Skip to main content
Log in

Treatment of Obesity-Related Hypertension in Children and Adolescents

  • Hypertension and Obesity (E Reisin, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

The obesity epidemic has become a common concern among pediatricians, with an estimated 32 % of US children and adolescents classified as overweight and 18 % as obese. Along with the increase in obesity, a growing body of evidence demonstrates that chronic diseases, such as Type 2 diabetes, primary hypertension, and hyperlipidemia, once thought to be confined solely to adulthood, are commonly seen among the obese in childhood. Following a brief summary of the diagnosis and evaluation of hypertension in obese children and adolescents, this review will highlight recent research on the treatment of obesity-related hypertension. Pharmacologic and non-pharmacologic treatment will be discussed. Additionally, current and emerging therapies for the primary treatment of obesity in children and adolescents, which have been gaining in popularity, will be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Ogden CL, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA. 2012;307(5):483–90. Demonstrates that the incidence of childhood obesity in the US appears to have plateaued at 16.9%.

    Article  PubMed  Google Scholar 

  2. Brug J, van Stralen MM, te Velde SJ, et al. Difference in weight status and energy-balance related behaviors among schoolchildren across Europe: the ENERGY-Project. PLoS One. 2012;7(4):e34742.

    Article  PubMed  CAS  Google Scholar 

  3. Pizarro JV, Royo-Bordonada MA. Prevalence of childhood obesity in Spain; National Health Survey 2006-2007. Nutr Hosp. 2012;27(1):154–60.

    Google Scholar 

  4. Rito A, Wijnhoven TM, Rutter H, et al. Prevalence of obesity among Portuguese children (6-8 years old) using three definition criteria: COSI Portugal, 2008. Pediatr Obes. 2012;7(6):413–22.

    Article  PubMed  CAS  Google Scholar 

  5. Song Y, Wang HJ, Ma J. Secular trends of obesity prevalence in urban Chinese children from 1985 to 2010: gender disparity. PLoS One. 2013;8(1):e53069.

    Article  PubMed  CAS  Google Scholar 

  6. •• Gupta N, Goel K, Shah P. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev. 2012;33:48–70. Updated assessment of the epidemiology of obesity in developing countries.

    Article  PubMed  CAS  Google Scholar 

  7. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1:11–25.

    Article  PubMed  Google Scholar 

  8. Blüher S, Meigen C, Gausche R, et al. Age-specific stabilization in obesity prevalence in German children: a cross-sectional study from 1999 to 2008. Int J Pediatr Obes. 2011;6(2-2):e199–206.

    Article  PubMed  Google Scholar 

  9. Din-Dzietham R, Liu Y, Bielo MV, et al. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation. 2007;116:1488–96.

    Article  PubMed  Google Scholar 

  10. McNiece KL, Poffenbarger TS, Turner JL, et al. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr. 2007;150:640–4.

    Article  PubMed  Google Scholar 

  11. Meng L, Liang Y, Liu J, et al. Prevalence and risk factors of hypertension based on repeated measurements in Chinese children and adolescents. Blood Press. 2013;22:57–64.

    Article  Google Scholar 

  12. Marrodan Serrano MD, Cabanas Armesilla MD, Carmenate Moreno MM, et al. Association between adiposity and blood pressure levels between the ages of 6 and 16 years. Analysis in a student population from Madrid, Spain. Rev Esp Cardiol, 2012, ePub ahead of print.

  13. Abolfotouh MA, Sallam SA, Mohammed MS, et al. Prevalence of elevated blood pressure and association with obesity in Egyptian school adolescents. Int J Hypertens 2011, Article ID 952537.

  14. Ostchega Y, Carroll M, Prineas RJ, et al. Trends of elevated blood pressure among children and adolescents: data from the National Health and Nutrition Examination Survey 1988-2006. Am J Hypertens. 2009;22:59–67.

    Article  PubMed  Google Scholar 

  15. • Aounallah-Skhiri H, El Ati J, Traissac P, et al. Blood pressure and associated factors in a North African adolescent population: a national cross-sectional study in Tunisia. BMC Publ Health. 2012;12:98. Illustrates the relationship between obesity and elevated BP in US children.

    Article  Google Scholar 

  16. Prineas RJ, Ostchega Y, Carroll M, et al. US demographic trends in mid-arm circumference and recommended blood pressure cuffs for children and adolescents: data from the National Health and Nutrition Examination Survey 1988-2004. Blood Press Monit. 2007;12(2):75–80.

    Article  PubMed  Google Scholar 

  17. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention, Detection, Elevation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.

    Article  PubMed  CAS  Google Scholar 

  18. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–76.

    Article  Google Scholar 

  19. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA. 2007;298(8):874–9.

