A 15-year-old boy, who was obese and lived in a boarding school in Bengaluru, was taken to a hospital as he was suffering from a severe cold and cough. On routine checking, doctors found that hisblood pressure(BP) readings were high for his age, and even his cholesterol was mildly elevated.
He was not prescribed any medication to control his BP, but advised to monitor it twice weekly and also carry out lifestyle modifications like reducing weight, avoiding junk food and doing regular physical activity along with meditation and yoga. Six months later, after the boy lost significant weight, doctors were happy to see that his BP readings were regular.
According to Dr Yogesh Kumar Gupta, consultant paediatrician at Fortis Hospital, Bengaluru, who treated the child, the school student’s BP returned to normal because it was detected early. “This case tells us the importance of early detection of hypertension and how lifestyle modifications can curb hypertension at an early age.”
What worried the doctor was the hypertension, which once was primarily diagnosed in adults, as it is now being reported by health care professionals across the world and in India among children and adolescents.
The Bengaluru teenager’s case is not an isolated one. In India, as well as globally, an increasing number of children are being detected with BP or hypertension. Described as paediatric hypertension, it has now become a growing global concern.
Dr Rajiv Narang, professor and HOD of cardiology, AIIMS, New Delhi, said in recent years the topic of childhood hypertension has received increasing attention worldwide. He said this is also reflected in a recent meta-analysis published in the medical journal ‘The Lancet’. The meta-analysis included 83 studies encompassing approximately 440,000 children. Its findings clearly demonstrated that the prevalence of hypertension among children is rising globally, Dr Narang added.
The study showed that from 2000 to 2020, the prevalence of hypertension among children and adolescents under the age of 19 years has nearly doubled, increasing from about 3.2% to 6.2%, thus affecting 114 million young people around the world.
More than 9% of children and adolescents have masked hypertension — high blood pressure that only shows up with out-of-office tests, meaning hypertension could be undetected during regular checkups, it found.
Data from India is also consistent with global trends on rising hypertension among children and adolescents. Several Indian studies, including those conducted at AIIMS, New Delhi, have reported prevalence rates ranging from 3% to 30%, depending on the population studied and the methodology used.
There is growing evidence that blood pressure tracks from childhood into later life, thereby increasing the long-term risk of coronary heart disease, stroke, and other cardiovascular complications. “Childhood hypertension is an important clinical and public health concern because elevated blood pressure in early life predisposes individuals to cardiovascular disease in adulthood.”
Though India has launched the Indian Hypertension Control Initiative (IHCI), an initiative involving the Union Health Ministry, Indian Council of Medical Research (ICMR), state governments, and the World Health Organisation (WHO), it does not address childhood hypertension.
According to Dr P Ganeshkumar, head of non-communicable diseases division, ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai, an estimated 200 million (20 crore) adults in India suffer from hypertension.
“The overall prevalence of hypertension in the age group 18-69 years is 28.5%,” he said, adding that hypertension is the number one risk factor for deaths related to cardiovascular diseases (CVDs).
Top reasons
Obesity has emerged as the top reason for hypertension among children. The Lancet study clearly shows that children and adolescents with obesity are at nearly eight times higher risk of developing high blood pressure, and approximately 19% of children with obesity have hypertension, compared to 2.4% of kids and adolescents who are considered to be within a healthy weight range.
As per a WHO report globally, 33 million children under five years were classified as overweight in 2000, which rose to 37 million by 2022. What is worrisome is that an earlier Lancet study has predicted that about 450 million adults in India are expected to be overweight or obese in 2050.
Dr Samir Kubba, director and unit head, Narayana Dharamshila Superspeciality Hospital, Delhi, states that the leading causes of childhood hypertension include childhood obesity, unhealthy dietary patterns since childhood, lack of exercise, sedentary childhood patterns, excess time on social media, etc. “All these factors contribute to rising rates of hypertension in adolescents.”
Other reasons include consumption of salt-rich, high-calorie foods or ultra-processed food; abnormal sleep patterns, stress, smoking, etc. Quoting various studies, Dr Gupta said urban, overweight youth are significantly more likely to develop hypertension.
“There are multiple reasons for children developing hypertension. But the question arises as to what can be done to address this emerging health problem,” said Dr Narang.
First step – early screening
The first step is to recognise hypertension in children as an essential public health issue. And, the best way forward is regular screening. However, screening for hypertension in children presents specific challenges compared with adults. Blood pressure measurement in children requires the use of appropriately sized cuffs for different ages and arm circumferences. Moreover, blood pressure cut-off values vary with age, sex, and height, necessitating the availability of reference charts at screening sites.
Studies conducted by investigators at AIIMS, New Delhi, have proposed simplified age-based cut-offs to facilitate large-scale screening: blood pressure should be less than 120/80 mmHg at five years of age, less than 125/85 mmHg at 10 years, and less than 135/90 mmHg at 15 years. “These simplified thresholds can be effectively used in school and community screening programs,” said Dr Narang. Early warning signs of elevated BP also pose a challenge. So, parents and teachers should take note when a child complains of persistent headaches, fatigue, changes in vision, and chest discomfort.
“All these may signal the need for medical assessment in older children. Early detection is important to prevent or slow down the progression of hypertension or its associated complications and helps in better management,” added Dr Gupta.
As prevention is the best cure, strategies must focus on addressing modifiable risk factors, experts added.
Dr Ganeshkumar suggested that control of elevated blood pressure among kids can be easily achieved through lifestyle interventions in schools and communities. “Childhood obesity is often associated with elevated blood pressure. Therefore, by reducing childhood obesity, the incidence of hypertension could be reduced further.”
Efforts should also be undertaken by the government, schools and even parents to reduce childhood obesity through promotion of healthy diets, promoting regular physical activity, and broader lifestyle interventions.
Parents must be role models for their children when it comes to adopting healthy dietary and lifestyle habits. “Parenting is a great responsibility. Community and parental education are a must. The school educational curriculum must focus on healthy dietary and lifestyle patterns, encourage sports, encourage BP monitoring early, maybe from classes 10 or 12, especially in high-risk groups - obese children, children with family history of hypertension, diabetes and cardiovascular disease,” he added.
Early childhood detection of hypertension is the only way forward, keeping in mind that cardiovascular diseases are the leading cause of death and disability in India – a concerning issue also highlighted by a Lancet study. “Early identification and prevention of hypertension in childhood have the potential to reduce the burden of cardiovascular disease in the future significantly,” Dr Narang summed up.
The story is reported by Kavita Bajeli-Datt of The New Indian Express