146 99 blood pressure

How Serious Is Your Hypertension?

Hypertension, or high blood pressure, is a health condition that affects about one in three American adults. But not everyone who has hypertension has high blood pressure to the same degree. Doctors use four hypertension categories to help classify how likely your blood pressure level is to affect your health: prehypertension, stage 1, stage 2, and hypertensive crisis.

Normal Blood Pressure

Blood pressure is measured by taking two different measurements of the pressure within your arteries: systolic pressure and diastolic pressure. Systolic pressure, the first or top number of the blood pressure reading, is the highest level of pressure in your arteries, which occurs when your heart muscle contracts and forces a burst of blood into the aorta. Diastolic pressure, which is the bottom number, is the pressure that exists within your arteries between heart muscle contractions, which is when your heart is filling with blood.

If your blood pressure reading is less than 120/80 millimeters of mercury or mm Hg (the unit of measurement that is used to describe blood pressure), you have normal blood pressure. This means that your systolic pressure is less than 120 mm/Hg and your diastolic reading is less than 80 mm/Hg.

Blood pressure fluctuates throughout the day, so it is normal for your blood pressure to change from reading to reading. Your blood pressure is considered normal if it is less than 120/80 mm Hg most of the time.

Prehypertension: When Blood Pressure Is Above Normal

If your blood pressure is higher than 120/80 mm Hg — meaning that one or both of these numbers are higher — your doctor may take a number of readings over time, and possibly have you track your blood pressure at home to get more information before making a diagnosis of hypertension.

If you have prehypertension, your blood pressure is above normal, but not high enough to warrant a diagnosis of hypertension. Prehypertension is considered to be a systolic pressure of 120 to 139 mm Hg or a diastolic pressure of 80 to 89. If your systolic pressure and diastolic pressure are not in the same category, you are considered to be in the more severe category of the two.

People who have prehypertension are likely to eventually develop hypertension, unless they take steps to lower their blood pressure. If you have prehypertension, your doctor may recommend healthy lifestyle changes to prevent or delay the onset of hypertension.

Stage 1 and Stage 2 Hypertension

Hypertension is diagnosed when your systolic pressure is 140 mm Hg or above or when your diastolic pressure is 90 or above. In people who have diabetes or kidney disease, hypertension is diagnosed when blood pressure is 130/80 mm Hg or higher. The higher your blood pressure is, the greater your risk of developing blood pressure-related complications such as heart disease, heart failure, stroke, or kidney failure.

The first stage of hypertension is called stage 1 hypertension. The systolic pressure is 140 to 159 mm Hg or your diastolic pressure is 90 to 99 mm Hg. The next stage of hypertension, stage 2 hypertension, is diagnosed when your systolic pressure is 160 mm Hg or higher or your diastolic pressure is 100 mm Hg or higher.

A diagnosis of hypertension means that you need treatment to get your blood pressure under control. Your doctor may recommend lifestyle changes and high blood pressure medication to help manage your blood pressure.

Hypertensive Crisis: A High Blood Pressure Emergency

A systolic pressure reading above 180 mm Hg or a diastolic pressure reading above 110 mm Hg may mean that you are in hypertensive crisis and need emergency medical care. If you get a reading in this range at home, wait a few minutes and take your blood pressure again; call for emergency medical care if your blood pressure remains excessively high.

Talk with your doctor about your blood pressure and what your numbers mean for you. Even if you have hypertension, taking steps to keep your blood pressure under control can reduce your risk of blood pressure-related health problems.

Lowering Elevated Diastolic Blood Pressure Will Lessen Chance of Developing Elevated Systolic Blood Pressure

April 2, 2010

Dear Mayo Clinic:

I have normal systolic blood pressure, but my diastolic goes between 82 and 96 during the work day and goes down to normal at night or when there is no stress. Should I be concerned or is this normal?


If you don’t have other health issues that increase your risk of cardiovascular problems, the situation you describe — isolated diastolic hypertension — isn’t dangerous now. But it’s not normal, either. People with elevated diastolic blood pressure often develop elevated systolic blood pressure over time. You can help prevent that by taking steps to lower your diastolic blood pressure to a normal level.

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in the arteries when the heart beats (systolic pressure). The second, or lower, number measures the pressure in the arteries between beats (diastolic pressure). Normal blood pressure is below 120/80 mm Hg.

