High Blood Pressure in Adolescents: Why It Matters?

Arterial hypertension (AH) in adolescents is more common than generally believed, affecting approximately 3.2% of the population aged 11 to 18 years [1]. This is not just a temporary phenomenon: high blood pressure (BP) in childhood and adolescence is one of the most significant risk factors for the development of cardiovascular diseases (CVD) in adult life, such as coronary heart disease and stroke [2, 4, 7]. Moreover, the presence of hypertension in childhood significantly increases the likelihood of its persistence into adulthood [2].

In recent decades, professional medical societies, including the European Society of Hypertension and the American Academy of Pediatrics, have actively developed and updated guidelines for the prevention, diagnosis, and treatment of AH in children and adolescents [2]. The goal of these efforts is to improve early detection, accurate diagnosis, and effective treatment to slow down the future growth of CVD incidence [2].

Diagnostic Challenges and the Importance of Screening

Diagnosing hypertension in adolescents can be a challenging task. A single elevated BP measurement often leads to false-positive results, so multiple doctor visits are required to confirm the diagnosis [4]. In some cases, especially in overweight or obese adolescents, hypertension may be underdiagnosed by up to 20% [4].

For a more accurate assessment of BP and the detection of its daily fluctuations, ambulatory blood pressure monitoring (ABPM) is recommended [7]. This provides a complete picture of BP changes during the day and night, which is critically important for making a correct diagnosis and choosing treatment tactics.

Early detection of AH is crucial, as undiagnosed conditions can lead to severe complications. For example, in one case, an ischemic stroke became the first manifestation of undiagnosed coarctation of the aorta—a congenital heart defect that can remain unnoticed until adolescence [3].

Causes of High Blood Pressure in Adolescents: From Rare to Common

Unlike adults, in whom hypertension is more often primary (essential), in children and adolescents it is predominantly secondary, meaning it is a consequence of another disease [5]. A thorough examination is important to identify the underlying cause.

Among the possible causes are:

• Congenital anomalies of the cardiovascular system: Coarctation of the aorta (narrowing of the aorta) is a congenital defect that can manifest as high BP, especially in the upper extremities, and a difference in pressure between the upper and lower limbs [3]. Delayed diagnosis is fraught with systemic hypertension and cerebrovascular events such as stroke [3].
• Kidney diseases: Renal pathologies are one of the most common causes of secondary hypertension in children. In rare cases, renal vascular anomalies may occur, such as renal artery stenosis, which can be part of rarer conditions such as "Coral Reef Aorta"—a rare disease characterized by calcified plaques in the aorta [5].
• Endocrine disorders: Certain hormonal disorders can also cause an increase in BP.
• Lifestyle factors: High salt intake, especially from processed foods, is a known risk factor for cardiovascular diseases and can contribute to the development of hypertension in children and adolescents [4].

Treatment Approaches: From Lifestyle to Medications

The treatment of hypertension in adolescents is based on principles similar to adult treatment, but with consideration of the growing organism's characteristics [7].

Lifestyle Modifications

This is the first and often the most important step in treatment:

• Salt intake restriction: Given the widespread availability of processed foods rich in salt, reducing its consumption can bring population-level benefits [4].
• Healthy diet: A balanced diet rich in fruits, vegetables, and whole grains, low in saturated fats and sugar.
• Regular physical activity: Helps control weight and improves cardiovascular health.
• Maintaining a healthy weight: Combating overweight and obesity is critical, as they are significant risk factors for hypertension [4].

Pharmacotherapy

If lifestyle changes do not yield the desired result or hypertension is severe, drug treatment is prescribed. There are clear guidelines for drug selection developed by leading medical organizations [2].

In some complex cases, such as pulmonary arterial hypertension (PAH)—a condition distinct from systemic hypertension but also associated with high pressure—specific medications may be used. For example, selexipag, a prostacyclin receptor agonist, is used as part of triple combination therapy in children with PAH, although its use in children does not yet have official approval and is performed "off-label" [6]. This highlights the complexity and individualized approach to treating certain forms of hypertension in pediatrics.

Studies show that treating hypertension in children and adolescents leads to improvements in intermediate health outcomes [7]. However, further studies are required to confirm long-term benefits regarding "hard" endpoints (e.g., reducing the frequency of heart attacks or strokes) [7].

Economic Aspects and Treatment Adherence

The treatment of hypertension in adolescents is associated with certain costs. An analysis of direct medical costs (for pharmacotherapy, doctor visits, laboratory tests, hospitalization) and direct non-medical costs (e.g., for transport to the clinic) showed that they can be significant [1].

An important aspect of successful treatment is patient adherence to therapy. A study among young adults (20-39 years) in Korea revealed that a significant portion of patients do not comply with either drug treatment or lifestyle modification recommendations [8]. Factors associated with low adherence included male gender, smoking, alcohol consumption, and lack of awareness of their own BP level [8]. These data, although obtained for an older age group, are also relevant to adolescents, emphasizing the need for educational work and support to foster a responsible attitude toward their health.

Conclusion: The Future of Health in the Hands of Parents and Doctors

Hypertension in adolescents is a serious condition that requires timely diagnosis and comprehensive treatment. Early detection and adequate management of BP in adolescence are critically important for preventing the development of severe cardiovascular diseases in adult life [2, 4, 7].

Parents, educators, and medical workers must be aware of the risks and symptoms of high BP, as well as the importance of regular medical check-ups and the formation of a healthy lifestyle in adolescents. Only through joint efforts can a healthy future be ensured for the younger generation.

Sources

1. 1. Analysis of direct costs for hypertension treatment among adolescents in Poland.
2. 2. Management of high blood pressure in children: similarities and differences between US and European guidelines.
3. 3. Ischemic stroke as the first manifestation of undiagnosed aortic coarctation in an adolescent: a case report.
4. 4. What's new in pediatric hypertension?
5. 5. Coral reef aorta in a child: a case report.
6. 6. Experience with selexipag in triple therapy for pulmonary arterial hypertension in Chinese children.
7. 7. Hypertension in children: a review of epidemiology, outcomes, and target organ damage.
8. 8. Factors associated with non-adherence to hypertension treatment among young adults in Korea.

The information provided in this article is for informational purposes only and does not replace professional medical advice. Always consult a physician for the diagnosis and treatment of any medical conditions.