High-Risk Kids, Diabetics Need Regular Blood Pressure Checks

FRIDAY Oct. 17, 2008 -- To protect long-term heart health, children as young as 3 and diabetics should have their blood pressure checked regularly, experts say.

Once identified, young patients with high blood pressure -- particularly obese children at high risk for developing metabolic syndrome -- should have further testing for a wide range of related risk factors, they added.

Meanwhile, hypertensive diabetics should embark on an individualized plan of attack -- one that focuses on both blood sugar and blood fat control -- to manage their blood pressure.

The suggestions were given during a panel meeting hosted by the American Society for Hypertension (ASH) in New York City last week.

Speakers stressed that the gathering's intent was to put forth the organization's updated positions with respect to the 70 million Americans currently coping with high blood pressure.

Nonetheless, presenters made an effort to place current standard blood pressure guidelines within a context of mounting urgency and concern, by referencing the latest available research and statistics.

"Globally, hypertension is one of the leading world health problems," said Dr. Bonita Falkner, a professor of medicine and pediatrics at Thomas Jefferson University, Jefferson Medical College, in Philadelphia. "And we also know that in adults, hypertension has a heightened outcome in terms of morbidity and mortality. And what has been evolving is the connection between childhood and adulthood."

Falkner noted that about 3.5 percent of American children have high blood pressure, while another 3.5 percent have what is known as "prehypertension."

This, she said, translates into about 5 million children with some form of high blood pressure risk. Fueling the problem are the 12 million American children -- roughly 17 percent of the nation's kids -- who are clinically overweight or obese, 30 percent of whom have high blood pressure.

"And when you put obesity and high blood pressure together, there are probably about 5 million children who have the metabolic syndrome, which is a substantial health problem that warrants considerable attention," she added.

ASH researchers referred to a recent study published in the organization's journal that projects that by the time currently obese adolescents reach the age of 35, 16 percent will have premature heart disease -- a tripling of current figures.

"So, the main point here is that high blood pressure in children is just the beginning of high blood pressure," Falkner said. "It's easily identifiable in children, and the link to adult health is becoming clear. So, as the obesity epidemic in children steadily increases and related risk factors -- such as high blood pressure -- worsen, we are obviously facing a higher and higher risk for accelerated heart disease down the road, and perhaps even blood vessel injury to young hearts."

"This is why," she concluded, "it is very important that young children get screened as they grow and develop and enter adolescence."

For his part, ASH President-Elect Dr. George L. Bakris, director in the hypertensive diseases unit at the University of Chicago School of Medicine, emphasized that high blood pressure among diabetics is a widespread problem.

More than 75 percent of diabetic adults have high blood pressure or use medication to control their blood pressure, he and his colleagues noted.

"But to promote better blood pressure control, you really need a strategy that begins at the outset with combination drug therapy to control for a range of health concerns that touch upon blood pressure control and heart disease risk," he said.

Diuretics, calcium antagonists and ACE inhibitors are some of the medications that could be used in combination.

In addition, the ASH is highlighting proteinuria -- the excessive amount of protein in the urine -- as a serious health concern among hypertensive diabetics that needs to be attended to while engaging in blood pressure management.

"Combination therapy is already in standard guidelines as a 'consideration,' " he explained. "But the purpose here is to focus on the newest information we have to help promote better blood pressure control. And, in that respect, what we are now saying is that in certain circumstances, depending on the particular needs of a patient, this should really be done. Not just considered, but done."

Posted: October 2008


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