Research regarding diastolic blood pressure has evolved considerably over the last several decades. During the 1970s and 1980s, many researchers and physicians believed the diastolic reading was the more important of the two blood pressure measurements. Now, we know they are both equally important.

Minimal elevations of diastolic blood pressure (less than 95 mm Hg) alone don’t pose an immediate significant health risk. But that’s assuming you’re in good health otherwise and don’t have any additional factors that put you at risk for cardiovascular problems. Those factors include diabetes, kidney disease, obesity, smoking, hardening of the arteries (atherosclerosis), or a history of heart disease or a heart attack.

If you don’t have any additional risk factors, regularly monitoring your blood pressure and making lifestyle changes to decrease your diastolic blood pressure may be all that’s necessary at this time. Taking steps to reduce your blood pressure to a normal level is important because an elevated diastolic pressure puts you at a higher-than-average risk of developing elevated systolic blood pressure as you age. Changes that can make a difference include eating a low-salt diet, avoiding alcohol, exercising regularly, not smoking and maintaining a healthy weight.

If you have other cardiovascular risk factors, any elevation in diastolic blood pressure — even if it’s small — significantly increases your risk of cardiovascular problems. If that’s the case for you, I strongly recommend you work with your physician to create a comprehensive treatment plan that addresses all your risk factors, including high blood pressure.

Effective management of high blood pressure is important because if left untreated it can have serious, long-term consequences. High blood pressure damages the lining of the blood vessels and accelerates hardening of the arteries throughout the body. This, in turn, can lead to a variety of health issues, such as cerebrovascular disease, heart attack and peripheral vascular disease, among others. These are cholesterol-related complications that people often think of when considering health problems associated with high blood pressure.

But there’s another way high blood pressure is equally dangerous. The constant pounding of high blood pressure on blood vessels can also lead to serious health problems, including the type of stroke where there is bleeding in the area between the brain and the tissues that cover it (subarachnoid hemorrhage), congestive heart failure, kidney failure and abdominal aortic aneurysm.

In addition, increasing evidence suggests a correlation between high blood pressure and dementia. Research has shown that successful treatment of high blood pressure is associated with a reduced risk for dementia and Alzheimer’s disease. So, to protect the brain, treat high blood pressure.

To effectively address your situation, I encourage you to make an appointment with your doctor to assess your elevated diastolic blood pressure and, based on your health history and other medical issues, develop a plan to manage it appropriately.

—John Graves, M.D., Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.

Reading the new blood pressure guidelines

The definition for what is considered high blood pressure has been tightened. Here’s what you need to know.

Updated: December 13, 2019Published: April, 2018

If you didn’t have high blood pressure before, there’s a good chance you do now.

In 2017, new guidelines from the American Heart Association, the American College of Cardiology, and nine other health organizations lowered the numbers for the diagnosis of hypertension (high blood pressure) to 130/80 millimeters of mercury (mm Hg) and higher for all adults. The previous guidelines set the threshold at 140/90 mm Hg for people younger than age 65 and 150/80 mm Hg for those ages 65 and older.

This means 70% to 79% of men ages 55 and older are now classified as having hypertension. That includes many men whose blood pressure had previously been considered healthy. Why the change?

Behind the numbers

“Blood pressure guidelines are not updated at regular intervals. Instead, they are changed when sufficient new evidence suggests the old ones weren’t accurate or relevant anymore,” says Dr. Paul Conlin, an endocrinologist with Harvard-affiliated VA Boston Healthcare System and Brigham and Women’s Hospital. “The goal now with the new guidelines is to help people address high blood pressure — and the problems that may accompany it like heart attack and stroke — much earlier.”

The new guidelines stem from the 2017 results of the Systolic Blood Pressure Intervention Trial (SPRINT), which studied more than 9,000 adults ages 50 and older who had systolic blood pressure (the top number in a reading) of 130 mm Hg or higher and at least one risk factor for cardiovascular disease. The study’s aim was to find out whether treating blood pressure to lower the systolic number to 120 mm Hg or less was superior to the standard target of 140 mm Hg or less. The results found that targeting a systolic pressure of no more than 120 mm Hg reduced the chance of heart attacks, heart failure, or stroke over a three-year period.

More than blood pressure

The new guidelines have other changes, too. First, they don’t offer different recommendations for people younger or older than age 65. “This is because the SPRINT study looked at all patients regardless of age and didn’t break down groups above or below a certain age,” says Dr. Conlin.

