Teenager – Your Blood Pressure Is a Bit High: What Should You Do? What did we do?
May 3, 2020
Back in October, I attended the American Academy of Pediatric National Conference in New Orleans with Dr. Dear Friend. We were there with a group of pediatricians from our health-care system, and it was a high-yield conference. Part of it was because we actually traveled to the conference and it was a fun destination. We had too much fun attending the lectures during the day, exploring new Orleans at night and also trying to reduce our plastic use! One of the talks we attended was on Pediatric Hypertension.
This is an increasing problem in the United States, about 3.5% of the pediatric population. Many of my teenage patients will have elevated blood pressure (this is the new accepted term rather than borderline hypertension), and this is usually accompanied by having a BMI > 85%, more males than females, and a family history of essential hypertension. Usually teenagers are not yet at the point (thank goodness) that we have to start medication. But pediatric patients who have elevated blood pressure are the group who will more likely go on to be hypertensive in adulthood. From the 2017 AAP “Clinical Practice Guidelines a powerful paragraph “Data on BP tracking from childhood to adulthood demonstrate that higher BP in childhood correlates with higher BP in adulthood and the onset of HTN in young adulthood. The strength of the tracking relationship is stronger in older children and adolescents.10 Trajectory data on BP (including repeat measurements from early childhood into midadulthood) confirm the association of elevated BP in adolescence with HTN in early adulthood11 and that normal BP in childhood is associated with a lack of HTN in midadulthood.11” https://pediatrics.aappublications.org/content/140/3/e20171904 And during one of those talks at the AAP Conference in New Orleans, they showed the above slide “Life Style Intervention.” It’s such an innocuous slide but the most important, and the hardest thing to achieve.
I have often mentioned in clinic that being a parent and having my own two children to mother and worry about has made me a better pediatrician. Our son is in his early years of high school, and during his summer physical his blood pressure was borderline. He falls into the typical group that is at risk, his maternal grandfather and paternal grandmother have essential hypertension. He is also male. His physical and this measurement was right before his summer cross country camp, and he had gained a few pounds more than at the end of the academic year.
For my own patients, I will ask you more detailed questions in clinic about your diet and exercise patterns. I will pull up your family history. I will likely order some labs and an EKG at a subsequent visits if our prescribed lifestyle measures do not lower the blood presure. I ask anyone reading this to check with your own pediatrician. But I can tell you most of health outcomes can improve with lifestyle interventions and these are the hardest to do. It’s much easier to give someone a pill, but it’s harder to really sit with a family and try to change the fundamentals that caused that teenager to have hypertension. You can’t change your family history, but many other factors are what we call in medicine “modifiable.” This is how we modified our son’s risk factors.
Lifestyle Interventions for Elevated Blood Pressure
- Cross Country/Track/Running: Our son was already on the middle school cross country team, but we encourage him to continue on the high school cross country team. Right after that visit, we agreed to have him join his Cross Country team in their summer running camp up in Julian, California. It was well worth the money, and he enjoyed the camraderie as well. He began running 5-8 miles a day. Even now during the quarantine, he is still going for his runs about 30 minutes during the day. Aerobic exercise is very important. For the most part the children I see in clinic that have elevated blood pressures are not doing aerobic sports. If they are little and because we are in southern california, I recommend soccer. If they are middle school or high school, I ask them to join cross country or track.
- Lower the Salt and Processed Food in Their Diet: In general I always recommend a low salt and less processed food diet. This is easy to recommend but I realize very hard to implement. Families are battling big food companies and an entire society that has pushed us away from unprocessed grains and whole fruits and vegetables. Also the economy that now requires most families to have both parents work full time and sometimes overtime to be able to support a normal middle-class lifestyle has decreased your available time to do the important task of feeding our children. This could be several blog posts. But I realized that in our family, it is many of the habits that come from Mr. Plastic Picker’s side. We had been very good about taking all the ramen out of the house, but it keeps on creeping back. I just had a heated conversation with my mother-in-law because she has been feeding our son ramen in the afternoon during quarantine home-schooling. She herself has hypertension and I think like most grandparents likes to give the kids things she is no longer able to eat. The most important thing you can do is get the high-salt foods out of the house. If it’s not there, than your child (because teenagers are still children) will not be tempted. For us it was the ramen, soy sauce, the packaged chips, seaweed. Now I feel bad because we ordered pizza last night. But we have been having the kids eat lots of fresh fruit and I’ve been cooking more vegetables. Avoid fast food also. I analyzed the salt content of the “vegan food” options at Burger King once, and there is simply no way to eat low salt when you eat fast food https://drplasticpicker.com/food-review-driving-made-the-impossible-burger-possible/.
- Fresh Fruit and Vegetables: “A high intake of fruits, vegetables, and legumes (ie, a plant-strong diet) is associated with lower BP.” This is such a simple sentence from the AAP 2017 Clinical Practice Guidelines but so important. This dovetails with Dr. Plastic Picker’s less plastic message as well. For all the guilt I feel about the ramen I let creep back into our son’s diet and the pizza, I’m hopeful because we have fundamentally increased the fresh fruits and vegetables in our lives over the last year. We just returned from our local Sprouts market, and even during COVID-19 – I was ablet to fill our grocery cart with mangos, apples, fresh green beans, bell peppers, zuchinnis, cucumbers and blue berries. In regards in hypertension, food can truly be medicine.
- Proper Sleep: Proper sleep is very important as disrupted circadian rhythms will lead to increased cortisol. I always refer my patients to one of my friends Dr. Craig Canapari, who is the Director of Pediatric Sleep Medicine at Yale. He has written extensively about the importance of teenage sleep. https://drcraigcanapari.com/teen-sleep-info/ Refer to his site for further information, but just remember sleep is also medicine in regards to pediatric hypertension.
- Model Good Behavior: Usually when I have a teenager with elevated blood pressure or pediatric hypertension, there is at least one adult with blood pressure problems. As adults, we are the ones that control the budget. We are the ones that buy the food, that order the pizza. I know I am responsible for my child’s health, and I own my part. I also know that as a family, we are all connected. I speak firmly but also collegially with everyone on my “team” that surround my son, his grandmother, his father, and even other mom friends, about my concerns. We make these changes as an entire family, so that it will help improve his health but also our own. I have been trying to jog with our son in the evenings now, and it gives me extra motivation to increase my own aerobic exercise. Also knowing that I need to feed him more whole fruits and vegetables, encourages me to eat them too.
I had been meaning to write this article for months, and I am so happy that I finally did. It helped me review the guidelines and also think about our own son. When I see my patients in clinic, I try to treat them like my own children – and suggest changes that I would make. We have to learn to forgive ourselves, and any of the above efforts will help. Just try to change 1-2 habits at a time, and you will see a difference. It has actually helped me so much to focus on plastic reduction, as it dovetails with healthier eating in general. Overall despite the ramen and the pizza, we have been doing much better with whole fruits and vegetables since I became Dr. Plastic Picker. I am excited to see my son when he wakes up, and I am going to measure his blood pressure and see what his readings are. Stay tuned!
AAP Guidelines in Hypertension as Discussed on Healthychildren.Org https://www.healthychildren.org/english/news/pages/aap-publishes-new-guidelines-on-identifying-and-treating-high-blood-pressure-in-children.aspx
“Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents” 2017 from the AAP. https://pediatrics.aappublications.org/content/140/3/e20171904 (this article has 570 citations, it’s super long. If anyone says they read the entire thing, they are lying).
“28 Rules for Better Sleep” by Dr. Craig Canapari https://drcraigcanapari.com/28-ways-to-sleep-better/