Running head: TREATING HYPERTENSION IN CHILDREN AND ADOLESCENTS 1

Obese Children and the Use of Lifestyle Modifications to Treat Hypertension

NUR 4111

Sarah Rankin

Bon Secours Memorial College of Nursing

TREATING HYPERTENSION IN CHILDREN AND ADOLESCENTS 2

Obese Children and the Use of Lifestyle Modifications to Treat Hypertension

Childhood obesity is a major public health crisis both nationally and internationally. In

recent years many campaigns have come about to help combat the childhood obesity epidemic,

examples include Play 60 from the NFL and Michelle Obamas Lets Move campaign.

While these campaigns are wonderful we still have an epidemic on our hands in the United

States that doesnt seem to be slowing down. Childhood obesity has been linked to many

diseases such as insulin resistance, type 2 diabetes, high cholesterol, sleep apnea, and

hypertension.

Background

Over the last 30 years childhood obesity has more than doubled in children and

quadrupled in adolescents (Ogden, Carroll, Kit, & Flegal, 2014). It is estimated that the number

of 6 to 19 year olds considered overweight or obese is almost 33.2%, 18.2% of those fall into the

obese category (Obesity society, 2017). Obesity in children is defined as having a body mass

index (BMI) greater than or equal to the 95th percentile. Obesity is caused by factors such as

lack of physical activity and caloric intake greater than body requirements. Because there has

been such an increase in the number of obese children we are now seeing diseases that used to

occur in adulthood in the pediatric population, specifically hypertension.

Blood pressure measurements for children are based on sex, age, and height. The blood

pressure (BP) measurements are assessed using a chart that indicates what percentile the BP falls

in. A normal BP for a child occurs when both the systolic and diastolic numbers fall below the

90th percentile with prehypertension occurring when a childs systolic and/or diastolic numbers

are at or above the 90th percentile (Gralia, Yehle, Ahmed, & Ross, 2015). Hypertension can be
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clinically diagnosed in children when a child has had 3 or more separate BP readings greater than

or equal to the 95th percentile (>120/80) (Lopez, Stuckey, & Mallory, 2016). Hypertension has

become alarmingly common in obese children and adolescents; it has many consequences such

as target organ damage and can lead to life-long health problems. Childhood hypertension like

adult hypertension can be classified into two categories, either primary or secondary. Secondary

hypertension has an identifiable cause such as hyperthyroidism or congenital abnormalities, once

the cause is treated the hypertension typically resolves and BP returns to normal. Primary

hypertension can be defined as having hypertension with no known etiology. There are many

risk factors for Primary hypertension in children, the strongest risk factor is and elevated BMI

(Gralia, Yehle, Ahmed, & Ross, 2015).

Long Term Consequences

Hypertension has many long term consequences in children including irreversible

damage to organs such as the heart, eyes, and kidneys. Both obesity and hypertension also have

a strong link to changes in the vascular system including arterial stiffness and endothelial

dysfunction (Gralia, Yehle, Ahmed, & Ross, 2015). Because these changes are occurring early

in children their bodies are sustaining more damage earlier in life that will affect their health as

they age and likely shorten their lives. Research shows that children who have had a BP reading

in the 95th percentile are more likely to have hypertension into and throughout adulthood (Lopez,

Stuckey, & Mallory, 2016). It is important to detect hypertension early and make sure that

children receive the proper treatment so it does not affect their health later in life.

Management
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Just like adults the best way to treat and manage hypertension is through diet and

exercise. Weight loss is the first therapy most clinicians use to treat obese children with

hypertension. Changing diet and exercise patterns is a form of tertiary prevention that has been

shown to be very effective in the treatment of hypertension. Many studies have showed

significant results using physical activity as a way to reduce blood pressure in children and

adolescents. One study found that children and adolescents who participated in at least 60

minutes of moderate to vigorous physical activity a day for 7 days had a decrease in both their

diastolic and systolic BP (Lopez, Stuckey, & Mallory, 2016).