    Article  PubMed  CAS  Google Scholar 

  20. •• Flynn J, Zhang Y, Solar-Yohay S, et al. Clinical and demographic characteristics of children with hypertension. Hypertension. 2012;60:1047–54. Clinical trial data on the characteristics of hypertensive children, including the prevalence of primary and secondary hypertension, and the influence of obesity.

    Article  PubMed  CAS  Google Scholar 

  21. • Kapur G, Ahmed M, Pan C, et al. Secondary hypertension in overweight and stage 1 hypertensive children: A Midwest Pediatric Nephrology Consortium Report. J Clin Hypertens. 2010;12(1):34–9. Multi-center study showing the increase in primary hypertension in children seen at referral centers.

    Article  Google Scholar 

  22. Anjana RM, Lakshminarayanan S, Deepa M, et al. Parental history of type 2 diabetes mellitus, metabolic syndrome and cardiometabolic risk factors in Asian Indian adolescents. Metabolism. 2009;58(3):344–50.

    Article  PubMed  CAS  Google Scholar 

  23. van den Elzen AP, de Ridder MA, Grobbee DE, et al. Families and the natural history of blood pressure. A 27-year follow-up study. Am J Hypertens. 2004;17(10):936–40.

    PubMed  Google Scholar 

  24. Alpay H, Özdemir N, Wühl E, et al. Ambulatory blood pressure monitoring in healthy children with parental hypertension. Pediatr Nephrol. 2009;24:155–61.

    Article  PubMed  Google Scholar 

  25. Baracco R, Kapur G, Mattoo T, et al. Prediction of primary vs secondary hypertension in children. J Clin Hypertens. 2012;14:316–621.

    Article  Google Scholar 

  26. Brady TM, Fivush B, Flynn JT, et al. Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr. 2008;152(1):73–8.

    Article  PubMed  Google Scholar 

  27. Hanevold C, Waller J, Daniels S, et al. The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics. 2004;113:328–33.

    Article  PubMed  Google Scholar 

  28. • Dhuper S, Abdullah RA, Weichbrod L, et al. Association of obesity and hypertension with left ventricular geometry and function in children and adolescents. Obesity. 2011;19:128–33. Examination of the contributions of obesity and blood pressure to altered left ventricular geometry in pediatric patients.

    Article  PubMed  Google Scholar 

  29. Foster BJ, Ali H, Mamber S, et al. Prevalence and severity of hypertensive retinopathy in children. Clin Pediatr. 2009;48(9):926–30.

    Article  Google Scholar 

  30. August GP, Caprio S, Fennoy I, et al. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab. 2008;93(12):4576–99.

    Article  PubMed  CAS  Google Scholar 

  31. Horne RS, Yang JS, Walter LM, et al. Elevated blood pressure during sleep and wake in children with sleep-disordered breathing. Pediatrics. 2011;128(1):e85–92.

    Article  PubMed  Google Scholar 

  32. Leung LC, Ng DK, Lau MW, et al. Twenty-four-hour ambulatory BP in snoring children with obstructive sleep apnea syndrome. Chest. 2006;130(4):1009–17.

    Article  PubMed  Google Scholar 

  33. Weber SA, Santos VJ, Semenzati Gde O, et al. Ambulatory blood pressure monitoring in children with obstructive sleep apnea and primary snoring. Int J Pediatr Otorhinolaryngol. 2012;76(6):787–90.

    Article  PubMed  Google Scholar 

  34. Attia G, Ahmad MA, Saleh AB, et al. Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol. 2010;31(7):1025–36.

    Article  PubMed  Google Scholar 

  35. Amin RS, Kimball TR, Bean JA, et al. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med. 2002;165(10):1395–9.

    Article  PubMed  Google Scholar 

  36. NHANES, Prevalence of obesity among children and adolescents: United States, trends 1963-1954 through 2007-2008. Available at http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm. Accessed February 8, 2013.

  37. MacGregor GA, Markandu ND, Sagnella GA, et al. Double-blind study of three sodium intakes and long-term effects of sodium restriction in essential hypertension. Lancet. 1989;334:1244–7.

    Article  Google Scholar 

  38. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001;344:3–10.

    Article  PubMed  CAS  Google Scholar 

  39. He FJ, MacGregor GA. Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension. 2006;48(5):861–9.

    Article  PubMed  CAS  Google Scholar 

  40. Mattes RD, Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr. 1991;10(4):383–93.

    PubMed  CAS  Google Scholar 

  41. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336:1117–24.

    Article  PubMed  CAS  Google Scholar 

  42. Couch SC, Saelens BE, Levin L, et al. The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure. J Pediatr. 2008;152(4):494–501.

    Article  PubMed  Google Scholar 

  43. •• Yang Q, Zhang Z, Kuklina EV, et al. Sodium intake and blood pressure among US children and adolescents. Pediatrics. 2012;130:611–9. Illustrates the excess intake of sodium among US children, and its relationship to elevated blood pressure.

