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Hypertension Among Children On the Rise and Should Be Monitored

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By Maria Cendejas and editing by Stacey Sexton

More than half of children admitted to an urban Florida pediatric emergency department in 2007-2008 had high blood pressure, according to the journal Pediatric Emergency Care.

High blood pressure is often a sign of kidney or other health problems in children.

“Evaluating the readings thoughtfully and ordering further tests could be the key to diagnosing a serious problem,” said Dr. Phyllis Hendry, associate professor in the department of emergency medicine at the University of Florida College of Medicine-Jacksonville and co-author of the study.

 Researchers looked at charts of approximately 1,000 patients aged 18 years old and under who were admitted to Shands Jacksonville Medical Center over a 13-month period in 2007-2008.

 “Researchers were only expecting to see about 100 patients with elevated triage blood pressure in the 90th percentile or higher but found more than 500,” Hendry said. “More than 20 percent had severely high levels in the 95th percentile or higher.”

 It was also found that high blood pressure was recognized on the medical record in only a small percentage of cases among residents, according to the  pediatric emergency physicians.

 “In adult emergency patients, we are very focused on blood pressure, and abnormal values are clearly defined,” Hendry said. “In children, it’s easy to dismiss a high value because often they are anxious, crying or in pain. There are a number of things that can affect blood pressure.  However, the pain level of the child was not associated with blood pressure elevation. Neither was the race of the child."

 This means that hypertension among children is increasing. It affects 5 percent of American youth, up from 1 percent in the 1970-1980s.

The ER can play a larger role in finding potential problems.  But it's sometimes hard to know how much weight to give the data.  There is a lengthy list of variables that determine a “normal” blood pressure for a child.

 “You can be transitioning from examining a premature baby that weighs 3 pounds to a 300-pound adolescent, so what is normal blood pressure supposed to be?” Hendry said.

 Standards are also based on measuring blood pressure three times and taking the mean of the three readings, which isn't practical in an ER.  But if patients are in the ER for many hours, their vital signs are usually checked again or at discharge.

 Researchers say if a child’s blood pressure remains high, physicians should suggest that patients have a follow-up appointment with their primary care physician within a few weeks.  At the follow-up, the doctor should check if blood pressure is still elevated.

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