Should physicians intervene during childhood to prevent adult hypertension?

Hypertension in adulthood is a major health problem, and drug treatment of hypertension is expensive and has adverse side effects. By the time that treatment of hypertension begins during adulthood, considerable damage may have already been done to the arterial system, to the left ventricle, and perhaps to other organs. Thus, from several points of view, prevention would be preferable to treatment. We can consider both the high-risk approach and the population approach during childhood for the prevention of adult hypertension. In the high-risk approach, we must first identify individual children who are at high risk and then intervene among them on a one-on-one basis. Identifying the future hypertensive is difficult because of large day-to-day variability in blood pressure during childhood, poor tracking of blood pressure from childhood to adulthood, and the current lack of good gene markers for hypertension. With the population approach, we do not need to identify high-risk children, but take steps among all children that will help prevent the development of hypertension in the entire population. At the present time, our best approach for the prevention of adult hypertension seems to be the population approach. We should make the usual diet, for all children, lower in sodium and fat and higher in potassium and calcium. This is effected by increasing their intake of vegetables, fruits, and whole grains, which should become the basis of the diet, rather than high-fat meat and dairy products. Further, increasing strenuous physical activity in our children may help prevent the development of obesity. Finally, preventing the initiation of cigarette smoking and excess alcohol consumption will help in our efforts to prevent hypertension and its sequelae in the next generation of adults.