    Article  PubMed  Google Scholar 

  44. Whitlock EP, O’Connor EA, Williams SB, et al. Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics. 2010;125:e396–418.

    Article  PubMed  Google Scholar 

  45. Oude Luttikhuis H, Baur L, Jansen H, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev. 2009;21(1):CD001872.

    Google Scholar 

  46. Savoye M, Shaw M, Dziura J, et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA. 2007;297(24):2697–704.

    Article  PubMed  CAS  Google Scholar 

  47. American Dietetic Association. Position of the American Dietetic Association: individual-, family-, school-, and community-based interventions for pediatric overweight. J Am Diet Assoc. 2006;106(6):925–45.

    Article  Google Scholar 

  48. Lee JS, Sheer JLO, Lopez N, et al. Coverage of obesity treatment: a state-by-state analysis of Medicaid and state insurance laws. Public Health Rep. 2010;125(4):596–604.

    PubMed  Google Scholar 

  49. Ludwig DS, Peterson KE, Gortmaker SL. Releation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001;357:505–8.

    Article  PubMed  CAS  Google Scholar 

  50. He FJ, Marrero NM, MacGregor GA. Salt intake is related to soft drink consumption in children and adolescents: a link to obesity? Hypertension. 2008;51:629–34.

    Article  PubMed  CAS  Google Scholar 

  51. de Ruyter JC, Olthof MR, Seidell JC, et al. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med. 2012;367(15):1397–406.

    Article  PubMed  Google Scholar 

  52. Ebbeling CB, Feldman HA, Chomitz VR, et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N Engl J Med. 2012;367(15):1407–16.

    Article  PubMed  CAS  Google Scholar 

  53. Kersh R, Stroup DF, Taylor WC. Childhood obesity: a framework for policy approaches and ethical considerations. Prev Chronic Dis. 2011;8(5):A93.

    PubMed  Google Scholar 

  54. Farpour-Lambert NJ, Aggoun Y, Marchand LM, et al. Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. J Am Coll Cardiol. 2009;54:2396–406.

    Article  PubMed  CAS  Google Scholar 

  55. Maggio AB, Aggoun Y, Martin XE, et al. Long-term follow-up of cardiovascular risk factors after exercise training in obese children. Int J Pediatr Obes. 2011;6(2–2):e603–10.

    Article  PubMed  Google Scholar 

  56. Stabouli S, Kotsis V, Karagianni C, et al. Blood pressure and carotid artery intima-media thickness in children and adolescents: the role of obesity. Hellenic J Cardiol. 2012;53:41–7.

    PubMed  Google Scholar 

  57. Tounian P, Aggoun Y, Dubern B, et al. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet. 2001;358:1400–4.

    Article  PubMed  CAS  Google Scholar 

  58. Bostanci BK, Civilibal M, Elevli M, et al. Ambulatory blood pressure monitoring and cardiac hypertrophy in children with metabolic syndrome. Pediatr Nephrol. 2012;27(10):1929–35.

    Article  PubMed  Google Scholar 

  59. Welch WP, Yang W, Taylor-Zapata P, et al. Antihypertensive drug use by children: are the drugs labeled and indicated? J Clin Hypertens. 2012;14:388–95.

    Article  Google Scholar 

  60. Meyers RS, Siu A. Pharmacotherapy review of chronic pediatric hypertension. Clin Ther. 2011;33:1331–56.

    Article  PubMed  CAS  Google Scholar 

  61. Kotsis V, Stabouli S, Papakatsika S, et al. Mechanisms of obesity-induced hypertension. Hypertens Res. 2010;33:386–93.

    Article  PubMed  Google Scholar 

  62. Hall JE, da Silve AA, do Carmo JM, et al. Obesity-induced hypertension: role of sympathetic nervous system, leptin, and melanocortins. J Biol Chem. 2010;285(23):17271–6.

    Article  PubMed  CAS  Google Scholar 

  63. • Yoon E, Cohn L, Rocchini A, et al. Antihypertensive prescribing patterns for adolescents with primary hypertension. Pediatrics. 2012;129:e1–8. Population-based study of antihypertensive medication prescribing in children and adolescents.

    Article  PubMed  Google Scholar 

  64. James WPT, Caterson I, Coutinho W, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363(10):905–17.

    Article  PubMed  CAS  Google Scholar 

  65. Mittendorfer B, Ostlund Jr RE, Patterson BW, et al. Orlistat inhibits dietary cholesterol absorption. Obes Res. 2001;9(10):599–604.

    Article  PubMed  CAS  Google Scholar 

  66. Chanoine JP, Hampl S, Jensen C, et al. Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. JAMA. 2005;293(23):2873–83.

