Male1: Today, we have a society that were worried about good health and for some strange reason, we are starting to see some kids who get hypertension and it is not that we are worried about cholesterol, sometimes they are sent to the ER especially to nephrology, why is that and is hypertension becoming more prominent, or are there certain rules to it. What could you say about this particular one?
Male2: We see children with high blood pressure. Parents may not believe it, but we do see children with high blood pressure. Every day, we see more children with high blood pressure.
Male1: Is that because we are getting fatter’?
Male2: I believe that that is the main reason. In general, we used to say that in children, hypertension is secondary to another problem. Usually, that problem was a kidney problem that is why most of the case with high blood pressure comes to a kidney doctor to see what is going on. Nowadays, with the obesity epidemic, we are seeing many more children, all of these children overweight and are obese and we see a lot of high blood pressure in this population.
Male1: Adult population, if you get hypertension, you could get a stroke and heart disease, can kids get strokes and heart disease with hypertension?
Male2: I think that is one of the most important questions and problems we face nowadays. I am very concerned that people are not very well aware of the fact that high blood pressure and to answer your question, children do get heart complications and brain complication. Let me explain more in detail. We have had many children who left ventricular hypertrophy which is a thickening of the muscle of the heart and that is because of the high blood pressure that they have had for a while.
Male1: You call that hypertensive heart disease now in children?
Male2: I do not call it that way but I think that it is a good way of saying it.
Male1: It is on its way.
Male2: It is on its way and I am very concerned that these kids sooner or later, in a few years, I think as a young teens or in the young 20s or 30s, they may have coronary heart disease, because if they are untreated undiagnosed high blood pressure. Going back to the brain, actually, we have seen children with strokes caused by high blood pressure and it is very concerning. I think we should be more careful checking the pressures and making sure that blood pressure is normal and if not, we have to find out either what is the cause that is causing the blood pressure to be higher or obviously as I said, the obesity epidemic, we have all of these kids with high blood pressure. We not only have to think about blood pressure, obviously, we have to take care of their weight and many times by decreasing weight, blood pressure goes back to normal.
Male1: So the first focus is if the kid is obese is to try to get much more active and more selective in eating, that is the first thing?
Male2: What I recommend is, I always start with what we call lifestyle modifications, which includes exercise, anything from sports to decrease the time watching TV, videos as you know, kids spend many, many hours inactive, in sedentary activities. They have to exercise more.
Male1: Exercise, lower your weight because it will pump your blood pressure a little bit, correct?
Male2: Absolutely, both. Exercise will help decrease the weight and will also decrease the blood pressure.
Male1: Our kids now that we are putting on medicine to lower blood pressure, is that true??
Male2: Absolutely true. We have to start medications for different reasons, obviously, one when the blood pressure is very severe, we need to start medications. When we start with lifestyle modifications and the patient does not get better, we have to start with the medications, obviously when the patient is symptomatic, we have to start with medications and very important, when we do all these evaluation for high blood pressure, we look for end organ damage. We study the heart, we study the kidney, we study the retina, we study the blood and we study the urine.
Male1: If they will see a cardiologist, an ophthalmologist, yourself, and a team approach to avoid all of these things, is that correct?
Male2: Correct. We always look for damages to other organs and if we find any organ damage that is a very important indication to start medications.
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