Daily Dose: Pediatric Primary Hypertension

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On March 30, 2023, we reported on a new scientific statement from the American Heart Association (AHA) published in Hypertension titled, "Pediatric Primary Hypertension: An Underrecognized Condition: A Scientific Statement From the American Heart Association."

The statement

Authors stated that the leading type of childhood hypertension (HTN) is primary HTN, especially in adolescence, raising the risk for cardiovascular disease (CVD) events in adulthood, Risk factors for HTN in children and adolescents that are not modifiable include genetics, low birth weight, and environmental exposures. Risk factors that are modifiable include obesity, physical activity, and nutrition. A recent meta-analysis of 18 studies with high-quality data on sodium intake and BP measurements found that systolic BP increased by 0.8 mm Hg and diastolic BP increased by 0.7 mm Hg for every additional gram of daily sodium intake. This is a point of concern because dietary sodium intake among children and adolescents in the US is “far above” recommended levels, largely due to consumption of processed foods.

The statement notes that primordial prevention is an important public health goal; a population with lower BP will have fewer comorbidities related to HTN and CVD. “Ongoing primordial prevention efforts such as obesity prevention campaigns that promote increased physical activity and healthy diets such as the DASH [Dietary Approaches to Stop Hypertension] diet may contribute to a reduced prevalence of hypertension,” wrote authors. “Of the behavioral risk factors for hypertension in youth, poor diet has the highest prevalence and may offer the greatest opportunity for intervention.”

Clinicians and policymakers should also consider social determinants of health when assessing patients, including factors such as food insecurity and exposure to traumatic events, according to the statement. “These factors can strongly affect whether an individual or family has access to the resources needed to implement primordial prevention strategies,” wrote researchers. “Of interest are strategies to prevent or mitigate these conditions by improving access to healthy foods and health care, increasing social support for families, and promoting resiliency with subsequent effects on childhood BP and hypertension.”

Note from authors

"There is a need for increased understanding and greater research surrounding high blood pressure in youth," said Bonita Falkner, MD, chair of the scientific statement writing committee. "Future studies to improve both the recognition and diagnosis of high blood pressure in this age group, as well as clinical trials to evaluate medical treatment and recommend public health initiatives, are all vital to improving the increase we are seeing in hypertension in children.”

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