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The following conditions indicate the need for drug treatment in children with high blood pressure: Damage to target organs like the heart and kidneys Diabetes Secondary high blood pressure Symptoms such as headache, nosebleeds, or dizziness Continued high blood pressure despite weight loss, salt reduction, and exercise
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The drug treatment for children with high blood pressure is similar to the treatment of adults, though at lower doses (see 13): Treat mild high blood pressure with a low-dose diuretic, equivalent to 125 mg of hydrochlorothiazide If a second drug is necessary, the most common choice is a beta blocker If the combination of a diuretic and a beta blocker doesn t control blood pressure, then an ACE inhibitor, an angiotensin II receptor blocker, or a calcium channel blocker can be added These have been recently shown to be safe in children Just as adults with diabetes do better with ACE inhibitors, children with diabetes should be given this drug first If possible, a single medication is always best because children are reluctant to take one pill a day, much less two pills two or three times a day Frequent monitoring is important prior to starting drug treatment and while the child is taking the drug to check the effect of the drug and to be sure the child is actually taking the medication A parent can do this at home, checking the blood pressure every few days After they re forced to take a pill every day, most children gladly start to make lifestyle changes such as a reduction in food intake, a reduction in salt, or an increase in exercise Each of these changes may result in an elimination of the pill Stopping blood pressure medication after a year or so of successful blood pressure control is worthwhile to determine whether medication can be permanently discontinued Be sure you work with your child s doctor on this plan! No one knows the long-term effects of medications for high blood pressure on the growth and development of children However, researchers are working on these questions as you read this, so we may have some answers soon
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Discovering prenatal changes that affect blood pressure Finding out about preeclampsia, eclampsia, and the HELLP syndrome Delivering a baby and reducing the risk to the mother-to-be Taking hormones for contraception and during menopause
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roviding medical care to a pregnant woman (so far, I haven t helped any pregnant men) is one of a physician s more gratifying activities You start out with a happy woman and end up with a thrilled woman and a healthy new life that is, most of the time On occasion, I have run into patients who have medical problems like high blood pressure associated with a pregnancy The following factors apply to high blood pressure and pregnancies: May appear before or during the pregnancy and may be temporary or permanent Occurs in about 10 percent of first pregnancies and 8 percent of all pregnancies Is more common in women who previously used oral contraceptives Most of the time, high blood pressure management during pregnancy is simple and straightforward Only rarely does a pregnant woman suddenly develop signs and symptoms around the middle of the pregnancy that put her and her growing fetus at risk for sickness and even death Fortunately, this complication (preeclampsia; I discuss it later in this chapter) has become unusual, but it still happens For this reason, you need to be aware of it if you re the pregnant woman, the future father, or a caring friend or relative
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Part IV: Taking Care of Special Populations
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In this chapter, you discover the different ways that high blood pressure develops during pregnancy, its various causes, and the necessary treatments I hope you come away from this chapter with a greater appreciation for the miracle of birth and a better understanding of blood pressure management when high blood pressure complicates this miracle
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