

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Arlington, Va.: Is this the first study noting a trend in rising childhood blood pressure or is this just another report contribuing to an already-noticed trend?

Dr. Jeffrey Cutler: The first national study.

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Vienna, Va.: My friend has an unexplainable case of high blood pressure. He is not overweight and has a restricted diet because of food allergies. Normal conventions do not apply in explaining why he has high blood pressure. What could be the cause of his health problem?

Dr. Jeffrey Cutler: As you know, overweight, other dietary factors (including alcohol), and physical activity explain most cases of hypertension, along with genetic factors that are not well understood. However, there are many uncommon causes--they fill textbooks. If your friend is determined to find a cause and especially if he is having difficulty keeping it controlled, there are certified specialists in hypertension to whom he could be referred.

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Fairfax, Va.: My mother has high blood pressure. Should I be worried about having high blood pressure as well and does exercise and diet help or is it inevitable? Also, when I was younger, I did not grow up on fatty foods (McDonald's was a treat).

Dr. Jeffrey Cutler: While it does run in families, partly for genetic reasons, it is far from inevitable. Clinical trials have shown that weight control or reducing dietary salt can prevent the development of hypertension. The DASH diet can also help, as does staying physically active. More information is available on the NHLBI web site (www.nhlbi.nih.gov). You are right about fast foods--those that are high in saturated fats raise cholesterol and may also contribute to high blood pressure.

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