Kids' High Blood Pressure Often Missed

Doctors say an increased reliance on computerized records could be part of the solution to this problem, as electronic databases may offer a much easier and more reliable way to keep track of pediatric patients from visit to visit.

"The whole idea is that as more and more of this information is put into an electronic format, the computer will allow us to process this information in ways that we have not before," Kaelber said.

Rao agreed. "For example, in electronic health records, if blood pressure is elevated above normal ... the computerized system could send an alert to the physician."

Hypertension? Not My Child

But while computerized systems may go a long way in making sense of diagnostic data, preconceived notions about the onset of high blood pressure could stymie efforts to detect more cases of pediatric hypertension.

"Both among parents -- and unfortunately, among pediatricians -- the idea that a child could have a chronic disease in terms of high blood pressure is hard to believe," Kaelber said. "Part of that is because a child is not going to come into the doctor's office having a heart attack, stroke or kidney problems due to high blood pressure.

"In that sense, high blood pressure is very much a silent disease in children."

Unfortunately, if it is undetected in childhood, hypertension may remain silent for decades. Kaelber said high blood pressure problems missed in childhood are unlikely to be detected in the patient's 20s and early 30s -- a time during which most people assume they are in good shape and subsequently skimp on doctor visits.

"Our concern is that there is probably a cohort of people who are newly diagnosed with high blood pressure in their 40s and 50s who have actually had it for decades," he said. By this time, the condition may have already caused significant damage to the heart, the kidneys and other organs.

But there is another reason that detecting hypertension early is important; it may be a signal for other underlying and serious health conditions.

"Some children have high blood pressure secondary to an often correctable disease -- for example, kidney disease, such as renal vascular stenosis," Rao said. "Missing high blood pressure means missing such secondary causes."

What Parents Should Do

While parents may be shocked upon learning their child has high blood pressure, catching the condition early means that they can also get a head start in treating the problem.

If a child is found to have high blood pressure, a pediatrician will likely recommend three to six months of medicine-free interventions -- increased exercise and dietary changes that may cut out excess calories and salt.

"The first line of treatment for hypertension is basic: weight loss, salt restriction, and plenty of exercise," Rao said.

Edwards agreed. "As we know, obesity seems to be one of the big factors correlated with hypertension," he said. "This needs to be very aggressively treated."

After lifestyle modifications, if the child has not made significant progress, treatment may shift to medications.

Kaelber suggests that parents would also do well to be on guard against high blood pressure during routine checkups.

"Ideally, this raises awareness among parents that blood pressure is an issue among children," he said.

"And it is also a nice, gentle reminder to pediatricians that if they haven't looked at a child's blood pressure, it might be a good idea."

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