Inside one boy’s high blood pressure struggle—and the health system that’s helped him manage the condition.
Start Reading
It’s these very risks that led hospital administrators at Stanford Medicine Children’s Health to develop a dedicated, comprehensive pediatric hypertension program to specifically treat children—one of the few such programs on the West Coast. Led by Dr. Abanti Chaudhuri, an experienced nephrologist, the program relies on a team of multidisciplinary experts to provide individualized care for children who suffer from hypertension.
Dr. Abanti Chaudhuri | Pediatric Hypertension Program Director, Stanford Medicine Children’s Health
“The approach to treating a child with high blood pressure is different in many ways than the approach to treating an adult,” Chaudhuri says. She cites the variability of blood pressure goals based on age, sex and height, and the challenge of medication dosing for children as a few of the differentiating factors. The program’s mission is to diagnose hypertension in children and treat them early, before they become hypertensive adults.
The Diagnosis
Jacob’s blood pressure had always been high, but it had historically been attributed to nervousness. However, when Jacob became sick to the point of needing hospitalization for two days in 2017, his mom Amy wondered if his high blood pressure was to blame. Jacob was sent to a nephrologist at Stanford Children’s. Hypertension is often treated by nephrology experts because kidney problems can lead to high blood pressure—and uncontrolled hypertension over time can cause severe damage to the kidneys.
The nephrologists conducted a 24-hour blood pressure test, sending Jacob home with a cuff that monitored him day and night—“the gold standard for diagnosing hypertension in children,” Chaudhuri says. The results confirmed his mother’s fears: Jacob had extraordinarily high blood pressure that measured at the 99th percentile for kids of similar age, sex and height.
The approach to treating a child with high blood pressure is different in many ways than the approach to treating an adult.
Dr. Abanti Chaudhuri | Pediatric Hypertension Program Director, Stanford Medicine Children’s Health
Stanford Children’s is advancing pediatrics through industry-leading clinical care, biomedical research and innovation.
Hypertension Is Not Just an Adult Disease
n 2017, doctors at one of the premier hospitals in
California diagnosed a patient named Jacob with severe
hypertension, a condition common in older people.
About 1 in 3 adults in the U.S. are affected by hypertension, but Jacob didn’t fit the typical profile for someone with significantly high blood pressure: He was only 7 years old.
Now a teenager, Jacob is one of an estimated 2% to 5% of children in the U.S. who have hypertension, according to the American Heart Association. There are two types of hypertension: Primary hypertension emerges without an associated underlying disease, and is the leading type of childhood hypertension, while secondary hypertension arises from a serious medical issue, such as a congenital heart defect or kidney disease.
What’s more, the prevalence of childhood hypertension is rising, a result of increased rates of obesity among young people. If left untreated, high blood pressure in childhood is likely to carry over into adulthood, raising the risk of organ damage and other issues such as cardiovascular and kidney diseases later in life.
Around the time of his angioplasty, Jacob experienced significant weight gain, which exacerbated his high blood pressure. Controlling one’s weight is a challenge for anyone, let alone a child without the experience or tools to manage extensive lifestyle changes. For these situations, young patients and their families can work with a dietitian to advise on nutrition and exercise plans. They also have access to other resources, such as social workers who can help address emotional and social stress and pediatric nephrology nurses who are always on call to answer questions.
The experts at Stanford Children’s design specific treatment plans for each patient. Although the pediatric hypertension program is led by nephrologists, they also work with other pediatric specialists to guide care, including those from cardiology, endocrinology and interventional radiology.
Chaudhuri says they first try to control the patient’s blood pressure through medication or nonsurgical methods, but sometimes additional interventions are needed. Jacob’s narrowed renal artery led to his right kidney becoming smaller, a cause for concern. Chaudhuri consulted with the pediatric interventional radiology team, and in March 2018, they performed a balloon angioplasty, a procedure to widen his renal artery.
After the intervention, Jacob’s blood flow improved, and his pressure stabilized enough for him to discontinue medication, but only temporarily.
The Treatment
“We really stress trying to focus on lifestyle modifications—increasing exercise, eating healthier, avoiding sugary drinks and processed foods,” says Erin Herse, who has been Jacob’s nurse since his journey began. In the last few years, Jacob has fully committed to these healthy habits, she notes, and “as a result, we’ve seen a lot better control of his blood pressure.”
The Healthy
Lifestyle
Five years later, with constant monitoring, tests and guidance from Stanford Children’s pediatric hypertension program, Jacob is almost ready to be off medication entirely. It was challenging at times for Jacob to stick to his routine while managing the pressures of being in middle school. “It’s been an experience,” Amy says. For the mother of three, the progress was hard won, requiring the whole family to serve as Jacob’s support system.
The result is a testament to the value of interdisciplinary care, as well as the buy-in from Jacob and his family, Chaudhuri stresses. “It takes a village,” she says, referring to the program’s coalition of experts. “The ease of access to different resources required to make this work is a very big part of what sets this program apart.”
As for Jacob? “We won’t let go of him. We will make sure he gets connected with the right people, and he continues to live a healthy lifestyle,” Chaudhuri adds. “The goal is to set patients up for success as adults.”
Learn More
Stanford Children’s immediately started him on medication to try to lower his blood pressure while investigating the cause. Eventually, an ultrasound and an MRA—a scan similar to an MRI but for blood vessels—in January 2018 confirmed Jacob had renal artery stenosis, meaning his renal artery was narrow, which restricted blood flow to his right kidney. This caused his right kidney to become smaller than his left, resulting in his hypertension.
“It wasn’t a good feeling,” Amy says, recalling when she learned about Jacob’s condition. “And he was so little.”
I
Custom Content from WSJ is a unit of The Wall Street Journal Advertising Department. The Wall Street Journal news organization was not involved in the creation of this content.
AUDIO
Amy Hochstatter | Mother of Patient
Erin Herse | Clinical Nurse, Nephrology Clinic, Stanford Medicine Children’s Health
AUDIO
Erin Herse | Clinical Nurse, Nephrology Clinic, Stanford Medicine Children’s Health
AUDIO
For years, Jacob and his mother Amy have regularly visited Stanford Medicine Children’s Health to receive treatment from Dr. Abanti Chaudhuri and her team.
Dr. Chaudhuri and Erin Herse, a clinical nurse, are among the multidisciplinary team of caregivers that staff the pediatric hypertension program—one of the few such programs on the West Coast.
Jacob is one of the millions of American children who have high blood pressure.
It’s vital to address high blood pressure in children early. If left untreated, the condition is likely to carry over into adulthood, raising the risk of significant medical issues, such as organ damage and kidney disease.
The pediatric hypertension program is built on an interdisciplinary approach, relying on a diverse range of experts to deliver care.
Thanks to consistent support from Stanford Medicine Children’s Health and significant lifestyle changes, Jacob has been able to manage his high blood pressure.
Dr. Chaudhuri and Erin Herse, a clinical nurse, are among the multidisciplinary team of caregivers that staff the pediatric hypertension program—one of the few such programs on the West Coast.
Jacob is one of the millions of American children who have high blood pressure.
It’s vital to address high blood pressure in children early. If left untreated, the condition is likely to carry over into adulthood, raising the risk of significant medical issues, such as organ damage and kidney disease.
The pediatric hypertension program is built on an interdisciplinary approach, relying on a diverse range of experts to deliver care.
Dr. Chaudhuri and Erin Herse, a clinical nurse, are among the multidisciplinary team of caregivers that staff the pediatric hypertension program—one of the few such programs on the West Coast.
Amy Hochstatter | Mother of Patient
AUDIO
AUDIO