The guidelines also redefined the various categories of hypertension. It eliminated the category of prehypertension, which had been defined as systolic blood pressure of 120 to 139 mm Hg or diastolic pressure (the lower number in a reading) of 80 to 89 mm Hg. Instead, people with those readings are now categorized as having either elevated pressure (120 to 129 systolic and less than 80 diastolic) or Stage 1 hypertension (130 to 139 systolic or 80 to 89 diastolic).

A reading of 140/90 mm Hg or higher is considered Stage 2 hypertension, and anything higher than 180/120 mm Hg is hypertensive crisis.

Check your blood pressure at home

The new guidelines note that blood pressure should be measured on a regular basis and encourage people to use home blood pressure monitors. Monitors can range from $40 to $100 on average, but your insurance may cover part or all of the cost. Measure your blood pressure a few times a week and see your doctor if you notice any significant changes. Here are some tips on how to choose and use a monitor.


  • Select a monitor that goes around your upper arm. Wrist and finger monitors are not as precise.
  • Select an automated monitor, which has a cuff that inflates itself.
  • Look for a digital readout that is large and bright enough to see clearly.
  • Consider a monitor that also plugs into your smartphone to transfer the readings to an app, which then creates a graph of your progress. Some devices can send readings wirelessly to your phone.


  • Avoid caffeinated or alcoholic beverages 30 minutes beforehand.
  • Sit quietly for five minutes with your back supported and your legs uncrossed.
  • Support your arm so your elbow is at or near heart level.
  • Wrap the cuff over bare skin.
  • Don’t talk during the measurement.
  • Leave the deflated cuff in place, wait a minute, then take a second reading. If the readings are close, average them. If not, repeat again and average the three readings.
  • Keep a record of your blood pressure readings, including the time of day.

What should you do?

If you had previously been diagnosed with high blood pressure, the new guidelines don’t affect you too much, says Dr. Conlin, as you still need to continue your efforts to lower it through medication, diet, exercise, and weight loss. “However, based on new information in the guidelines, your doctor may propose treating your blood pressure to a lower level,” he says.

The larger issue is that many men ages 65 and older suddenly find themselves diagnosed with elevated or high blood pressure, since the new normal is a whopping 20 points lower than before. Does this mean an automatic prescription for blood pressure drugs? Not necessarily.

“They should consult with their doctor about first adjusting lifestyle habits, such as getting more exercise, losing weight, and following a heart-healthy diet like the DASH or Mediterranean diet,” says Dr. Conlin.

Medications are recommended to lower blood pressure in Stage 1 hypertension if you’ve already had a heart attack or stroke or if your 10-year risk of a heart attack is higher than 10%. (You can find your 10-year estimation at www.cvriskcalculator.com.) For others with Stage 1 hypertension, lifestyle changes alone are recommended.

“Overall, the new guidelines may help people get more involved with monitoring their blood pressure, which can hopefully prevent complications from hypertension,” says Dr. Conlin.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.


Your blood pressure is an important part of your overall health.

But what is it? Blood pressure is the force of the blood pushing against the walls of your blood vessels. If it is too high, it can put a strain on your heart and blood vessels, and can lead to increased risk of heart disease and stroke.

Your blood pressure is measured using a device called a sphygmomanometer – that cuff that goes around your arm. The measurement then indicates a unit of pressure known as millimeters of mercury (or mm Hg). It shows how hard your heart is working to pump blood.

Your blood pressure is written as two numbers. The top number, known as the “systolic pressure,” measures the force of the blood against the artery walls when the heart contracts to pump blood out. It is working its hardest at that point.

The bottom number is the “diastolic” pressure, which shows the force of the blood when the heart is “resting” in between contractions. That number is lower.

Doctors use standard guidelines to determine if your blood pressure falls into a range known as “normal.” If it is too high and is consistently higher than the guidelines, it known as “hypertension.”

What are the dangers of high blood pressure?

High blood pressure, or hypertension, is known as the “silent killer.” This means it does not have any symptoms and can go untreated for a long time, which can lead to many major health risks. If left untreated, a blood pressure of 180/120 or higher results in an 80% chance of death within one year, with an average survival rate of ten months. Prolonged, untreated high blood pressure can also lead to heart attack, stroke, blindness, and kidney disease.

