NewsMakers
Children with high blood pressure often become adults with high blood pressure
An estimated 2-5% of children have hypertension, or high blood pressure, and primary hypertension—indicating it is not due to an underlying medical condition—is now the most common type of high blood pressure in kids, especially in adolescents.
High blood pressure in children is not uncommon, and research shows it may lead to high blood pressure in adulthood, as well as problems with the heart, blood vessels and kidneys, according to a new scientific statement from the American Heart Association published in the Association’s Hypertension journal. An American Heart Association scientific statement is an expert analysis of current research and may inform future guidelines.
An estimated 2-5% of children have hypertension, or high blood pressure, and primary hypertension—indicating it is not due to an underlying medical condition—is now the most common type of high blood pressure in kids, especially in adolescents. The new scientific statement reviews current evidence of what leads to high blood pressure in children and adolescents, and highlights clinical and public health implications for health care professionals, researchers and the public.
“Primary hypertension onset in childhood is not a benign condition,” said Bonita Falkner, M.D., FAHA, chair of the scientific statement writing committee and an emeritus professor of medicine and pediatrics at Thomas Jefferson University in Philadelphia. ”This is a health problem that is often amplified by lifestyle and behaviors, many of which are modifiable. Since kids with high blood pressure levels tend to maintain high blood pressure into adulthood, diagnosing and appropriately addressing high blood pressure in youth is imperative to ensure improved lifetime health as early as possible.”
Blood pressure is recorded using two numbers: the systolic blood pressure (the top number in a blood pressure reading) indicates the pressure blood is exerting against the artery walls when the heart beats; and the diastolic blood pressure (the bottom number in a blood pressure reading) indicates the pressure blood is exerting against the artery walls while the heart is resting between beats. High blood pressure occurs when the force of blood flowing through the blood vessels is consistently too high. Damage from high blood pressure may lead to heart disease potentially leading to heart attack, stroke, kidney disease, peripheral artery disease, vision loss, angina (chest pain) and more.
Some factors that may contribute to high blood pressure in children are not modifiable, such as genetics, low birth weight and even environmental exposures. One large study in China evaluated children ages 7 through 18 and found an association between air pollution from industrial and vehicle emissions and other pollutants and an increased risk of abnormal blood pressure.
There are some significant risk factors for high blood pressure that may be modified to improve blood pressure levels, including obesity, physical activity and a key factor—nutrition. A recent meta-analysis of 18 studies with high-quality data on sodium intake and blood pressure found that systolic blood pressure readings increased by 0.8 mm Hg and diastolic blood pressure levels increased by 0.7 mm Hg for every additional one gram of daily sodium intake. This is concerning because dietary sodium intake in the U.S. among children is above recommended nutritional guidelines, according to the 2019 report from the National Academies of Sciences, Engineering and Medicine.
“A healthy lifestyle in childhood may be extremely helpful in mitigating the risk of developing hypertension in youth,” said Falkner. “Preventive measures for families that promote healthy lifestyles in children are important, such as eating healthy food, encouraging physical activity that leads to improved physical fitness and healthy sleep, and avoiding the development of obesity. Regular blood pressure monitoring by a health care clinician is also essential so that if high blood pressure is present, it can be quickly detected and addressed.”
Recognizing high blood pressure in children and adolescents who are otherwise healthy and without symptoms may be challenging. Health care professionals should be trained on the specific techniques to measure pediatric blood pressure more accurately, and if levels are elevated, the child’s blood pressure should be checked on at least three different days using appropriate measurement techniques, as outlined in the scientific statement.
Current pediatric guidelines from the American Academy of Pediatrics, European Society of Hypertension and Hypertension Canada define a diagnosis of childhood-onset high blood pressure to be systolic and/or diastolic blood pressure levels that are greater than the 95th percentile of blood pressure values in healthy children, based on age, sex and height. There is currently a lack of data on specific blood pressure levels in childhood that may predict later cardiovascular conditions, such as heart failure, kidney failure, stroke or cardiovascular death, and thus the use of the 95th percentile guidelines rather than measures for high blood pressure in adults.
