Researchers found that programs targeting both diet
and physical activity were more effective than programs that focused
on one or the other.
Although it's generally thought of as a disease of middle-aged and
elderly people, children can also develop high blood pressure, or
hypertension. The American Heart Association recommends that
children have yearly blood pressure checks, saying that detecting
high blood pressure early will improve a child's health.
Dr. Bonita Falkner told Reuters Health that in the U.S., at least
3.5 percent of children and adolescents have hypertension and
another 3.5 percent are at risk because of slightly elevated blood
Falkner studies hypertension at Jefferson Medical College at Thomas
Jefferson University in Philadelphia and was not involved in the new
High blood pressure is more common among children who are overweight
and obese, so the authors of the review wanted to see if
obesity-prevention programs also improved blood pressure in kids.
"Blood pressure during childhood can track into adulthood, and when
kids have elevated blood pressure they are more likely to have
hypertension when they become adults," coauthor Dr. Youfa Wang told
Reuters Health in an email.
Wang, from the University at Buffalo, State University of New York,
said the new review is part of a larger comprehensive study on
childhood obesity funded by the Agency for Healthcare Research and
Quality (AHRQ). The project also includes researchers from the Johns
Hopkins Bloomberg School of Public Health in Baltimore.
Wang and his colleagues analyzed data from 23 studies of obesity
interventions, including almost 19,000 kids in total. The
interventions targeted diet, physical activity or both and lasted at
least one year, or six months for school-based programs.
Studies compared children who received a particular intervention
with those who did not. In the majority of studies, children were
randomly assigned to go through the obesity-prevention program or to
be in a comparison group.
The 23 studies tested a total of 28 different interventions. Most of
them were done in schools or in combined school and home settings.
Four of the interventions showed positive effects on both body fat
and blood pressure. Eleven suggested a beneficial effect on blood
pressure, but no effect on body fat.
Wang and his colleagues then combined the findings of 19 studies
that reported on systolic blood pressure (the top number in a blood
pressure reading) and 18 that reported on diastolic blood pressure
(the bottom number).
They found that obesity prevention programs reduced blood pressure
among children, by an average of 1.64 millimeters of mercury (mm Hg)
in systolic blood pressure and 1.44 mm Hg in diastolic blood
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The reduction was more pronounced in the studies that used a
combined approach with both diet and physical activity
interventions, the authors wrote in Circulation.
"It's not a huge impact, but the totality of the data that they
looked at with the analysis of multiple projects seemed to be
optimistic," Falkner said.
"So it's hopeful that some impact can be achieved," she said. "No
one really lost a lot of weight but at least with the efforts there
was some decrease in blood pressure."
Falkner said measuring blood pressure has become a standard part of
children's medical care, just like measuring height and weight. But
deciding what's normal and what's high blood pressure is more
complicated than it is in adults.
"In adults, generally, there is an accepted standard of 140/90 (mm
Hg), which is the cut-off point," she said. "If blood pressure goes
beyond that it becomes a risk factor for cardiovascular diseases."
For kids, on the other hand, assessments are based on how their
blood pressure compares to other children of their age, height and
Treatment depends on how high the blood pressure is, Falkner
"If it's markedly elevated then the doctors generally do some
testing to see if there's some underlying cause for the high blood
pressure," she said.
She said there are things parents can do that are beneficial for
kids' blood pressure, such as helping them lose weight if they're
overweight or obese.
Dietary changes such as reducing sodium or following the DASH diet
could help, she added. DASH stands for Dietary Approaches to Stop
"The DASH diet is kind of like the Mediterranean diet," Falkner
said. "It's rich in fruits and vegetables, fiber and low-fat dairy."
"The idea behind this is that there are multiple nutrients that are
beneficial for the cardiovascular system," she said.
Circulation, online Feb. 19, 2014.
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