In the News

As reported by the Danbury News-Times, August 22, 2007.

Study Targets High Blood Pressure In Children

By Robert Miller

A combination of poor diet, lack of exercise and physician inattention may be leaving more than 1 million children and adolescents in the United States with undiagnosed high blood pressure -- a disease that in adults contributes to heart disease, strokes and kidney damage.

"I absolutely agree,'' said Dr. Jack Fong, chairman of pediatrics at Danbury Hospital, when told Tuesday of the study's conclusions. "I wouldn't be surprised at all."

The study, published today in the Journal of the American Medical Association, looked at the case histories of more than 14,000 healthy children age 3 to 18. The children, who lived in northern Ohio, had at least three medical checkups between June 1999 and September 2006.

The physicians who did the study -- all affiliated with Case Western University School of Medicine in Cleveland -- found that 507 children in the study had high blood pressure, but that only 131 had a diagnosis of the disease in their medical records.

One of the authors -- Dr. David Kaelber, who also is affiliated with Harvard Medical School -- estimated as many as 1.5 million children in the United States may suffer from undiagnosed high blood pressure.

Fong said the numbers aren't surprising, simply because about 30 percent of children in American society today are overweight and more than 15 percent are obese. High blood pressure and obesity often go hand-in-hand.

And the reasons for this are the usual suspects -- bad diet and lack of exercise.

"You've got to look at what the diet of children is today -- high in fat, high in salt, high in carbohydrates," said Dr. Larry Scherzer, lead physician in pediatrics at the University of Connecticut School of Medicine in Farmington. "That can't be good for them."

Fong said that a diet high in fats -- even the fats found in non-junk foods like whole milk -- contribute to this.

"I tell parents that whole milk is a perfect food -- for a baby,'' Fong said. "But as children get older, they should be drinking skim milk, or at least 1 percent milk."

And, he said, children aren't eating enough fresh fruits and vegetables. That means they aren't getting enough potassium, which is a factor in reducing high blood pressure.

Fong said there are established standards for childhood blood pressure, which start low when a child is very young, then gradually move toward the adult standards as they reach the teen years. The American Heart Association now says adults should have a blood pressure reading that is no more than 120/80.

But Scherzer also said many family doctors use the adult standard for children, and don't realize the children may have high blood pressure.

"They use one single definition of hypertension, despite the differences in age," he said.

Dr. Josef Burton, a New Milford pediatrician, said pediatricians have to have an assortment of inflatable high blood pressure cuffs, with smaller sizes to fit smaller arms, bigger sizes for bigger arms.

"You can even have very small ones for babies," he said. "But you have to have a lot of different ones."

Scherzer said many doctors assume that a child coming in for a physical -- an exam that can include childhood inoculations -- is suffering from anxiety. Because anxiety can boost blood pressure, doctors assume that's the cause of the hypertension. They either never schedule a follow-up test, or the parents fail to bring the child back.

"Ideally, the best place to do a follow-up would be in the school nurse's office," Scherzer said, noting that children are far less likely to be anxious there.

Burton said there's another reason kids aren't being diagnosed with high blood pressure -- schools are calling for fewer physical exams, and insurance companies are paying for fewer of them.

"It is a big problem," he said, noting that because insurance companies are cutting corners, doctors are forced to do so as well.

"If I find a child with high blood pressure at the beginning of an exam, I always make sure to take it again after the shots," he said. "But how many doctors can afford to spend the extra time with patients today?"

Fong said parents and doctors have to understand that chronic medical conditions -- heart disease, diabetes, and kidney disease -- may have their roots in childhood obesity, high cholesterol and high blood pressure.

"You don't have a heart attack at 50 because of things you start doing at 49," Fong said. "It may be because of things that started at 1 or 2."