When high blood pressure is diagnosed in youth, treatment may include dietary changes, increased physical activity, a reduction in screen time (television or other digital devices) and in some cases medication. Studies on medication recommendations for high blood pressure in youth are somewhat lacking. There is only one long-term randomized clinical trial that examined high blood pressure medication in children, and it was specifically in children with chronic kidney disease. Since primary hypertension is now known to be the main type of high blood pressure in youth, trials are needed focusing on medications for children with high blood pressure not related to another medical cause.
The statement authors note that public health efforts to study and improve high blood pressure in children may be difficult for numerous reasons, yet it may be useful to gather information from pediatric databases to calculate and monitor trends in blood pressure in children relative to population-based variations in obesity, physical activity, nutrition, unmet social needs and adverse childhood experiences. Additionally, broader interventions, such as lowering sodium content in food in the U.S. and providing healthier food choices in schools, may be helpful in improving cardiovascular health particularly during childhood.
“There is a need for increased understanding and greater research surrounding high blood pressure in youth,” said Falkner. “Future studies to improve both the recognition and diagnosis of high blood pressure in this age group, as well as clinical trials to evaluate medical treatment and recommend public health initiatives, are all vital to improving the increase we are seeing in hypertension in children.“
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council on Hypertension; the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; the Council on Kidney in Cardiovascular Disease; the Council on Lifestyle and Cardiometabolic Health; and the Council on Cardiovascular and Stroke Nursing. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.
Co-authors and members of the writing committee are Vice Chair Samuel S. Gidding, M.D., FAHA; Carissa M. Baker-Smith, M.D., M.P.H., FAHA; Tammy M. Brady, M.D., Ph.D., FAHA; Joseph T. Flynn, M.D., M.S., FAHA; Leslie M. Malle, M.S.N., FAHA; Andrew M. South, M.D., M.S., FAHA; Andrew H. Tran, M.D., M.S., FAHA; and Elaine M. Urbina, M.D., M.S., FAHA. Authors’ disclosures are listed in the manuscript.
NewsMakers
Could your oral health be affecting fertility?
Chronic oral inflammation may impair female fertility by triggering a systemic immune response that affects the ovaries. A new study shows this leads to oxidative damage, reduced egg quality, disrupted follicle development and reduced live birth rate. These findings point to a potential biological link between oral health and unexplained infertility, opening new directions for future treatments.
A new study led by Prof. Michael Klutstein at the Hebrew University of Jerusalem and Prof. Asaf Wilensky at the Hebrew University-Hadassah Medical center and spearheaded by the students Dr. Paz Kles and Stephen Ameho has uncovered a striking biological link between chronic oral inflammation and female fertility, suggesting that conditions in the mouth may have far-reaching effects on reproductive health.
Published in the Journal of Dental Research, the study shows that persistent inflammation in the oral cavity can impair ovarian function, reduce egg quality, and ultimately lower fertility rates.
Researchers examined in a mouse model inflammation associated with dental implants, a common clinical scenario, and tracked how immune signals spread throughout the body. Their findings reveal that inflammation does not remain confined to the oral cavity but triggers a systemic immune response that reaches the ovaries.
The consequences were significant. Chronic oral inflammation in the animals was linked to increased levels of inflammatory cytokines in the ovaries, along with shifts in immune cell populations. This was accompanied by oxidative damage to ovarian tissue, impaired development of follicles, and reduced quality of oocytes.
These biological changes translated into measurable reproductive outcomes, with markedly reduced birth rates observed under inflammatory conditions in the animals.
The study also identified deeper cellular effects. Oocytes exhibited DNA damage and epigenetic alterations resembling those seen in reproductive aging, pointing to a possible mechanism by which inflammation accelerates the decline in fertility.
“Inflammation is often thought of as a localized response, but our findings show that it can have systemic consequences that extend as far as the reproductive system,” said Prof. Michael Klutstein. “This work suggests that chronic oral inflammation may be an underrecognized factor in female infertility, potentially contributing to cases that currently have no clear explanation.”