Out with the old

Since 2003, the guidelines for diagnosing and treating high blood pressure were:

  • normal: less than 120/80 mm Hg
  • pre-hypertensive: systolic between 120-139 or diastolic between 80-89
  • stage 1 hypertension: systolic 140-159 or diastolic 90-99
  • stage 2 hypertension: systolic 160 or higher or diastolic 100 or higher
  • hypertensive crisis: systolic 180 or higher or diastolic 110 or higher

In November 2017, the American Heart Association and the American College of Cardiology revised the guidelines. They are:

  • normal: less than 120/80 mm Hg
  • elevated: systolic between 120-129 and diastolic less than 80
  • stage 1 hypertension: systolic between 130-139 or diastolic between 80-89
  • stage 2 hypertension: systolic at least 140 or diastolic at least 90 mm Hg
  • hypertensive crisis: systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

What is the difference?

The major difference between the old and new guidelines is the elimination of the category of “pre-hypertension.” However, findings from research studies show that complications can exist when blood pressure is as low as 130-139 over 80-89.

The new guidelines change the categories. Those same readings that would have been pre-hypertension are now categorized as stage I hypertension. Doing so means earlier treatment, which can help prevent future increases in blood pressure and more serious complications associated with hypertension.

What does it mean if you fall into the new guidelines?

With these new guidelines, it is estimated that about 14 percent of people will now be classified as having hypertension; many of those individuals may be younger. However, only a small percentage will require intervention by medication. Individuals who now fall into a hypertensive category will receive more aggressive prevention interventions, like lifestyle changes.

What can I do to lower my blood pressure?

There are things we can all do to help control blood pressure. These “lifestyle modifications” are changes you can make in your daily life.

  • Follow the Dietary Approaches to Stop Hypertension, or DASH diet. This includes fruits, vegetables, whole grains, and low-fat dairy products with reduced saturated and total fat.
  • Increase your physical activity. Add 90 to 150 minutes each week of aerobic exercise. Also, include three days of strength training each week. Not only can this help reduce or control your blood pressure, but it can also help with weight management. In overweight individuals, a weight loss of even five to 10 percent has been shown to reduce blood pressure.
  • Decrease your sodium to no more than 1500 milligrams each day. Less is even better. Experiment with spices instead of adding salt to your food.
  • Limit your alcohol. It is recommended that men have no more than two drinks per day and women have no more than one to help control blood pressure.
  • Manage your stress. Because stress can have a major impact on our bodies, it is important to have an effective coping technique. There are many techniques for relaxation.
  • If you smoke, quit. Quitting smoking can have a huge impact on your health.

These are some of the most proactive ways one can support a normal blood pressure and an overall healthy life. But sometimes, even a healthy lifestyle is not enough to maintain a safe blood pressure. When lifestyle modifications do not lower blood pressure to better levels, medication can be prescribed.

Again, the guidelines come into play because your doctor will prescribe an appropriate medication based on your blood pressure category. That determines how often you need to be seen to have your blood pressure checked and what medication is needed. Sometimes, more than one medication is necessary. Some patients may need more frequent monitoring. Anyone with a blood pressure reading in the “crisis” stage will be given immediate medical attention.

Be good to yourself, and try to keep your blood pressure in that normal range by living a healthy lifestyle. Your heart will thank you!


Discovering high blood pressure (hypertension)

Q. I have hypertension, what does this mean?

A. Hypertension is the medical term for high blood pressure. Both terms mean the same thing.

Hypertension (high blood pressure) is defined as having a blood pressure reading of more than 140/90 mmHg over a number of weeks. Our blood pressures change all the time throughout the day, so your doctor is looking to make sure that your hypertensive reading is not just a one-off.

You may also have hypertension if just one of the numbers is higher than it should be. If the top number (systolic pressure) is consistently higher than 140 – this is known as Isolated Systolic Hypertension. If the bottom number (diastolic pressure) is consistently higher than 90 – this is known as Isolated Diastolic Hypertension.

If you have hypertension, this higher pressure it puts extra strain on your heart and blood vessels. Over time, this extra strain increases your risk of a heart attack or stroke. Hypertension can also cause heart and kidney disease, and is closely linked to some forms of dementia. If you have hypertension it is vital that you do not ignore it and follow a healthy lifestyle to lower it and take any hypertension medications you are given.