There has also been multiple studies done evaluating diets effect on hypertension in

obese children and adolescents. There is no denying the correlation between increased sodium

intake and increased BP readings. One researcher looked at sodium intake and found that for

every additional 1,000 mg of sodium consumed above the daily recommendation by overweight

and obese participants risk of hypertension increased by 74% (Yang, Zhang, Kuklina, Fang,

Ayala, Hong, & Merritt, 2012). Overall a reduction in sodium intake and participation in

moderate to vigorous physical activity has been shown to be effective in reducing hypertension

in children and adolescents. When both diet and exercise are included in the plan of care there is

a greater reduction in not only BP, but also BMI (Gralia, Yehle, Ahmed, & Ross, 2015).

Changing the child or adolescents lifestyle is not an easy task and the clinician will need help to

make sure the patient stays on track with the plan of care.

In order to treat the child with lifestyle changes like diet and exercise you must get the

family involved and on board with treatment, sometimes this can be hard. Hypertension is

sometimes called the silent killer/disease this is because those who have it often have no

symptoms until the disease has progressed and caused organ damage. Because of this many
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families may not think anything is wrong with their child even when you tell them they have

hypertension because they have no outward signs or symptoms. Many families may also ignore

the fact that their child or adolescent is overweight, in a recent study it was found that only 25%

of mothers acknowledged that their child or adolescent was overweight (Gralia, Yehle, Ahmed,

& Ross, 2015). These factors may make it harder for the clinician to get the family on board to

help with the lifestyle modification, but it is vital to the childs health that they do. Research has

shown that lifestyle modifications to reduce hypertension are more effective when the family is

involved (Gralia, Yehle, Ahmed, & Ross, 2015). Because family involvement and participation

in patient care plan is so significant it is imperative that the family is included in the plan of care

and teaching of these lifestyle modifications.

Nursing Interventions

The only way to detect hypertension is to take BP readings. When children go to the

doctor they should have their blood pressure checked every time, but unfortunately that is not

always the case. One study found that only 67% of children had their blood pressure screened

during check-ups and only 35% during sick visits (Gralia, Yehle, Ahmed, & Ross, 2015). In

order to detect and prevent hypertension in children these numbers should be at 100%, the only

way to know if there is a problem is to screen for it. Nurses can help to combat this by checking

every childs blood pressure every time they come into the office.

Checking blood pressure at every visit is a form of primary prevention that all clinicians

should participate in. It is also vital that they get an accurate reading, in order to do this they

must use the correct cuff size for the child or adolescent and make sure they are calm and seated

in the correct position. The guidelines and recommendations are always changing so it is very
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important that nurses and health care providers stay up to date so their clients can receive

adequate care.

Nurses and primary care providers play an important role in detecting hypertension in

obese children and adolescents. By measuring the BP on every child at every office visit it will

be easier to detect a problem early and make the lifestyle changes necessary to treat

hypertension. These lifestyle changes however will not be possible without the involvement of

the childs family. Modifying diet and exercise in obese children and adolescents has been

shown to be an effective treatment for hypertension in this population. By detecting and treating

hypertension early we can have a positive impact on their health and their future.
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References

Gralia, N.M., Yehle, K.S., Ahmed, A., & Ross, M. (2015). Managing hypertension among obese
children in primary care: Updated evidence. The Journal for Nurse Practitioners, 11(3),
328-334.

Lopez, A., Stuckey, P., & Mallory, D. (2016). Making positive health changes in
obese/overweight children with hypertension. Pediatric Nursing, 42(5), 243-246.

Obesity Society (2017). Facts about childhood obesity. Retrieved from

http://www.obesity.org/obesity/resources/facts-about-obesity/childhood-overweight

Ogden, C.L., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2014). Prevalence of childhood obesity
and adult obesity in the United States 2011-2012. Journal of the American Medical
Association, 311(8), 806-814.

Yang, Q., Zhang, Z., Kuklina, E., Fang, J., Ayala C., Hong, Y., & Merritt, R. (2012). Sodium
intake and blood pressure among US children and adolescents. Pediatrics, 130(4), 611-
619.