The findings add to growing evidence that oral health is closely linked to overall health. Chronic oral inflammatory conditions such as periodontitis are widespread and have already been associated with a range of systemic diseases.
The researchers note that further investigation in clinical settings will be essential to determine how these findings translate to patient care. If confirmed, the work could open new avenues for diagnosis and treatment, including the use of anti-inflammatory or antioxidant approaches to improve fertility outcomes.
NewsMakers
Maintaining a healthy heart may require regular doses of positivity
The findings of this study further point to the importance of attending to mental and behavioral health for cardiovascular disease prevention and cardiovascular health optimization.
Positive psychology interventions such as mindfulness, gratitude journaling and optimism training can consistently improve blood pressure, inflammation markers and other cardiovascular disease risk factors within a matter of weeks, a recent study found. However, since these benefits are associated with lifestyle changes such as eating healthier and greater physical activity, the researchers suggested that ongoing reinforcements may be needed to stay on course long term.
Rosalba (Rose) Hernandez, a professor of social work at the University of Illinois Urbana-Champaign, led a team that analyzed the findings of 18 randomized controlled trials that used positive psychological and mindfulness interventions to enhance mental or physical health.
The programs that the team reviewed included individual methods — such as structured telephone sessions, journaling with brief check-ins and digital platforms such as apps and text messaging — and interactive in-person group sessions, as well as hybrid formats that blended these with online tools and virtual meetings. Most of the programs consisted of weekly sessions and at-home activities that reinforced the skills taught, with the majority of programs lasting from six to 12 weeks, the team found.
In general, the programs included 50-200 adults with elevated cardiovascular risk factors such as uncontrolled hypertension, heart failure or other conditions. Typically, the participants were in their late 50s to mid-60s, and women comprised 35-55% of the samples across those studies that reported their participants’ gender, according to the researchers.
“In hypertension and postacute coronary syndrome cohorts, mindfulness-based programs delivered over an eight-week period reduced systolic blood pressure and lowered inflammatory markers such as high-sensitivity C-reactive protein and fibrinogen,” said Hernandez, who is a Fellow of the American Heart Association. “A 12-week spirituality-based digital intervention achieved one of the largest reductions — reducing systolic blood pressure measured with a standard cuff by 7.6 points, and central systolic pressure — which is measured in the aorta as it leaves the heart — by 4.1 points.”
In prior research on positive psychology interventions, scientists seldom defined the dose that was needed to obtain the beneficial effects, Hernandez said. She and the team members sought to clarify the frequency and duration that was most likely to improve individuals’ cardiovascular health.
Programs that had more frequent contact with their participants yielded the most consistent physiological benefits, underscoring the opportunity to embed positive psychological strategies into long-term cardiovascular care, Hernandez said.
The team found that the strongest behavioral improvements were achieved by an eight-week program delivered over WhatsApp that combined weekly sessions with daily microtasks, motivating participants to engage in greater physical activity, eat a healthier diet and take their medication as prescribed. A program that included motivational interviewing succeeded in increasing cardiac patients’ levels of physical activity by 1,800 steps a day and their medication adherence, while the mindfulness programs improved participants’ activity levels and diets only, according to the study.
“The therapeutic dose that was most consistently linked with improvements in blood pressure, inflammation and endothelial function was daily practice reinforced by weekly sessions over eight to 12-week periods,” Hernandez said. “Therapeutic dosing typically involved high-frequency dosing over this time period to obtain short-term physiologic benefits, while ongoing less-intensive contact may be needed to sustain behavioral change.”
Published in the journal Cardiology Clinics, the study was co-written by University of South Florida social work professor Soonhyung Kwon; Alyssa M. Vela, a professor of surgery and of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine; and Katharine S. Edwards, a professor of cardiovascular medicine and of psychiatry and behavioral medicine at Stanford Medicine.
“The findings of this study further point to the importance of attending to mental and behavioral health for cardiovascular disease prevention and cardiovascular health optimization,” Vela said. “This speaks to the need for routine screening and integration of cardiac behavioral medicine to allow for access to important interventions.”
