What is it about?
Adolescent hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.
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Why is it important?
The upper limit for “normal” blood pressure in adults is well known, and the same threshold is used for both men and women, but a diagnosis of hypertension in children aged 3 to 18 is more challenging, because children grow so rapidly and blood pressure changes with height. For many children, hypertension is only diagnosed when it is severe, or once they reach adulthood. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. The importance of early and accurate diagnosis cannot be overstated, given the long-term health consequences of untreated hypertension and the fact that pediatric hypertension is a diagnostic indicator for some serious underlying medical conditions.
Perspectives
This article actually began as the literature review for another paper (Hypertension in Low-Income Adolescents; doi: 10.1177/2333794X17741819), but it quickly became a stand-alone paper due to the importance of the topic and the complexity of the contributing factors. There is a common misconception that only overweight or obese people have hypertension, but the fact that there are metabolically-obese, normal-weight people, as well as overweight and obese people who are metabolically normal, would argue that there may not be a simple cause-and-effect relationship between them. The fact that they can appear independently as well as together would indicate that they might both be signs that something has gone wrong metabolically, and therefore perhaps both of them are effects. I hope that the data from our cohort, in conjunction with this literature review, will result in earlier diagnosis and treatment, and renewed efforts to fully understand the causes of obesity and hypertension. The self-perpetuating nature of these complex diseases requires that every effort be made to find solutions for the current generation of children and adolescents who will become the parents of tomorrow.
D Rose Ewald
University of North Carolina-Greensboro
Read the Original
This page is a summary of: Risk Factors in Adolescent Hypertension, Global Pediatric Health, February 2016, SAGE Publications,
DOI: 10.1177/2333794x15625159.
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