What causes hypertension?

For most people, there may be no single cause for their hypertension. We do not know exactly what causes hypertension. We do know that your lifestyle can affect your risk of developing it. You are at a higher risk if:

  • you eat too much salt;
  • you don’t eat enough fruit and vegetables;
  • you are not active enough;
  • you are overweight; or
  • you drink too much alcohol.

There are some factors that increase your risk of developing hypertension, which you cannot control. These include:

  • Age: as you get older, the effects of an unhealthy lifestyle can build up and your blood pressure can increase.
  • Ethnic origin: people from African-Caribbean and South Asian communities are at greater risk than other people of hypertension.
  • Family history: you are at greater risk if other members of your family have, or have had, hypertension.

Some people may have hypertension that is linked to another medical condition, such as kidney problems. For these people treating the medical problem may lower their blood pressure back to normal.

How to lower hypertension

The good news is that if you have hypertension, healthy changes will help to bring it down. And you don’t have to wait until you have hypertension to make healthy lifestyle changes. The more you can reduce your blood pressure, the lower your risk of a heart or stroke will be.

  • Eat less salt – see our Salt page
  • Eat more fruit and vegetables – see our Fruit and vegetables page
  • Keep to the recommended daily alcohol limits – see our Alcohol page
  • Keep active – see our Get active pages
  • Be a healthy weight – see our Healthy weight and Losing weight pages
  • Take any hypertension medicines or diabetes medication you have been given – see our Blood pressure medicines pages.

By making these changes to your daily life you will help to dramatically lower your risk of developing heart disease, stroke or kidney disease due to hypertension in the future.

New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension

High blood pressure should be treated earlier with lifestyle changes and in some patients with medication – at 130/80 mm Hg rather than 140/90 – based on new ACC and American Heart Association (AHA) guidelines for the detection, prevention, management and treatment of high blood pressure.

The new guidelines – the first comprehensive set since 2003 – lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition will result in nearly half of the U.S. adult population (46 percent) having high blood pressure, with the greatest impact expected among younger people. Additionally, the prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45, the guideline authors note. However, only a small increase is expected in the number of adults requiring antihypertensive medication.

“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” said Paul K. Whelton, MB, MD, MSc, FACC, lead author of the guidelines. “We want to be straight with people – if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”

Blood pressure categories in the new guideline are:

  • Normal: Less than 120/80 mm Hg;
  • Elevated: Systolic between 120-129 and diastolic less than 80;
  • Stage 1: Systolic between 130-139 or diastolic between 80-89;
  • Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
  • Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

The guidelines eliminate the category of prehypertension, categorizing patients as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89). While previous guidelines classified 140/90 mm Hg as Stage 1 hypertension, this level is classified as Stage 2 hypertension under the new guidelines. In addition, the guidelines stress the importance of using proper technique to measure blood pressure; recommend use of home blood pressure monitoring using validated devices; and highlight the value of appropriate training of health care providers to reveal “white-coat hypertension.” Other changes include:

  • Only prescribing medication for Stage I hypertension if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk (using the same risk calculator used in evaluating high cholesterol).
  • Recognizing that many people will need two or more types of medications to control their blood pressure, and that people may take their pills more consistently if multiple medications are combined into a single pill.
  • Identifying socioeconomic status and psychosocial stress as risk factors for high blood pressure that should be considered in a patient’s plan of care.

In a corresponding analysis of the guidelines’ impact, Paul Muntner, PhD, et al., suggests “the 2017 ACC/AHA hypertension guideline has the potential to increase hypertension awareness, encourage lifestyle modification and focus antihypertensive medication initiation and intensification on US adults with high CVD risk.”

The new ACC/AHA guidelines were developed with nine other health professional organizations and were written by a panel of 21 scientists and health experts who reviewed more than 900 published studies. They are the successor to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7), issued in 2003 and overseen by the National Heart, Lung, and Blood Institute (NHLBI). In 2013, the NHLBI asked the AHA and ACC to continue the management of guideline preparation for hypertension and other cardiovascular risk. The guidelines were published in the Journal of the American College of Cardiology and Hypertension. For a wide array of ACC-developed tools, resources and commentary for both clinicians and patients, visit the ACC’s High Blood Pressure Guidelines Hub.

