OT- High Blood Pressure in Kids- Updated 6/10

[gandycat]

This is totally not budget related but there are a lot of you and I thought possibly someone might have gone thru this and have advice. My 10 year old has developed off and on high blood pressure. It first came to attention at one of his GI appts (he has acid reflux) and we checked it at home with a monitor. It was 158/103 one check and the ped told me to bring him to the ER. They did blood work and an EKG and it was normal. By the time we followed up with the ped (just 3 days later), the BP was normal. It stayed normal for about 2 months and now is elevated again. They did do a renal ultrasound which was normal. Because it's elevated again, the ped wants me to take him to a cardiologist. I should say that he is very tall and always has been. He's 10 and is 5'5" and weighs 114 lbs. He is not overweight and he is pretty active. He also just started puberty. Has anyone gone thru this? Any advice is appreciated.

Update:

Thank you for the good thoughts and prayers, everyone! Got mostly good news. They have no idea what is causing the hypertension but she said b/c it seems to spike and then go back to normal that she's not worried aobut it for now. We'll monitor it at home and doctor appts. They did some tests to rule out Marfan Syndrome (the ped wanted it ruled out, people with Marfan's are often unusually tall). There was a valve issue that came up on the sonogram. He has a thickening of the bicuspid valve which causes it to not close all the way (she said it's trileaflet but thicker than normal). She said it's trivial but she wants him to have a sonogram each year for the next 2-3 years to see if there are any changes. He might have been born with it or it can be caused by infection. As long as it doesn't change, it should be fine. She said that it's very unusual to have this happen to this particular valve, she hasn't seen it before, she said a bunch of times that it is perplexing. It can be connected to connective tissue disorders so they'll keep an eye on it to make sure it doesn't change. She said it does not cause hyptertension. So, good news mostly and we'll cross our fingers that this is the end of the problems! If anyone has any info or experience with this, I'd be happy to hear.

 

[sherreis]

How scary to go through! Has the doctor any blood work to check your son's kidney function or any other blood work?

 

[gandycat]

How scary to go through! Has the doctor any blood work to check your son's kidney function or any other blood work?

All of the bloodwork was normal (they did a full panel), urine test was normal and an ultrasound of his kidneys and bladder were normal. That's why they are looking to heart issues, that's all that's left to explain it. The ped said that there is a slight chance it's just primary hypertension but b/c he's not overweight, it's a slim chance. It is scary, I'm trying not to worry!

 

[wbn36]

By any chance, was his high blood pressure during a time when his GI problems were bad? When my reflux is bad I get rapid heart rate, chest pains, shortness of breath. I would track his BP in relations to his reflux. I bet there is a direct dorrelation.

 

[ajh88]

I just wanted to throw a couple of things out there (which you may already be doing anyway).

You should check his BP at the same time every day (using the same monitor). Ideally, he should be resting for several minutes (like 15 or so) before you check it.

If you are using a wrist monitor, I would switch to one that goes on the arm. If you already using an arm monitor and you get a high reading, you might check the other arm to see how close the readings are.

If you get a high reading (like you mentioned), do as you did and call the doctor. In the meantime, I would have him sit and try to relax - deep breathing, etc. - for about 5-10 minutes then re-check it. I get "white coat" high readings at the doctor's office on occasion but when she has me relax and breathe deeply, it is back in the "normal" range.

Wbn36 has a good point as well - a flare up of his GI problems could be correlating to his elevated BP readings.

I know this can be scary - I hope they find the underlying cause for you and your son soon.

 

[gandycat]

By any chance, was his high blood pressure during a time when his GI problems were bad? When my reflux is bad I get rapid heart rate, chest pains, shortness of breath. I would track his BP in relations to his reflux. I bet there is a direct dorrelation.

He has weaned off of his meds in the past year (we started with Reglan, then Zantac and finally his Prevacid). He did stop the Prevacid a week or so ago. In the past he's had asthma symptoms when we've tried to wean him (the GI said that the acid can irritate the vegas nerve and the reaction is airway closure). We did it really, really slowly this time and he hasn't complained once about reflux pain and hasn't had any asthma symptoms. I think if the cardiologist doesn't find anything it might be worth trying his Prevacid again and see if it makes a difference. Thanks for the input!

 

[gandycat]

I just wanted to throw a couple of things out there (which you may already be doing anyway).

You should check his BP at the same time every day (using the same monitor). Ideally, he should be resting for several minutes (like 15 or so) before you check it.

If you are using a wrist monitor, I would switch to one that goes on the arm. If you already using an arm monitor and you get a high reading, you might check the other arm to see how close the readings are.

If you get a high reading (like you mentioned), do as you did and call the doctor. In the meantime, I would have him sit and try to relax - deep breathing, etc. - for about 5-10 minutes then re-check it. I get "white coat" high readings at the doctor's office on occasion but when she has me relax and breathe deeply, it is back in the "normal" range.

Wbn36 has a good point as well - a flare up of his GI problems could be correlating to his elevated BP readings.

