Systolic and diastolic blood pressure levels for children and teenagers have risen substantially since 1988, according to a new study supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health. The study links part of the rise to a concurrent increase in the prevalence of overweight and obesity.

The study - "Trends in Blood Pressure Among Children and Adolescents" - appeared in the May 5, 2004 issue of The Journal of the American Medical Association (JAMA). The study was conducted by researchers at Tulane University in New Orleans, LA, and the NHLBI in Bethesda, MD.

"The obesity-related rise in blood pressure among American children is a serious health issue," said NHLBI Acting Director Dr. Barbara Alving. "We need to take steps to reverse this trend. One key step is to give physicians tools that can help them deal with this problem, which is why we're issuing these new guidelines." High blood pressure is a major risk factor for heart disease and the chief risk factor for stroke.

The systolic and diastolic blood pressure increases between the two surveys were large and occurred for all age and race/ethnic groups, and both genders. The systolic pressure increased by 1.4 mm Hg and the diastolic by 3.3 mm Hg from 1988-94 to 1999-2000. Even after adjusting for BMI, systolic and diastolic blood pressures were 1 and 2.9 mm Hg higher, respectively, in 1999-2000, compared with 1988-94. This suggests that lifestyle factors other than overweight, such as physical activity and specific dietary nutrients, were also involved in the trends.

The new guidelines describe hypertension and prehypertension as significant health issues in the young due to the marked increase in the prevalence of overweight children. Overweight and high blood pressure are components of the insulin resistance syndrome, a combination of multiple risk factors for cardiovascular disease and type 2 diabetes. Therefore, the guidelines call for a comprehensive assessment of cardiovascular risk factors. The new guidelines, noting the association of high blood pressure and overweight with sleep apnea, also suggest that a history of sleeping patterns should be obtained in a child with hypertension.

Treatment for children with high blood pressure usually consists of lifestyle changes, including weight management, physical activity, and dietary changes. Drug therapy is used if needed. The revised guidelines incorporate recent research and present updated recommendations for lifestyle approaches, such as dietary changes for children and adolescents who have prehypertension as well as hypertension. Revised drug recommendations include dosage recommendations for many of the newer drugs studied in recent clinical trials.

"We want to give our children the best possible start in life," said Alving. "That means insuring they have a healthy blood pressure and weight. We need to teach them to be physically active and to follow a heart-healthy eating plan. Otherwise, we may be giving them an early start on heart disease."

For a complete press release, please go to: www.nih.gov/news/pr/may2004/nhlbi-04.htm.

Tables from the new clinical practice guidelines on hypertension in children and adolescents are available at www.nhlbi.nih.gov/guidelines/hypertension/child_tbl.htm

United States Department of Health and Human Services