December 1, 2015
In treating hypertensive children, pediatric nephrologist Tammy Brady noticed that while most patients did not have a secondary condition like heart or kidney disease, an increasing number were overweight or obese. Indeed, looking into the literature she found that the increase in hypertension corresponded to the rise in obesity rates among children, which have tripled in the United States over the past three decades.
“In the 1970s and 1980s, about 1 percent of children were hypertensive—today that number is up to 5 percent,” Brady says.
Brady also found that successfully treating these obese-hypertensive patients was particularly challenging. Getting patients’ weight down would lower their blood pressure levels, but how do you achieve that when so many factors may underlie obesity.
“We’d say you need to work on weight loss and they’d come back for their next appointment in six months having gained weight,” Brady says. “The standard-of-care tools that we had were not successful.”
What these patients needed, Brady concluded, was a multidisciplinary clinic that could effectively address both the hypertension and weight issues. Brady pieced together such a hypertension-obesity clinic, adding a dietician, physical and occupational therapists, a behavioral psychologist and a pediatric cardiologist to her team.
“So I thought, let’s try and come up with a one-stop shop to treat all of the aspects of hypertension and obesity for these patients,” Brady says.
In this new clinic, patients are also seen more frequently—every three months rather than every six months—to keep them on track with the treatment plan. At each visit, the dietician guides the patient on nutrition and weight loss, the physical therapist on exercise options, the occupational therapist on how to incorporate recommendations into daily life, and the behavioral psychologist on underlying mental health issues that may be influencing the patient’s eating habits. Treatment recommendations promote a heart-healthy lifestyle—a diet that includes fruits and vegetables, limited screen time, and one or more hours of physical activity daily.
“Our dietician does a full metabolic workup and we assess patients for any physical reasons they can’t be active,” Brady says.
Also, an echocardiogram is performed as part of an assessment by the pediatric cardiologist for early signs of heart disease. All children with high blood pressure are at risk of heart thickening, or left ventricular hypertrophy (LVH), Brady notes, especially those who are overweight or obese.
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