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High Blood Pressure in Teens

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Updated June 28, 2007

While high blood pressure is commonly thought of as an "adult problem," teenagers and even younger children can develop high blood pressure.

Teenagers in the U.S. now weigh more and exercise less than teens of past generations. As a result, high blood pressure among teens has increased, as well: A large authoritative study showed that high blood pressure in teenagers increased from 1 percent to 5 percent between 1989 and 2002.

Causes of Teenage High Blood Pressure

It was once believed that most cases of high blood pressure in teenagers were caused by underlying problems with the heart or kidneys. Further research has shown that this is not true, and it now appears that teenagers develop high blood pressure in approximately the same proportions as adults.

In other words, most cases of high blood pressure in teenagers are classified as primary hypertension. As with adults, the underlying causes of primary hypertension are not entirely understood. Some teenagers appear to inherit the tendency to develop high blood pressure from their parents, while others fall victim to poor lifestyle choices, which result in obesity and becoming out of shape -- what doctors would call "decreased cardiovascular fitness."

It is important to realize that teenagers are not just smaller versions of adults. The hormonal changes of adolescence change some of the dynamics that affect high blood pressure risk. For example, eating junk food and not getting enough exercise is not always directly reflected by increasing body weight, yet these things can still affect blood pressure in teenagers. Surges in the sex hormones testosterone and estrogen also play a role in the development of high blood pressure among teenagers.

While the precise roles these hormones play are complex and not fully understood, it has been shown that teenagers who begin puberty at a younger age tend to have an increased overall risk of developing high blood pressure.

Diagnosing Teenage High Blood Pressure

Diagnosing high blood pressure in teenagers is more complicated than diagnosing high blood pressure in adults. Among adults, there are clear numerical guidelines for diagnosis, but this is not true for teenagers. This is mostly because teenagers do not have the same risks (such as a heart attack) as adults.

Instead of using absolutle guidelines, the diagnosis in teenagers is made by relying on statistics that are stated in percentiles. The official diagnosis guidelines issued by the American Heart Association are below. As you can see, these are complicated, which is why high blood pressure should only be diagnosed by a doctor.

  • Normal blood pressure - systolic and diastolic pressures <90th percentile
  • Prehypertension - Systolic and/or diastolic pressures >90th percentile but <95th percentile OR a blood pressure >120/80 even if that value is <90th percentile for age
  • Stage 1 hypertension - systolic and/or diastolic pressures between 95th percentile and 5 mmHg above the 99th percentile
  • Stage 2 hypertension - systolic and/or diastolic pressures >95th percentile plus 5 mmHg
A reading may seem high but actually can be fine when adjusted for age-specific averages. Or it may seem normal but actually be elevated.

Preventing and Treating High Blood Pressure in Teens

Because teenagers with high blood pressure tend to suffer more blood vessel and cardiovascular problems later in life, preventing and controlling high blood pressure is especially important during the adolescent years. Despite the complexity of diagnosis, the rules of prevention in teenagers are the same as those for adults:

  • Maintain a healthy body weight
  • Eat a healthy diet
  • Don't smoke
  • Exercise regularly (at least 20 minutes on 3 or more days per week)
  • Limit alcohol and drug use -- these are important causes of hypertension among teens
Treatment options for teenagers with high blood pressure vary. As with adults, more severe forms of high blood pressure require more aggressive treatment. Unlike adults, however, lifestyle adjustments tend to be the first treatment option, though medicines are still used when needed. The actual medicines used to treat high blood pressure in teenagers are the same as those used in adults, and the prescribed dose is usually similar to what would be considered an "introductory" or "trial" dose in adults.

References:

  1. Lewington, S, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903.
  2. Chobanian, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003; 289:2560.
  3. Li, S, et al. Childhood blood pressure as a predictor of arterial stiffness in young adults: the bogalusa heart study. Hypertension 2004; 43:541.
  4. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114:555.
  5. Muntner, P, et al. Trends in blood pressure among children and adolescents. JAMA 2004; 291:2107.
  6. Dasgupta, K, et al. Emergence of sex differences in prevalence of high systolic blood pressure: analysis of a longitudinal adolescent cohort. Circulation 2006; 114:2663.
  7. Falkner, B, et al. The relationship of body mass index and blood pressure in primary care pediatric patients. Journal of Pediatrics 2006; 148:195.

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