NEW YORK (Reuters Health) ? More kids than previously thought could be at risk for dangerously high blood pressure, with as many as a quarter having blood vessels that look like those of much older people, according to a new study.
Because there is a theoretical possibility that some of these kids could suffer a stroke or a heart attack down the road, researchers say the findings mean all kids should have their blood pressure measured.
"I do think it's important that everybody gets screened for high blood pressure," said Dr. Karen Redwine of Arkansas Children's Hospital in Little Rock, whose findings appear in the Journal of Pediatrics.
"The overall rate for developing high blood pressure when you're a teenager is still very low," she added in an interview with Reuters Health. "But there is a subset of people whose rate of developing high blood pressure is anywhere from two to five times that, and a lot of those are children who would now be considered normal."
Those children have slightly elevated blood pressure and are diagnosed with so-called "prehypertension." The label is controversial, however, because it doesn't describe a disease -- rather, it is a risk factor for later developing high blood pressure, which itself is a risk factor for heart disease.
An expert who wasn't part of the new study said he worried it could be used to push medications without evidence that they will do kids any good.
"What troubles me a bit is that they talk about pharmacologic therapy," said Dr. Curt D. Furberg, an expert in heart disease prevention and drug safety at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.
"When I look at the author list, there is one from Bristol-Myers Squibb," he added. "Drug companies want to increase their market. In this area, considering healthy young kids for pharmacologic therapy doesn't make sense."
The National Heart, Lung, and Blood Institute in 2004 defined prehypertension in kids as a top blood pressure number between 120 and 139 or a bottom number between 80 and 89. High blood pressure starts at 140 over 90.
If lifestyle changes like cutting down on salt and exercising aren't enough to control high blood pressure in kids, NHLBI advises trying drugs.
In adults, high blood pressure ups the risk of stroke and heart attack a few percent. For children, however, the NHLBI acknowledges that the long-term consequences of having high blood pressure are unknown for children, as are the side effects of drug treatment.
"In my mind there are many more pressing issues in medicine than screening for hypertension in adolescents, where we don't even know if treatment is beneficial," Furberg, a professor of public health, told Reuters Health.
The new study is an attempt at estimating how often children with prehypertension go on to develop full-blown high blood pressure, or hypertension.
Tapping into data from a large screening study -- funded by drugmakers -- at Texas schools, Redwine and colleagues found that 11 out of 1,006 students developed high blood pressure during the study.
That corresponds to a rate of one in 200 teenagers every year. Although the rate appeared similar for kids with prehypertension, a broader definition created by Redwine and her colleagues nearly tripled the rate.
According to the new definition, just one blood pressure measurement above normal would put a kid in the "at-risk" group.
Up until now, Redwine explained, doctors used to think that one high blood pressure measurement might just be a fluke -- because the kid was nervous or a little sick.
Now, she said, "if it's elevated even once then you need to watch it and monitor it."
Currently, the NHLBI doesn't recommend drug therapy for kids with prehypertension. But the new report suggests investigating the use of medication in those deemed "at risk."
According to the Texas screening study, that could be as many as 26 percent of U.S. teenagers with the new definition -- including healthy kids who aren't overweight.
To Furberg and other critics, prehypertension -- let alone the expanded definition in the new study -- is a concept that comes with threats of overdiagnosis, overtreatment and wasteful health spending.
"This is what the industry is trying to do, to get people on drugs," he said. "They are pushing that for adults, and now they seem to move to kids, which is troublesome."
Redwine countered that, although one of her co-authors is employed by Bristol-Myers Squibb, her report did not advocate drug use in children with prehypertension.
"It is not the point to say that they need to be treated," she told Reuters Health.
The U.S. Preventive Services Task Force, a federally-supported expert panel, recommends screening adults for high blood pressure. It is currently updating its 2003 guidelines for children and adolescents, which noted that the evidence was insufficient to weigh the harms and benefits of screening kids.
SOURCE: http://bit.ly/qwbARr The Journal of Pediatrics, online August 25, 2011.
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