Obesity Can Put Children at Risk of High Blood Pressure

• The number of obese or overweight children are increasing significantly, parallel to a higher prevalence of high blood pressure in children. Currently, these groups are up to 10.6 times more at risk of high blood pressure than children without these conditions.
• High blood pressure or hypertension in the young increase the risk of adult hypertension and cardiovascular risks. It is also the reason for accelerated vascular aging that might cause premature heart attacks, strokes or chronic kidney disease.
• Childhood hypertension has prevalence of thickening heart muscle by 30-40%, which increases cardiovascular risk independently of blood pressure level and body mass index (BMI).
• Screening high blood pressure in children is highly recommended to prevent and decrease the risk of adult hypertension and cardiovascular attack; and may prompt a check of the parents and other family members.
• Aside from obese children, there are other groups of children at risk of the dangers posed by high blood pressure, especially infants who were born prematurely or underweight, with cancer, congenital heart conditions, brain tumor, are organ transplant recipients, or using medication that leads to increased blood pressure such as ADHD treated medication, diabetic patients and patients inflicted with kidney disease.
• There are medicated and non-medicated treatments available for children with high blood pressure depending on the individual diagnosis. Regular exercise and a healthy diet can also help to alleviate the condition.

High blood pressure in children is an extremely worrying trend due to the current growth in rates of obese or overweight children, which can subsequently increase a child’s risk of high blood pressure by up to 10.6 times higher than normal children. Although high blood pressure in children is not a new phenomenon, it is only now that parents are becoming aware of this potentially dangerous health problem.

• In 2012, the Thai Department of Health released the following figures:
  • 10.2% of preschool aged children were overweight.
  • 17% of school-aged children were overweight.
• In 2014, a study carried out by professors at Mahidol University had the following statistics published in the internationally recognized BMC Public Health journal:
  • 20.9% of Thai children were obese; 30.6% of boys were obese, while 12.8% of girls were obese, and 4% of Thai children were found to be suffering from high blood pressure. This study has shown a higher rate of obesity in Thai children compared to those of our Asian neighboring countries which shows a rate of approximately 10%.
  • Obese children are up to 10.6 times more likely to suffer from high blood pressure than those who are not obese.
• In 2015-2016, the rates of obesity had fallen to 8.2%, but the number is still extremely high.

Prevalence of childhood obesity globally

From the statistics gathered in Eric L. Cheung’s 2017 study, published in the Pediatrics Journal, it was found that 39-43% of people in North America, Europe and South America were overweight. It was also found that 21-23% of children in these groups, and around 10% of children in Asia suffered from obesity.

Blood pressure during childhood and its influential factors

• Age: Blood pressure increases with age, and by the time children reach 13, their blood pressure will be assumedly the same as that of an adult.
• Gender: Boys have higher blood pressure than girls.
• Height: Children who grow at a quicker-than-average rate tend to have higher blood pressure.
• Physical activity and mental stress: These factors also transiently elevates blood pressure regardless of age or gender.

What are the explaining mechanism of high blood pressure in obesity?

Studies into high blood pressure have found that the risk increases with a person’s weight, whether it is associated with insulin resistance; hormones found in fat tissues such as leptin or the presence of free radicals. In addition to these substances, the hormone aldosterone that has already been known to play a crucial role in regulating body’s sodium levels and blood pressure; as studied by Professor Wakoko Kawarazaki in work published in 2016, was significantly found dysregulation of this hormone in obese children. The professor also showed that obesity had an impact on the body’s ability to excrete and regulate sodium levels in the kidneys, meaning obese people are more at risk of developing high blood pressure alongside having abnormally high blood pressure in their kidneys.

The risks posed to children by high blood pressure

• A greater risk of blood vessel irregularities, including a higher risk of blood vessel deterioration or blood vessel aging as it is sometimes known, similar to that which affects the elderly.
• A greater risk of emergency situations occurring, including those related to the heart, strokes or even chronic kidney failure.
• A heightened risk of arterial disease that can result in a stroke, victims of which will suffer from numbness in the arms and legs which, if left untreated, could result in full or partial paralysis for the infant involved.

• 34% are due to causes related to the kidney disease.
• 20% are attributed to respiratory conditions.
• Causes associated with the central nervous system make up 13%.
• Issues related to medication account for another 13%.
• 8% are a result of abnormal snoring and sleep apnea.
• 6% can be put down to endocrine diseases.
• 3% are due to heart disease.

From recent studies in tertiary care center, high blood pressure in children are mostly from known-causes that needs further investigation in all children who have been diagnosed with this condition.

1.Children under the age of 3 with a history of the conditions listed below are considered to be most at risk:

• Infants born before the 32nd week of a pregnancy
• Newborns who are under the stated weight for their age.
• Newborns experiencing health complications, had an eventful birth history, or been in the ICU
• Newborns who have had a catheter inserted into the umbilical artery
• Infants with a history of heart conditions, or who have previously suffered heart failure
• Child patients with increased intracranial pressure
• Recipients of an organ transplant
• Child cancer patients
• Children who have received a bone marrow transplant
• Child patients with a history of kidney conditions, including:
  • Repeated urinary tract infections
  • Passing blood or proteins when urinating
  • Other forms of kidney disease, or issues related to abnormal kidney structure
  • A family history of kidney disease

• Child patients who take medication that could have an effect on blood pressure
• Children with underlying health conditions associated with high blood pressure, for instance:
  • Neurofibromatosis
  • Brain tumors, or tumors affecting other vital organs, such as the kidneys, heart, lungs and skin
  • Blood diseases (Sickle cell disease)

2.Children over the age of 3 who should be checked in every healthcare encounter:

• Children who are overweight or obese
• Children who take medication that could have an adverse effect on blood pressure, such as decongestants; drugs containing caffeine; anti-inflammatory medication; alternative medicines, for instance, herbal medication or dietary supplements; drugs used to treat ADHD (stimulants such as Ritalin and Concerta); hormonal contraceptives; stress relieving, steroid drugs; and addictive TCA drugs
• Children with kidney disease
• Children with a history of major arterial stenosis
• Diabetic children

Treatment may take the form of medicated or non-medicated courses of action, depending on each individual diagnosis. Doctors will first screen for any underlying health conditions, such as kidney disease, hormonal issues, heart disease and, if no clear cause is identified, they will proceed to check the family’s medical history and counsel for probable causes. The doctor is likely to suggest making the following lifestyle modifications for children diagnosed with high blood pressure:

• Suitable forms of exercise, to be undertaken regularly, at least 3-5 times per week, 30-60 minutes per session. Children may want to decide on which exercise to carry out according to their likes and dislikes, with examples including running, swimming and cycling. However, exercises should not be overly strenuous or involve excessive movement.
• Regulating their diet. Children tend to enjoy snacking between meals and this is a major cause of obesity. Hence, their diets should be carefully controlled, meaning they should only eat 3 meals per day, avoiding foods that are high in carbohydrates, fat, sugar and salt; recommend increasing high fiber such as whole grains, legumes, beans, seeds, nuts and fruit intake while being careful not to continue eating once they are already full.

For children who have underlying diabetes or chronic kidney disease, medicines should be properly prescribed regardless of blood pressure level.