High blood pressure is a condition in which blood pressure against the arterial walls is high (1). Due to the increasing prevalence of obesity and lack of physical activities, this condition is considered a growing health problem in children and adolescents as it directly increases the risk of developing heart diseases and stroke later in life (2). According to the CDC, around one in 25 of ages 12-19 years has hypertension, and one in ten has elevated blood pressure (3).
Read about causes, predisposing factors, symptoms, diagnosis, treatment, and prevention of high blood pressure in teenagers.
How Is Blood Pressure Measured In Teenagers?
Blood pressure measurement is recorded as “mmHg” (millimeters of mercury) in two numbers.
- Higher number is systolic pressure, the maximum arterial pressure when heart contracts, and
- Lower number is diastolic pressure, the lowest arterial pressure when the heart relaxes (1).
With changing cuff sizes, anxiety levels, caffeine intake, time of day, and patient positioning, it is difficult to obtain an accurate blood pressure measurement. For an accurate reading, children and teenagers should be made to sit quietly for at least three to five minutes beforehand with proper back support, flat and uncrossed feet (2).
A pediatrician or a physician may use a standard mercury sphygmomanometer, aneroid sphygmomanometer, or a digital sphygmomanometer (blood pressure cuff for automatic blood pressure reading) for measuring the blood pressure. In addition, they should have access to cuffs of varying sizes for an appropriate fit (2).
Who Is At Risk For Developing High Blood Pressure?
The following factors increase the risk of high blood pressure in teenagers (2):
- Obese and increased body mass index
- Lack of physical activity
- Family history of high blood pressure or cardiac disease
- Increased abdominal circumference
- Maternal smoking during pregnancy
- Boys are more likely to develop high blood pressure than girls
- Hispanics and blacks
What Are The Causes Of High Blood Pressure In Teenagers?
High blood pressure or hypertension in children and teenagers can be subdivided as primary (or essential) hypertension, i.e., without any definite cause, and secondary hypertension, if there is an underlying illness or disorder.
Primary hypertension is the most common cause of hypertension in adolescents. It affects high-risk adolescents and those undergoing hormonal imbalances and rapid growth spurts, resulting in transient rises in cholesterol and blood pressure levels. This transient increase can further be exacerbated by a high-fat diet, lack of exercise, and smoking. Secondary hypertension, on the other hand, could be the result of an underlying illness or systemic disease, which may include (4) (5):
- An underlying kidney and cardiovascular disease (CVD),
- Chronic illness (6)
- Severe pain (with cancer or burns) (6)
- Endocrine diseases, such as diabetes
- Neurological condition
- Mental health causes, such as mental stress and anxiety
- Drug absuse (anabolic steroids, cocaine), over-the-counter medications and supplements (caffeine, diet pills), and prescribed medicines (oral contraceptives, steroids) (2).
How To Prevent High Blood Pressure In Teenagers?
To maintain the blood pressure levels within normal limits, teens should adopt the following measures (3):
- Maintaining a healthy weight
- Eating healthy meals— nutritious, low in sodium, low in added sugars, fruits and vegetables
- Regular physical activity
- Staying away from smoking (5)
What Are The Signs And Symptoms Of High Blood Pressure In Teenagers?
High blood pressure in children and adolescents is mostly asymptomatic. Sometimes, they may develop symptoms that might indicate a high blood pressure emergency (hypertensive crisis), requiring immediate medical attention. These symptoms include (7):
- Early morning headaches
- Cognitive changes
- Nausea and vomiting
- Altered mental status
- Blurry vision
- Irregular heartbeat
- Chest pain
- Muscle tremors
How Is High Blood Pressure Diagnosed In Teenagers?
The American Heart Association (AHA) recommends all children and adolescents have annual blood pressure measurements for early detection and intervention of high blood pressure (8).
1. Obtaining an accurate measurement of blood pressure: Several factors can lead to elevated blood pressure in teenagers.
Therefore, a recorded elevation in blood pressure on three different occasions (at least one week apart) or an ambulatory blood pressure monitoring (ABPM) is required to validate the diagnosis of high blood pressure in teenagers. ABPM refers to a specific validated device that assesses blood pressure every 20 to 30 minutes.
In children (below 13 years), elevated or high blood pressure is the blood pressure in the 90th percentile or higher depending on their age, height, and sex, while hypertension is blood pressure in the 95th percentile or higher.
In adolescents (13 years and older), blood pressure of 120 to 129mmHg systolic and less than 80mmHg diastolic pressure is defined as elevated blood pressure, while hypertension is the blood pressure of 130/80 mmHg or higher (2).
2. Clinical evaluation of hypertensive teenager: It includes a detailed history and comprehensive physical examination to look for the presence of underlying cause and other comorbidities.
3. Diagnostic tests: Initial investigation with a urinalysis, evaluation of electrolyte, blood urea nitrogen, and creatinine levels, and echocardiography are the diagnostics tests perfomed. In teenagers with abnormal renal function or urinalysis results, renal sonography can be suggested; however, it is unnecessary if the physical examination results and urinalysis are normal.
Additional diagnostic studies to rule out comorbid conditions may include:
- Complete blood count
- Drug screening
- Fasting glucose or A1C level; aspartate/alanine transaminase levels
What Is The Treatment For High Blood Pressure In Teenagers?
1. Therapeutic lifestyle modifications
This is the primary treatment option and the only treatment option in patients with mild elevation in blood pressure. It focuses on:
- Weight reduction if overweight or obese
- Regular physical activity
- Dietary changes, including a healthy diet, and low-sodium intake
- Avoidance of substance use, such as illicit drugs and tobacco use
- Stress reduction
- Family-based interventions, including family counseling
2. Pharmacological therapy
Sometimes, adolescents with high blood pressure may require antihypertensive medication, particularly if they have symptomatic hypertension, secondary hypertension, target organ damage, comorbid conditions (such as diabetes mellitus), or persistent hypertension despite a trial of lifestyle modifications. Drugs, such as Calcium Channel Blockers (CCB), Angiotensin-Converting Enzyme Inhibitors (ACEI), Angiotensin Receptor Blockers (ARB), diuretics, vasodilators, aldosterone receptor blockers, and other antihypertensive drugs can treat high blood pressure in teenagers.
Earlier, high blood pressure was considered an adult illness and overlooked in children and adolescents. Currently, it is a growing health concern due to unhealthy eating habits and lifestyle changes. Management of high blood pressure in teenagers mainly includes lifestyle modification, which focuses on dietary changes, regular exercise, and medications to improve the teen’s quality of life.