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Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Nonstatins, Hypertension, Stress

Keywords: AHA17, AHA Annual Scientific Sessions, Antihypertensive Agents, Blood Pressure Monitoring, Ambulatory, White Coat Hypertension, Blood Pressure, Risk Factors, Prehypertension, National Heart, Lung, and Blood Institute (U.S.), Prevalence, Cardiovascular Diseases, Stress, Psychological, Hypertension, Stroke, Systole, Hypercholesterolemia, Myocardial Infarction, Diabetes Mellitus, Renal Insufficiency, Chronic, Hospitalization, Social Class, Life Style, Health Personnel, Cholesterol

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Hypertension symptoms & causes in children

What is hypertension?

Hypertension means “high blood pressure.” This refers to how hard the blood is pushing against the walls of the artery through which it flows—not how quickly it flows. In hypertension, the level of pressure is higher than normal.

How is blood pressure measured?

Blood pressure is measured in millimeters of mercury (mm Hg). A typical normal blood pressure in an adult is 120/80 mm Hg, or “120 over 80.” The top number refers to the pressure when the heart is pushing blood out through the arteries (systolic). The bottom number refers to the pressure when the heart is at rest—“between beats” (diastolic).

It’s easy to tell whether an adult has hypertension, because there’s a standard set of measurements:

  • Normal blood pressure—systolic < 120 mmHg and diastolic < 80 mm Hg
  • Pre-hypertension—systolic 120-139 mmHg or diastolic 80-89 mmHg
  • Stage 1 hypertension—systolic 140-159 mmHg or diastolic 90-99 mmHg
  • Stage 2 hypertension—systolic ≥160 or diastolic ≥100 mmHg

But it’s harder with children. That’s because there are no universal cut-offs as there are for adults; instead, whether a child has hypertension depends on how his blood pressure compares to his peers (determined by gender, height, and age).

  • Pre-hypertension—90th to 95th percentile
  • Stage 1 hypertension—95th – 99th (plus 5 mm mercury)
  • Stage 2 hypertension—anything higher than 99th plus 5 mm mercury

How common is hypertension in children?

Hypertension is becoming increasingly common in children and adolescents. A recent study that looked at 15,000 adolescents found that nearly one in five had hypertension. And there’s reason to believe that hypertension is vastly underdiagnosed in children, since:

  • it can be difficult to measure in infants and young children
  • it’s sometimes challenging to identify
  • it’s often thought of as not something that really affects kids

The rise in the number of children with primary hypertension in the United States is thought to correlate with the rise of obesity.

What complications are associated with hypertension?

While kids with hypertension are unlikely to have heart attacks and strokes, it still has significant risks. Hypertension causes changes in the structures of the blood vessels and heart. Since hypertension in children has historically been understudied, there isn’t a lot of data about exactly what these changes mean. But we do know that in adults, hypertension increases the chance of complications in the heart, blood vessels, and kidneys. There’s also compelling evidence that some of these changes are seen in children with high blood pressure.

These changes affect:

Blood vessels—high blood pressure can damage blood vessels throughout the body, which makes it harder for organs to work efficiently.

Kidneys—if the blood vessels in the kidneys are damaged, they may stop removing waste and extra fluid from the body. This extra fluid can raise blood pressure even more.

Other organs—if left untreated, hypertension makes it harder for blood to reach many different parts of the body, including the eyes and the brain, and can lead to blindness and strokes.

Can primary hypertension be prevented?

Pediatricians are making great efforts to prevent obesity and stem the tide of problems that accompany it. We believe that promoting healthy lifestyle choices will help combat this trend and will go a long way towards preventing primary hypertension in children (and keep adults healthier, too).

Some things are being done—nutritional information is being made more readily available, there’s one push to provide healthy options in schools and another to remove soft drinks from them—but still, it often comes down to families making the right decisions. We are dedicated to educating families to assist with appropriate dietary and activity choices to improve overall health and reduce the risk of hypertension.

What is “white coat hypertension”?

“White coat hypertension” is when a child’s blood pressure readings are high at the doctor’s office (mostly because she’s anxious, which can cause blood pressure to rise), but normal outside of the office (for example at home or at school).

This is pretty common in kids. By some estimations, between 30 and 40 percent of kids who have high blood pressure in the office actually have white-coat hypertension.

