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Leading doctors have called for a national UK programme to monitor schoolchildren for high blood pressure amid concerns that rising rates in adolescents will increase cases of organ damage, strokes and heart attacks.
Rates of high blood pressure have nearly doubled among children in the past 20 years, but no routine testing is performed in the UK, leaving doctors in the dark about the extent of the problem and which children need most help.
Identifying teenagers with high blood pressure would enable GPs to intervene early and reduce the risk of organ damage and potentially life-threatening cardiovascular disease as people reach their 30s and 40s, doctors said.
“We need to find out how bad the problem is, and that means finding a way to measure blood pressure in children who are still at school,” said Prof Manish Sinha, a consultant paediatric nephrologist at the Evelina London children’s hospital, Guy’s & St Thomas’s foundation hospitals NHS trust.
“The fundamental issue is that people don’t recognise that hypertension can be a childhood problem. We have a more unhealthy childhood population, and hypertension puts them at greater risk of events like kidney disease, stroke and heart attack earlier in their adult lives,” he added.
Nearly a third of British adults and half in the US have hypertension. Prevalence rises steeply with age as blood vessels naturally thicken and stiffen, and most people over 65 have the condition. Beyond age and genetics, poor diet, especially one high in salt, physical inactivity, being overweight or obese, drinking too much alcohol and smoking all contribute.
In young children, high blood pressure is mainly caused by other medical issues such as heart defects, kidney disease, genetic disorders or hormonal problems. But increasingly, doctors are seeing cases linked to excess weight, poor nutrition and lack of exercise.
High blood pressure can steadily damage the body for years before people experience symptoms. The excess pressure can cause aneurysms, or bulges, in weak arteries, which can be fatal if they burst. The strain on the heart can lead to heart failure.
Dr Emily Haseler, who studies childhood hypertension at King’s College London, said the rise in cases was on course to become a further burden on the NHS and damage UK productivity as more people of working age suffered the impacts of high blood pressure.
Monitoring could be folded into the national child measurement programme, which records height and weight at the end of primary school, or run through a new NHS health check in adolescence, she said. That would allow doctors to diagnose hypertension early so it could be treated, and would show how prevalent the condition was.
Alternative approaches could involve targeted blood pressure screening for children known to be at high risk, such as those with a family history, who were born prematurely, or who are overweight.
“We must start monitoring this so we can understand the scale of the problem and start thinking about what to do,” said Prof Igor Rudan, a co-head of the Centre for Global Health at the University of Edinburgh. “We need to know whether these kids are going to become adults who get heart attacks and strokes aged thirtysomething.”
Hypertension is the leading cause of premature death in the UK. It is rarely picked up before people reach their 40s or 50s, but trends are changing. Juliet Bouverie, the chief executive of the Stroke Association, said there had already been an “alarming surge” in strokes among people of working age.
“The digital age has brought about changes in how children spend their time that we haven’t seen in the history of humanity,” Rudan said. “Traditionally, kids were playing with each other outside as much as possible, but now parents just give them a screen. That’s a complete shift in children’s lifestyles.
“The combination of inactivity due to digital devices and poorer nutrition means we see plenty of obese children and they are getting hypertension at eight times the rate of other children,” he said.
But children may be easier to help than older people. “In kids, you have so much more opportunity to get them back on track,” Rudan said.
Research from Canada shows that childhood and adolescent hypertension increased from 1.3% in the 1990s to 6% in the 2010s. Twice as many have pre-hypertension or elevated blood pressure. The effect on health is stark: a study of more than 25,000 hypertensive teenagers found that over a 14-year follow-up period, their risk of kidney disease or failure was three times higher than in teenagers with healthy blood pressure.
Prof Ian Wilkinson, an honorary consultant physician at the University of Cambridge and president of the British and Irish Hypertension Society, said tackling high blood pressure earlier could give people many more years of healthy life. “What we’re currently doing is waiting for people to get to 40 or 50, waiting for their blood pressure to rise, and then treating them,” he said. “We are ignoring younger people.”
He favours blood pressure monitoring in secondary school and wants marketing professionals to create positive public health messages to reduce people’s salt intake and obesity.
“We are measuring height and weight, and giving vaccinations against various diseases, so why aren’t we addressing hypertension?” he said. “A third of adults in the UK have hypertension, and a substantial proportion of that is probably fuelled by obesity. It’s a national health emergency.”
Bouverie said it was concerning that more children and adolescents had high blood pressure as it was the cause of about half of all strokes. “Childhood is an opportunity to teach and establish healthy living patterns, such as getting regular exercise and eating a balanced diet,” she said. “This all helps to reduce the risk of stroke both now and in the future. Without these healthy habits, the body can store up problems for later in life and increase the chances of a person of any age having a stroke.”
