Prevention of high blood pressure in children: Time to act


Prevention of high blood pressure
in children: Time to act
Lt. Gen. Mahmud Ahmad Akhtar
Former Surgeon General Army/DGMS (IS)
Prof. Emeritus (Medicine and Therapeutics)

All over the world intensive efforts are being made by the World Health Organization (WHO), Health professional bodies and the Government health services for the prevention of diseases because in prevention lies the cost- effective resolution of health problems. As it is aptly known that prevention is not only better than cure- but is the only cure and the true cure. The life-long treatments are so expensive and the complications are very disabling that even the most rich and scientifically advanced countries cannot afford to bear the cost and sufferings of life-long diseases and their complications.

The ideal time to adopt preventive measures to prevent non-communicable diseases is in childhood even before birth as it has been found that babies born with low birth weight suffer more from non-communicable diseases therefore the girl child should be well fed which is not the case in Pakistan and early marriages should be avoided.

Unfortunately in Pakistan the professional bodies including NGO’S just hold meetings at five star hotels mostly discussing drug treatments that too are usually not cost-effective. The expenses of meetings held at luxurious hotels and many a time luxurious resorts like Bhurban, and abroad at Dubai, Bangkok etc. are added to the cost of medicine by the companies further overburdening the patient’s expenses which many patients cannot afford and suffer the hazard of diseases. Writing in “Off the Record” columns of Pulse International Mr.Shaukat Ali Jawaid has rightly stated that ‘professional bodies have become part of the problem rather than the solution’. This is also the reason that the government and professional bodies and the pharma industry avoid the implementation of World Health Organization’s Drug Expert Committee’s devised Essential Medicines list. Unfortunately Pakistan is the only developing country in the world not implementing the list, depriving common people of efficacious, safe, affordable /cost-effective medicines. Resultantly Pakistan is having the worst health indicators in the world, the health indicators belie the claims of the health ministry and the professional bodies of good performances.

Lt. Gen. (R) Mahmud Ahmad Akhtar

High blood pressure is a major problem in Pakistan causing enormous morbidity and mortality. Recent survey had shown that its prevalence is rising rapidly- 52% of the population is suffering from hypertension. For prevention of high blood pressure, efforts / campaigns should be started at the childhood level. Treatment of high blood pressure in childhood saves many lives and prevents complications.

Recently in the United States of America a child, Methew Goodwin had a blood pressure spike, following a minor surgery. He spent two weeks in the paediatric Intensive Care Unit. The cause was congenital kidney disorder that caused severe hypertension that required surgeons to remove one of the kidney and implant it at a new location - a procedure known as a kidney auto transplant. Now Methews is taking blood pressure lowering drugs, low sodium diet, loaded with vegetables and fruits and no soft drinks.

The studies have shown that millions of young Americans with elevated blood pressure do not know they have it. Methew’s mother, Celeste Goodwin created ‘The National Paediatric Blood Pressure Awareness Foundation’, a nonprofit advocacy group, to educate parents and professionals about the importance of regular blood pressure checks in children and adolescents.

Supporting this efforts in August 2018 the American Academy of Paediatric published a 74 page report updating its guide-lines for screening and managing high blood pressure in youngsters. The report included a much- simplified chart to help practicing physicians readily determine whether a child’s blood pressure is within normal parameters.

For children the definition of normal blood pressure is not based on a simple reading of systolic over diastolic blood pressure. Rather, because normal blood pressure varies with a child’s age, gender and height, doctors need to consult pages of charts to determine whether a patient’s pressure is normal or not. The new guidelines provides a short, easy to use table based on child’s gender and age from 3 to 18 years that the doctors can readily consult and even hang in the office, where they and parents can see it.

In the USA study after study have demonstrated that elevated blood pressure is correctly diagnosed in fewer than quarter of the children who have it .The new guidelines have been developed to detect more children with high blood pressure. The detection of high blood pressure in children is important although children do not usually suffer from the consequences of high blood pressure in the paediatric years, If not properly treated it can result in early adult heart attack, strokes and kidney disease. In Pakistan many young adults have been seen suffering from heart failure, heart attacks and renal failures. Therefore there is dire need to adopt effective preventive measures.

Dr. Joseph T Flyon, lead Author of the new guidelines says that,”While doing studies they have described thickening of the left ventricle and thickening of the blood vessel is clearly tied to atherosclerosis and heart attacks in adults.” Since high blood pressure often runs in families, detecting in a child may promote a check of the parents and other family members and end up saving their health and lives. About 20% of cases like Methew Goodwin have an underlying and correctable cause in children. Failure to make the correct diagnosis could be disastrous.

The prevalence of elevated blood pressure and frank hypertension in children and adolescents has risen dramatically in recent decades, largely as a result of increasing obesity in the young. In the USA 17% children are obese and approximately two million children have hypertension growing dependence on fast food, processed food and snacks that are high in salt contribute to high rise in hypertension. In Pakistan the prevalence of obesity has increased and the consumption of salt is very high .Every eatable is saturated with salt.

Preventive Measures: Consumption of junk/ processed food, sugary drinks saturated with salt, sugars and saturated fat are consumed enormously therefore preventive measures are needed urgently at the National level to check the menace. Sadly nothing tangible is being done at the professional organizations/ NGO’s and the Government levels. Sale of junk food and soft drinks should be banned in schools and in the areas adjoining the Schools. The USA guidelines urge Healthcare practitioners to measure and record blood pressure of every well child on preventive care visit.

Based on the chart if blood pressure is above normal the guidelines offer a clear follow-up procedure. Dr. Kessler noted that the underlying cause of blood pressure in children than adults especially younger than nine years is often seen and can be remedied. In children the white coat hypertension is very common during office measurement due to fear. The blood pressure monitor serves the purpose very well, it provides correct blood pressure reading and saves further investigation stress on child and family.

Based on the lead provided by the USA studies and guidelines, Pakistan should evolve a strategy to check children’s blood pressure and adopt necessary preventive measures. Pakistan’s Paediatric Association in collaboration with Pakistan Hypertension League and NGOs should formulate guidelines. Guide-lines are only as good as the people who actually follow them. Pakistan has a huge young population, bulk of population is in the younger age group. Preventive measures started in childhood should continue into adult-hood. Medical curriculum should be revisited and prevention should be given utmost importance. School health services should be organised to adopt preventive measures. Priority should be the main strategy in the medical check-ups /consultations, monitoring of blood pressure of children incorporated in the medical records regularly. Pakistan has a very large young population, 65% of the population is below 30, 29% between 15-19%, 26% below 14.

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