White coat hypertension is still a risk. Everyone’s blood pressure changes from time to time—it’s lower when you’re asleep, for example­­­­­—but if a child’s blood pressure continually rises when she’s anxious (such as before a test), it can be sign of high blood pressure at other times and potentially cause the same kinds of damage that standard hypertension causes.

White coat hypertension is diagnosed by taking the child’s blood pressure outside of the doctor’s office. This can be done in different ways:

  • Some parents feel comfortable doing it at home.
  • Sometimes we make arrangements for a school nurse to check the child’s blood pressure.
  • Your child’s doctor might recommend that she wear an ambulatory blood pressure monitoring device—a blood pressure cuff attached to a small device that sits on her belt , and measures her blood pressure at regular intervals over the course of 24 hours. This device is about the size of a deck of cards and is usually tolerated very well.

If your child is diagnosed with white coat hypertension, her doctor may still want to follow her, since some children with white coat hypertension will develop actual hypertension in the future.

Causes of hypertension in children

1. Primary hypertension

Primary hypertension means that the hypertension does not seem to be caused by some other underlyng medical condition. Many doctors think that the incidence of childhood or adolescent hypertension has been rising along with the obesity epidemic. The majority of teens and children over age 6 with hypertension have a family history of hypertension and/or are overweight.

2. Secondary hypertension

Secondary hypertension is caused by a known underlying medical condition. Of these, about

  • 80 percent of children have some kind of kidney disease or blood vessel abnormalities
  • 5 percent have an endocrinological disorder
  • 2 to 5 percent have heart disease

Hypertension in infants with hypertension almost always has a secondary cause. In addition, premature infants have a higher incidence of hypertension.

Among kids with hypertension, especially those who are very young, secondary hypertension is more common than primary hypertension. But among children who are older than 6 to 8 years old, the ratio of primary to secondary hypertension is approaching 50/50.

Signs and symptoms of hypertension

Often, kids and teens with pre-hypertension or stage 1 hypertension won’t show any symptoms at all. If your child has stage 2 hypertension, she might experience one or more of the following symptoms:

  • headaches
  • loss of vision
  • double-vision
  • chest pain
  • abdominal pain
  • breathing problems

An infant with stage 2 hypertension may seem irritable, not be feeding properly, or vomiting. Sometimes these infants are diagnosed with “failure to thrive.”

Frequently Asked Questions (FAQ) about Hypertension

Q: If left untreated, does hypertension get worse?

A: It’s hard to say. Researchers are starting to see that kids and adolescents with pre-hypertension are more likely to develop stage 1 hypertension, but we don’t know if or when stage 1 hypertension will progress to stage 2.

Q: Can hypertension be cured?

A: In some cases, secondary hypertension can be “fixed.” For example, if:

  • it’s caused by a narrowing in a blood vessel that the doctors are able to widen
  • it’s caused by a rare endocrine tumor that doctors are able to treat successfully

There are also cases in which hypertension might be transient; for example, if it’s caused by a temporary inflammation of the filters in the kidney.

Even when hypertension can’t be “fixed,” it can almost always be well-controlled, with diet and exercise and/or medication.

Q: If my child is being treated for hypertension, what should I watch out for?

A: Keep an eye out for:

  • chest pains
  • severe headaches that don’t seem to respond to at-home treatment
  • changes in vision
  • nausea
  • swelling of hands and feet
  • shortness of breath with limited exertion
  • changes in her urine (such as lack of urine production, urine that is brown or tea-colored)

Call your child’s doctor if she experiences any of these symptoms.

Q: Will my child need to go on medication?

A: Only a fraction of kids with hypertension require medication. Frequently, it’s treated with diet and exercise modification first. And if the child is overweight, every kilogram (around 2 pounds) of weight she loses, her blood pressure could bring her blood pressure down by about a point.

Q: Will my child have hypertension as an adult?

A: While children with hypertension are more likely to have it as adults, it’s not necessarily always the case. This depends on factors including the cause of the hypertension and how it responds to treatment.

Q: What is the most common treatment?

A: For children with pre-hypertension or stage 1 hypertension, changing to a more healthful diet and exercising more is often enough to manage the hypertension. For children with more severe hypertension, medication is often necessary.

Q: If my child is taking medication for hypertension, will she have to take it for the rest of her life?

A: Not necessarily. If your child has primary hypertension, appropriate lifestyle modifications may allow for medications to be stopped. In addition, if a secondary cause is identified and successfully treated, medications may not be necessary.

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