Obesity Hypertension Clinic: Reversing the Negative Cardiovascular Effects of Weight (ReNEW)
Obesity Hypertension: What is that?
Hypertension is a condition in which one's blood pressure is consistently high. In children, hypertension is diagnosed when a child's blood pressure remains about the 95th percentile on multiple measurements over several occasions. It is often due to an underlying cause like being overweight or obese. A child is considered overweight or obese if their body mass index (BMI) is at or above 85th percentile.
Why does being overweight or obese lead to hypertension?
Children (and adults) who are overweight or obese are more likely to have risk factors for heart disease like hypertension, high cholesterol, diabetes, insulin resistance and left ventricular hypertrophy (abnormal thickening of the heart). In fact, children as young as two years of age can even have atherosclerosis (hardening of the arteries). Individuals who are overweight or obese are more likely to be sensitive to salt (meaning their blood pressure is more likely to increase with high salt intake), have more hormones that cause high blood pressure and have more inflammation, which effects the blood vessels and heart.
Who does this affect?
Since 1980, the percentage of kids in the United States who are obese has almost tripled.
- Among U.S. children two to 19 years old, approximately 17 percent (12.5 million) are obese, and 15 percent are overweight.
- Between 20 percent and 47 percent of overweight and obese children have hypertension.
With approximately 1.3 million children younger than 18 in Maryland, this means that in Maryland there are 416,000 overweight or obese children, and between 83,200 and 195,520 children with obesity hypertension.
How do you treat obesity hypertension?
Weight loss is essential to the successful treatment of obesity hypertension. Children and adolescents should be encouraged to achieve and maintain a normal weight and to follow a heart healthy lifestyle. Children and their families should adopt a lifestyle that includes the following:
- Daily aerobic exercise:
- Aim for 60 minutes or more of moderate to vigorous activity every day — choose an activity that gets your heart pumping like running, soccer, tennis or jumping jacks.
- Minimize sedentary activities.
- Limit activities like computer/video/tablet games and TV watching to fewer than two hours per day.
- Make sure your diet includes regular daily intake of fresh vegetables, fruits and low-fat dairy.
- Minimize or eliminate sugar-sweetened drinks.
- Eliminate empty calorie drinks like juice, soda and sweet tea.
- Increase water intake.
- Avoid of foods high in salt.
- Aim for no more than 1,500 mg sodium per day.
- Reduce table salt consumption.
- Choose low cholesterol food options.
- Limit cholesterol intake to less than 300 mg each day.
- Stop smoking.
Some children with hypertension will need medication to treat their blood pressure. Children who require blood pressure medication are those with a cause for their hypertension other than obesity, those who are experiencing symptoms from their hypertension, those who have diabetes or left ventricular hypertrophy (an abnormal heart thickening in response to high blood pressure) and those who continue to have hypertension after six months of making lifestyle changes.
Where can my child receive evaluation and treatment?
The ReNEW Clinic at Johns Hopkins University provides an innovative multidisciplinary approach to the evaluation and treatment of obesity hypertension.
This clinic is designed to treat children with confirmed hypertension and a BMI at or above the 85th percentile. Referred children are evaluated and treated by providers from the following specialties:
Children are seen every three months by each provider to provide a multifaceted approach to weight loss, cardiovascular risk assessment and hypertension treatment.
- Tammy M. Brady, M.D., Ph.D.: Medical director, Pediatric Nephrology
- Jeffrey Garofano, Ph.D., Behavioral Psychologist
When can my child be seen?
This clinic takes place once a month. Because each child is seen by multiple providers, the clinic visit will be approximately two and a half hours long.
How do I make an appointment?
To make an appointment at the ReNEW Clinic, please call 410-955-1247.