I know this can be scary - I hope they find the underlying cause for you and your son soon.

Thanks for the input. We do have a wrist cuff. I brought it to the ped to check against their regular cuff and it was about the same. I do switch the writsts to see if there is a difference. If this issue keeps up I'll just buy a arm cuff. I try to be consistent with the time of day but I forget sometimes. And I do it when he's been resting. He does get anxious about it b/c he knows he went to the ER b/c of it but he seems to go thru phases of a few days of it consistently being high, then a longer period of it being normal. He is growing so fast (he's grown about 4 inches since January), sometimes I wonder if his body just needs to catch up at times.

Thanks for the ideas. Luckily my ped told me the same thing but if she hadn't, they are all things that can really make a difference.

 

[smokeyblue]

Sorry that you are having a scary time with your son. Two things come to mind. About the blood pressure cuffs, they can make a huge difference. I personally tend to notice that when they use a machine(Dynamp) it reads me very high vs. having someone doing it manually. Also, the size of the cuff makes a huge difference.

The second thing that comes to mind is something that may be a little far out. Describing your son as tall and thin and having the possibility of a cardiovascular issues makes me wonder if he may have Marfan's syndrome. Really the possibility would be rare, but the cases I have seen have been incidental findings when some other issue comes up unrelated to Marfan's. I know a doctor that has this condition and he just has to be cautious with his health. Again, this probably a very remote possibility.

Hope you find an answer soon.

 

[wbn36]

Hi, going to back to the GI for a minute. I do not have any "acid" reflux. I have hudge amounts of air that I burp up. It is still a reflux. Does he have any GI symptoms now.

FYI, you mentioned he was on Reglan. I too was on it. There is now just recently a huge controversy about it. This drug is only advised to be used for 3 months. There is a large potential for neurological side effects. I think it is called Tardive Dyskensia. My GI never told me this and perscribed this drug to me for months. All I am saying is that nobody ever told me this. I weaned off in Jan. and have been fine, but I should have been given the potential side effects when it was perscribed to me.

 

[gandycat]

Sorry that you are having a scary time with your son. Two things come to mind. About the blood pressure cuffs, they can make a huge difference. I personally tend to notice that when they use a machine(Dynamp) it reads me very high vs. having someone doing it manually. Also, the size of the cuff makes a huge difference.

The second thing that comes to mind is something that may be a little far out. Describing your son as tall and thin and having the possibility of a cardiovascular issues makes me wonder if he may have Marfan's syndrome. Really the possibility would be rare, but the cases I have seen have been incidental findings when some other issue comes up unrelated to Marfan's. I know a doctor that has this condition and he just has to be cautious with his health. Again, this probably a very remote possibility.

Hope you find an answer soon.

Thanks. He has had high readings at the office and ER too. They usually do the machine first then follow up doing it manually. I know that the wrist cuff isn't perfect. It's been pretty consistent with his reads at the peds but that doesn't necessarily make me feel better!

And Marfan's is not crazy at all. My husband's step mother's grandson has it so I've been aware of it since Ben was small and started growing. I've talked to my ped about it and she doesn't think he has any of the obvious characteristics but I'm sure that's part of the reason that she is pushing for us to see the cardiologist. I'm reassured by the ped not seeing it (and I have a friend who is a pediatric nurse who told me the same thing) but you never know. He's had really consistent growth since he was 2, pretty much 4" every year, he's never waivered from his curve. I'm 5'10" and my dh is 6'3" so she just thinks he's tall. I was concerned that he started puberty young (9.5) but she said with tall boys you want that to happen b/c excess growth hormones (meaning that would be making him tall) suppress puberty. so it's a sign that he's just growing at his own pace. She estimates he'll be 6'4" or 6'5" if you follow his growth chart into adulthood.

Thanks for the input. If I wasn't aware of Marfan's it's something that would absolutely help! You never know what the person asking for advice knows or not, lol!

 

[gandycat]

Hi, going to back to the GI for a minute. I do not have any "acid" reflux. I have hudge amounts of air that I burp up. It is still a reflux. Does he have any GI symptoms now.

FYI, you mentioned he was on Reglan. I too was on it. There is now just recently a huge controversy about it. This drug is only advised to be used for 3 months. There is a large potential for neurological side effects. I think it is called Tardive Dyskensia. My GI never told me this and perscribed this drug to me for months. All I am saying is that nobody ever told me this. I weaned off in Jan. and have been fine, but I should have been given the potential side effects when it was perscribed to me.

He is having no reflux symptoms at the moment. And yes, I'm aware of the Reglan issues. he was on it for several years. From what my GI explained, the neurological symptoms occur within the first few weeks, if you don't see them by then, it's not an issue. Maybe I'll do a bit more research on it though, thanks!

 

[donac]

Watch his sugar intake. A report on the news mentioned that sugar is coming up as a reason for high blood pressure.

 

[gandycat]

Thank you everyone for the ideas and good thoughts, I posted an update on the first page.