Increased prevalence looms

Approximately 17% of American children younger than age 18 years are obese, according to a new review by Bonita Falkner, MD, a professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia, and about 30% of them have hypertension directly attributable to their excessive weight.5 “We’re seeing that obesity in childhood results in higher BP, even down to 2-5 years of age,” she observes.

Those figures do not include another 17% who are overweight. “More than one third of children are either overweight or obese,” Dr. Falkner notes. “That converts to about 12 million children.”

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And their prognosis is not good. Epidemiologic studies show that hypertensive children become hypertensive adults. Consequently, the prevalence of premature coronary heart disease in young adulthood can be expected to more than triple (from 5% to 16%) for currently obese adolescents by the time they reach age 35 years, Dr. Falkner predicts.

Data in studies currently being conducted suggest that some children have begun displaying “intermediate markers of vascular injury which indicate that development of vascular pathology is occurring. For example, left ventricular hypertrophy is more frequently detected in adolescents with both high BP and elevated BMI,” Dr. Falkner notes in her review paper.

Lead author of pediatric hypertension guidelines published in 2004, Dr. Falkner emphasizes that this cohort comprises those youngsters with essential hypertension only. It does not include children whose high BP is a secondary effect of an underlying illness, such as kidney or heart disease.

Neither does it include children who experience an occasional BP spike. Adults have a specific numeric BP goal (<130/80 mm Hg), but because BP varies in children as they grow and develop, pediatric hypertension is defined relatively: Clinical diagnosis requires a systolic or diastolic BP >95th percentile for gender, age, and height at repeated measurements on at least three separate occasions.