Pediatric Hypertension

Elevated blood pressure due to obesity and other factors should be a concern of the dental professional regardless of the age of the patient. Elevated readings of systolic and/or diastolic pressure on 3 occasions above the 95th percentile are cause for concern. At present, hypertension in pediatric patients can be found in 1% to 5% of the population. With the growing rate of obesity, hypertension is also expected to increase. A small increased reading of 1 to 2 mm Hg in a child increases his or her chances of adult hypertension by 10%. 

In children, causes of hypertension can be multiple and a result of secondary causes such as renal or cardiovascular disease, acute or chronic kidney disease, hyperthyroidism, Cushing’s disease, and even atherosclerosis. Symptoms of elevated blood pressure can be mild, while severe cases might cause headaches, vision changes, and nausea. Enlargement of the left ventricle is found in 34% to 38% of children with untreated hypertension. Edema, fatigue, chest pain, exertional dyspnea, snoring, and sleep disorders are also possible. Initial treatment of this disorder includes nutritional counseling, exercise programs, and weight reduction. The dental professional should not limit BP readings and recordings to adults; they should be taken on children beginning at the age of 3 at consecutive visits. Referrals to physicians should occur with elevated readings at all 3 visits. In these cases, vasoconstrictors are contraindicated. There may be oral complications such as gingival hypertrophy found in patients taking medications such as calcium channel blockers. Xerostomia may occur with treatment for hypertension in children and adults, resulting in increased caries, ulcerations, and periodontal disease. Screening for hypertension in children is as important as screening in adults.