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How can my four-year-old have high blood pressure?

The question: My four-year-old son was recently diagnosed with high blood pressure. Two questions: If his high blood pressure is genetic, what could be the long-term implications? And how common is it for toddlers to have high blood pressure? My wife and I are both somewhat shocked and concerned with this development. Any insight is appreciated.

The answer: As incredible as it sounds, high blood pressure does occur in children and is not as rare as you may think. About 5 per cent of children and teens have high blood pressure, also known as hypertension. The rates are elevated in certain minority populations, including first nations and African-Canadians. There are indeed genetic factors at play, so children who have close relatives with hypertension are certainly at increased risk.

Children with hypertension almost always need to be assessed and followed by a pediatrician or pediatric hypertension specialist. Because physicians are more aware of the existence of pediatric hypertension, we are checking for – and hence detecting – high blood pressure more commonly in our young patients. Rising pediatric obesity levels are also contributing to higher rates of childhood hypertension.

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Since normal blood pressure levels change throughout childhood, physicians must rely on special charts to determine whether a child's blood pressure is appropriate for his or her age. Getting an accurate blood pressure reading in a small child is not as easy at it sounds. Although computerized blood pressure machines are increasingly common, the old-fashioned technique of using a stethoscope is the preferred and more accurate method. Children who are nervous or unco-operative when their blood pressure is checked can have falsely elevated readings, so multiple readings are almost always required.

Detecting high blood pressure at an early age is critical as some infants will have previously undetected, underlying heart or kidney disease causing the hypertension. Untreated hypertension can have long-term health consequences including increased risk of stroke, and heart and kidney disease. Early detection and treatment are tremendously important in preventing problems later in life. Some young children with hypertension may even need medication. Fortunately, many youth outgrow their high blood pressure, so regular monitoring is important. As always, staying active, making healthy eating choices and reducing salt intake can reduce the risk of hypertension in all age groups.

Send pediatrician Michael Dickinson your questions at He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail website. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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