The current study adds to a growing body of research linking psychological well-being — including traits such as optimism, positive affect and gratitude — with cardioprotective benefits.
NewsMakers
Heart disease risk may start in the womb, study finds
Young adults whose mothers had high blood pressure during pregnancy — either pregnancy-associated hypertension, pre-eclampsia or eclampsia — had more signs of early arterial injury, higher blood pressure, higher body mass index and higher blood sugar than peers.
A child’s future heart health may be partially shaped before they are born, reports a new Northwestern Medicine study that found pregnancy complications are linked to poorer cardiovascular health in offspring more than 20 years later.
The study found that young adults whose mothers had high blood pressure during pregnancy — either pregnancy-associated hypertension, pre-eclampsia or eclampsia — had more signs of early arterial injury, higher blood pressure, higher body mass index and higher blood sugar than peers.
The authors said the study adds to growing evidence that cardiovascular risk may be transmitted across generations through a combination of biological, environmental and behavioral factors.
“That means we must make sure people maintain good health from childhood into young adulthood, so that if or when someone becomes a parent, they pass on the best opportunity for good health to their children,” said study senior author Dr. Nilay Shah, assistant professor of medicine in the division of cardiology at Northwestern University Feinberg School of Medicine.
How the study was conducted
Shah and colleagues evaluated nearly 1,350 mother-child pairs from the Future of Families and Child Well-Being Study, which enrolled mothers and children at birth between 1998 and 2000 across 20 U.S. cities. The children were then followed into adulthood.
Using delivery hospitalization records, the Northwestern scientists first identified whether mothers experienced pregnancy complications, including high blood pressure during pregnancy, gestational diabetes (high blood sugar during pregnancy) or preterm birth (before 37 weeks of pregnancy).
The three pregnancy complications are on the rise, and affect almost one in four pregnancies in the U.S.
The research team then analyzed cardiovascular health of offspring at age 22, using blood pressure measurements, blood testing, body mass index assessments and carotid artery ultrasounds to look for signs of artery injury.
Finally, the scientists compared participants with and without exposure to each pregnancy complication and adjusted for factors like income, education, difference in birth weight and smoking during pregnancy.
Key findings
At around age 22, participants whose mothers had high blood pressure during pregnancy had:
- Higher body mass index (+2.8 BMI points)
- Higher diastolic blood pressure (+2.3 mm Hg)
- Higher blood sugar levels (+0.2% HbA1c)
- Thicker artery walls (~0.02 mm)
While the difference in artery wall thickness may seem small, the study authors said it corresponds to roughly three to five years of additional vascular aging. That means arteries looked older and less healthy than expected, which raises the risk of future heart disease.
Other pregnancy complications also showed some long-term effect:
- Exposure to gestational diabetes was linked to worse blood pressure and some evidence of artery thickening
- Being born preterm was associated with higher blood sugar levels
‘Most heart disease is preventable’
With pregnancy complications on the rise in the U.S., Shah said the study provides compelling evidence that improving health before and during pregnancy could help reduce heart disease risk in the next generation.
“There is evidence that both parents’ health at the time of conception and during pregnancy influences a child’s health,” he said. “So, promoting health from an early age, like exercising regularly, eating healthfully, never smoking and getting enough sleep, is not just meant for an individual, but doing so may help future generations be healthier, too.”
Shah also emphasizes that risk is not destiny.
“The good news is that most heart disease is preventable,” he said. “If you experienced high blood pressure or high blood sugar during pregnancy, or your child was born early, it does not absolutely mean that your child will have worse health as adults. But I would encourage you to pay attention now to your child’s health behaviors.
“What children learn in childhood sets the stage for their health across their lives. If you are wondering whether your children’s behaviors are healthy, or are considering making a change, please speak with your child’s pediatrician for advice and guidance.”
Other Northwestern co-authors include Emily Lam, Abigail Gauen, Dr. Sadiya Khan, Alexa Freedman and Norrina Allen.
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