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Doctors have long worried about children having too much peer and school pressure. Now, researchers are sounding an alarm for the first time about childhood pressure of a different kind --- blood pressure.
High blood pressure, or hypertension, was once barely a blip on a diagnostic dial at children's annual checkups.
Two studies released last week, however, show blood pressure to be on the rise in American children and teens. That's cause for concern now, doctors said, and not just in adulthood.
"We thought that if you had high blood pressure as a kid, you were at higher risk for having high blood pressure as an adult," said Gregory Harshfield, a professor of pediatrics at the Medical College of Georgia and co-author of one of the studies. That is still true, Harshfield said, but doctors also are seeing damage while children are still young.
A Tulane University study published last week in the Journal of the American Medical Association compared blood pressure statistics from a national survey between 1988 and 1994 and another in 1999 and 2000. It showed that systolic blood pressure, the measurement during a heartbeat, increased for boys and girls between 8 and 17 by an average of 1.4 points. Diastolic pressure, the measure taken when the heart is at rest, rose by 3.3 points. Researchers say any increase can be harmful.
In the other study, researchers at the Medical College of Georgia, including Harshfield, suggested that high caffeine consumption raised the blood pressure of teens in a vulnerable group. They found that African-American teens who drank more than three soft drinks a day experienced a 14 point increase in systolic pressure over three days.
Taken together, the studies are warning signals for children, teens and their parents that youngsters should watch their diets and exercise more to lower their blood pressure to avoid its negative consequences.
Doctors believe that as many as 2 million children and teens have high blood pressure. As a result, they already are experiencing damage to their hearts and veins. While caffeine may be a culprit in vulnerable groups such as African-Americans, obesity, lack of exercise and poor diet are most responsible across all populations, research shows.
The consequences are bad. Researchers have seen enlarged hearts, kidney problems and a thickening of part of the blood vessels among thousands of teens in studies across the country. The enlarging of vessel walls creates the perfect climate for hardening of the arteries in adolescence and in adulthood.
"The wall becomes thicker [in response to higher pressure] and becomes less compliant, like a garden hose instead of a straw," said Dr. Ronald Portman, professor of pediatric nephrology and hypertension at the University of Texas Medical School in Houston.
Aisha Stanley, 17, of Atlanta, a senior due to graduate May 21 from the Howard School, was diagnosed with high blood pressure last year after having headaches and feeling sleepy. Aisha has been taking medication for a year and has changed her diet, limiting salt and fats. She also has increased her exercise.
Her blood pressure is back to normal. "I feel good. I'm glad I got it under control."
Portman has become nearly evangelical about helping teens like Aisha bring their pressure into normal range. He is president of the International Pediatric Hypertension Association, a group formed four years ago to stem pediatric hypertension, and he is editor of the first textbook on pediatric hypertension, due to be published later this week.
The text will be used in many medical schools to help better educate medical students about the dangers of high blood pressure. Its symptoms in young people are often silent, making it difficult to diagnose, Portman said. It's also difficult to set norms because blood pressure varies by height, age and gender.
"What our job is as pediatricians is to come up with tests to identify who's going to have hypertension early so that with lifestyle changes, we can change that. So imagine you have a 7-year-old who's becoming Mr. Pudge. You still have time to change him; you can thin him out. We could put them on a certain type of anti-hypertensive medication, change their lifestyle and cure their hypertension before it ever starts."
That would help millions of adults too, Portman said. By stemming hypertension --- the reason behind about one in four visits to a doctor --- in youth, doctors could cut back dramatically the number of adults with hypertension.
"I want to put the internists out of business," he said.
While opponents of the sale of soft drinks in schools are not out to put soft drink manufacturers out of business, many would like to see the beverage makers curb one business practice --- selling cola in schools. The study from the Medical College of Georgia bolsters their argument, some researchers said.
"It strengthened the issue that having calorie-containing soft drinks in schools is ill-advised," said Dr. George Bray, division chief of clinical obesity and metabolic syndrome at the Pennington Biomedical Research Center, a research campus of the Louisiana State University system.
Canada's soft drink makers announced in January that they would voluntarily refrain from selling soft drinks in elementary and middle schools. Instead, they will sell bottled water, juice and sports drinks.
Also, school boards in Los Angeles and New York have voted to ban soft drinks.
Coca-Cola spokeswoman Kari Bjorhus referred questions about school sales to a statement issued by the National Soft Drink Association.
The statement stresses that moderate caffeine consumption is considered safe for most people and urged "moderation and common sense."
Some researchers agree that moderation of caffeine is key. They remind parents that teens and children do not need any caffeine or extra, empty calories. They suggest moderation in the stocking of school vending machines.
"Should there be vending machines in school? I have no objections, but let's be careful about what we put in there. Let's put bottled water, fruit juices. Let's have yogurt and carrot sticks," Portman said.
Copyright 2004 The Atlanta Journal-Constitution