    Article  PubMed  CAS  Google Scholar 

  67. Maahs D, Gonzalez de Serna D, Kolotkin RL, et al. Randomized, double-blind, placebo-controlled trial of orlistat for weight loss in adolescents. Endocr Pract. 2006;12(1):18–28.

    Article  PubMed  Google Scholar 

  68. Ozkan B, Bereket A, Turan S, et al. Addition of orlistat to conventional treatment in adolescents with severe obesity. Eur J Pediatr. 2004;163(12):738–41.

    Article  PubMed  Google Scholar 

  69. McDuffie JR, Calis KA, Uwaifo GI, et al. Efficacy of orlistat as an adjunct to behavioral treatment in overweight African American and Caucasian adolescents with obesity-related comorbid conditions. J Pediatr Endocrinol Metab. 2004;17(3):307–19.

    Article  PubMed  CAS  Google Scholar 

  70. Norgren S, Danielsson P, Jurold R, et al. Orlistat treatment in obese prepubertal children: a pilot study. Acta Paediatr. 2003;92(6):666–70.

    Article  PubMed  CAS  Google Scholar 

  71. Miller RA, Chu Q, Xie J, et al. Biguanides suppress hepatic glucagon signalling by decreasing production of cyclic AMP. Nature. 2013. doi:10.1038/nature11808.

  72. Atabek ME, Pirgon O. Use of metformin in obese adolescents with hyperinsulinemia: a 6-month, randomized, double-blind, placebo-controlled clinical trial. J Pediatr Endocrinol Metabol. 2008;21(4):339–48.

    Article  CAS  Google Scholar 

  73. • Wilson DM, Abrams SH, Aye T, et al. Metformin extended release treatment of adolescent obesity. Arch Pediatr Adolesc Med. 2010;164(2):116–23. Assessment of the effects of metformin on BMI in obese adolescents.

    Article  PubMed  Google Scholar 

  74. Yanovski JA, Krakoff J, Salaita CG, et al. Effects of metformin on body weight and body composition in obese insulin-resistant children: a randomized clinical trial. Diabetes. 2011;60(2):477–85.

    Article  PubMed  CAS  Google Scholar 

  75. Kelleher DC, Merrill CT, Cottrell LT, et al. Recent national trends in the use of adolescent inpatient bariatric surgery. Arch Pediatr Adolesc Med. 2012. doi:10.1001/2013.jamapediatrics.286.

  76. Inge TH, Jenkins TM, Zeller M, et al. Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass. J Pediatr. 2010;156(1):103–8.

    Article  PubMed  Google Scholar 

  77. Holterman AX, Browne A, Tussing L, et al. A prospective trial for laparoscopic adjustable gastric banding in morbidly obese adolescents: an interim report of weight loss, metabolic and quality of life outcomes. J Pediatr Surg. 2010;45(1):74–9.

    Article  PubMed  Google Scholar 

  78. Treadwell JR, Sun F, Schoelles K. Systematic review and meta-analysis of bariatric surgery for pediatric obesity. Ann Surg. 2008;248(5):763–76.

    Article  PubMed  Google Scholar 

  79. Inge TH, Miyano G, Bean J, et al. Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents. Pediatrics. 2009;123(1):214–22.

    Article  PubMed  Google Scholar 

  80. Zitsman JL, Digiorgi MF, Marr JR, et al. Comparative outcomes of laparoscopic adjustable gastric banding in adolescents and adults. Surg Obes Relat Dis. 2011;7(6):720–6.

    Article  PubMed  Google Scholar 

  81. Ingelfinger J. Bariatric surgery in adolescents. N Engl J Med. 2012;365(15):1365–7.

    Article  Google Scholar 

  82. Fullmer MA, Abrams SH, Hrovat K, et al. Nutritional strategy for adolescents undergoing bariatric surgery: report of a working group of the Nutrition Committee of NASPGHAN/NACHRI. J Pediatr Gastroenterol Nutr. 2012;54(1):125–35.

    Article  PubMed  Google Scholar 

  83. International Pediatric Endosurgery Group (IPEG). IPEG guidelines for surgical treatment of extremely obese adolescents. J Laparoendosc Adv Surg Tech A 2009, 19 Suppl 1:xiv-xvi.

Download references

Conflict of Interest

S. M. Halbach declares that she has no conflict of interest.

J. Flynn has received payment for serving as a consultant from Novartis and Pfizer, and payment for the development of CME lectures from the American Society of Hypertension.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Susan M. Halbach.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Halbach, S.M., Flynn, J. Treatment of Obesity-Related Hypertension in Children and Adolescents. Curr Hypertens Rep 15, 224–231 (2013). https://doi.org/10.1007/s11906-013-0334-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-013-0334-7

Keywords

Navigation