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Inactivity, a diet high in sugar and salt, and being overweight cause nine out of ten cases of high blood pressure in children and adolescents, according to a consensus paper by heart health experts published today in the European Heart Journal, a journal of the European Heart Journal. Society of Cardiology (ESC). The document, which focuses on hypertension in children aged 6 to 16 years, recommends that families be healthy together.

“Parents are significant change agents in promoting children’s health behaviours,” said first author Professor Giovanni de Simone of the University of Naples Federico II, Italy. “Very often, high blood pressure and/or obesity occur together in the same family. But even if this is not the case, lifestyle modification is expected to involve all family members.”

Dietary recommendations for treating high blood pressure in children include emphasizing fresh vegetables, fruits, and other high-fiber foods, limiting salt intake, and avoiding sugary drinks and saturated fats. Children and teens should do at least one hour of moderate to vigorous physical activity each day, such as jogging, cycling or swimming, and spend no more than two hours a day on sedentary activities. “Parents should monitor the amount of time their children spend watching TV or using smartphones and suggest active alternatives,” Professor de Simone said.

Realistic goals should be set for weight, diet, and physical activity focusing on the aspects most in need of improvement. “Logging weight, eating and exercise habits over time – but without becoming obsessive – can help young people and their families track progress toward their goals,” says Professor de Simone.

Recommended “health-enhancing reward system”. Professor de Simone said: “The ideal incentive is one that increases social support and reinforces the value of a targeted behavior, such as a family bike ride or a walk with friends.”

The document refers to childhood obesity and hypertension as “dangerous siblings” that gradually become serious health hazards. Research has shown that childhood hypertension is becoming more common and part of the increase can be explained by obesity, particularly abdominal obesity. It is estimated that less than 2% of normal weight children have hypertension, compared with 5% of overweight children and 15% of obese children. Professor de Simone said: “The increase in hypertension in childhood is of great concern because it is associated with the persistence of hypertension and other cardiovascular problems during adulthood.”

Early diagnosis of high blood pressure is so important that it can be managed with lifestyle and, if needed, medication. Even a single blood pressure measurement by a doctor or nurse can identify children with high blood pressure, but a second visit is recommended for confirmation. Professor de Simone said: “Screening should be carried out in primary care settings at least annually, regardless of the symptoms. This is because hypertension in children, as in adults, is usually asymptomatic.”

When blood pressure measurements indicate hypertension, a medical history and physical examination are needed to determine potential causes and identify modifiable behaviors. Information included family history of hypertension and cardiovascular disease, birth weight and gestational age; details about lifestyle such as smoking, salt intake, alcohol consumption, physical exercise and leisure activities; and possible symptoms include headaches, nosebleeds, vertigo, visual disturbances, low school performance, attention difficulties, shortness of breath, chest pain, palpitations and fainting.

In the early stages, treatment of childhood hypertension should focus on education and behavior change. If blood pressure goals are not achieved, a single low-dose drug should be given. If one drug is not effective, small doses of two drugs may be needed.

The author urges public health agencies to prioritize the prevention and treatment of hypertension in children and adolescents. For example, campaigns to raise awareness of the risk of high blood pressure in adolescents and the positive impact of a healthy lifestyle include physical activity, a nutritious diet low in salt and sugar, and not smoking. Other recommended actions include protected time for children on TV and social media without the promotion of junk food or potentially damaging lifestyle habits.

The consensus document was prepared by the ESC Council on Hypertension, European Association of Preventive Cardiology, European Association of Cardiovascular Imaging, Association of Cardiovascular Nursing & The Allied Profession, the ESC Council for the Practice of Cardiology, and the European Association for Pediatric and Congenital Cardiology.

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