An Overview of High Blood Pressure
By Karen Shackelford, MD
High blood pressure is a condition with serious health consequences that affects up to 80 million American adults. When detected and treated early, however, it can reduce the risk of heart attack, stroke, and kidney disease.
What Is Blood Pressure?
Blood pressure is the outward force that blood exerts on artery walls. Arteries are the blood vessels that carry blood and oxygen from the lungs to all of the organs and tissues of the body.
Arteries are composed of muscle and flexible, elastic connective tissue that stretches to accommodate the force of blood flow generated by the heart. And the pumping action of the heart is what allows blood to travel through these arteries.
Blood pressure is expressed in two numbers. The top number, systolic blood pressure, reflects the force generated by the contractions of the heart. The bottom number, the diastolic blood pressure, refers to the pressure of blood against the walls of the arteries when the heart is resting between contractions.
After the age of 20, all adults should begin to monitor their blood pressure at their regular healthcare visits. If you are older than 40 or have risk factors for high blood pressure, you should have your blood pressure checked in both arms at least annually. It’s important to use the correct size blood pressure cuff, which is why it may not be adequate to check your blood pressure in an automatic machine at the pharmacy or grocery store.
Normal blood pressure is considered to be less than 120/80 mm Hg. With 24-hour monitoring or frequent home blood pressure monitoring, daytime normal blood pressure is defined as an average blood pressure less than 135/85 mm Hg.
If your numbers are higher than this, it does not mean you have high blood pressure. Blood pressure can change in response to exercise, stress, medication, illness, and even the time of day. It’s important to take several readings over time in order to make an appropriate diagnosis.
Most adults with high blood pressure have primary hypertension, previously called “essential” hypertension. This simply means that the elevation in blood pressure is not due to any other cause. Primary hypertension gradually develops over several years. Unless you monitor it, you may never even be aware that you are experiencing a problem that could lead to significant organ damage.
Secondary hypertension refers to hypertension that is caused by another condition or medication. In most cases, secondary hypertension occurs suddenly and may cause greater elevation in blood pressure than primary hypertension. Thyroid disorders, kidney disease, obstructive sleep apnea, alcohol abuse, illegal drugs, and tumours of the adrenal gland are some of the causes of secondary hypertension.
There are a variety of factors that can increase your risk of high blood pressure. Some risk factors cannot be modified but others can be reduced with changes in diet and lifestyle. Risks that can’t be modified include age, family history, and race. For example:
After the age of 45, men are more likely to develop high blood pressure.
In women, the risk increases after the age of 65.
African Americans are at greater risk of hypertension which tends to develop earlier and cause more serious complications.
Modifiable risk factors include:
- Being overweight
- A sedentary lifestyle
- Tobacco use
- A high sodium or low potassium diet
- Excessive alcohol intake
- Lack of vitamin D
- Stress can also increase blood pressure temporarily and, over time, lead to chronic hypertension.
Although children are at lower risk of developing essential hypertension, they can develop high blood pressure as a result of other conditions. A child’s blood pressure should be measured at each annual check-up and compared to other children of the same age group.
Blood pressure readings can fall into one of five categories:
Prehypertension. If your systolic blood pressure is between 120-139 mm Hg or if your diastolic blood pressure reading is between 80 and 89 mm Hg, you may have prehypertension. Prehypertension, like high blood pressure, carries an increased risk of cardiovascular disease and typically worsens over time. Treatment includes non-pharmacological measures, such as weight reduction, increased physical activity, avoiding excess alcohol, and restricting salt intake.
Stage I hypertension. This refers to a systolic blood pressure of 140 mm Hg to 159 mm Hg or a diastolic blood pressure of 90 to 99 mm Hg. If only one of these values is elevated, then the higher value determines the severity of hypertension. This will lead to determination of the appropriate treatment.
Isolated Systolic/diastolic hypertension. Patients with a systolic blood pressure greater than 140 mm Hg and a diastolic pressure of less than 90 mm Hg are considered to have isolated systolic hypertension. Those with a diastolic pressure greater than or equal to 90 mm Hg but with a systolic pressure less than 140 mm Hg are considered to have isolated diastolic hypertension. The systolic blood pressure is the best predictor of risk in individuals over the age of 60. Studies show that there are significant benefits to treating blood pressure, particularly in patients with mild hypertension. Current recommendations suggest that blood pressure medication be initiated in patients with stage I hypertension, although it should be started earlier in people who have heart disease, diabetes, or chronic kidney disease.
Stage II hypertension. This refers to more hypertension, with a systolic pressure of 160 mm Hg or greater or a diastolic pressure of 100 mm Hg or greater. Stage II hypertension may initially require more than one medication for treatment.
Malignant hypertension. This refers to extremely high blood pressures, over 180 mm Hg systolic or 120 mm Hg diastolic, that develop quickly and produces end-organ damage. Malignant hypertension is a condition that requires immediate medical care. This condition is also known as hypertensive urgency or hypertensive emergency. Symptoms may occur as a result of organ damage, including confusion or mental status changes, blurred vision, seizures, shortness of breath, swelling, and chest pain due to angina, heart attack, or aneurysm.
The United States Preventive Services Task Force recommends ambulatory blood pressure measurement for accurate diagnosis of hypertension. Although you may have elevated blood pressure when measured in your doctor’s office, this can be the result of “white coat hypertension.” Screening by your healthcare provider may also miss “masked hypertension.” 12- and 24-hour average blood pressures using ambulatory blood pressure monitoring are often significantly different from readings taken in a clinic or hospital setting and result in fewer patients requiring treatment, with significantly fewer patients requiring treatment as a result. Other patients may have elevated blood pressure averages discovered with ambulatory monitoring that place them at risk for stroke and cardiovascular disease even when the readings obtained in a healthcare setting are normal.
If you are diagnosed with hypertension, your physician or healthcare provider may order laboratory tests to determine whether or not there is a secondary cause, such as a thyroid abnormality or abnormality of the adrenal gland. Other blood tests will measure electrolyte levels, creatinine, and blood urea nitrogen to determine if your kidneys are involved.
Urinalysis is another test often used to diagnose kidney damage as a result of blood pressure and to rule out kidney disorders that can be a secondary cause. Lipid profiles measure your cholesterol levels and are used to assess your risk of cardiovascular diseases like heart attack and stroke. Imaging studies are used to identify possible tumours of the adrenal glands or damage to the kidneys.
If you are diagnosed with hypertension, you will also need an eye examination. An examination with an ophthalmoscope can determine the effect your blood pressure has had on the blood vessels in the eye and whether or not your retina has sustained damage.
In addition to an electrocardiogram (ECG) to evaluate possible heart damage, an echocardiogram may be used to see if your heart has become enlarged or if you have other cardiac problems related to hypertension, like blood clots or heart valve damage. Doppler ultrasound examination can be used to check the blood flow through the arteries to determine if they have narrowed, thus contributing to high blood pressure.
The initial treatment for hypertension includes changes in lifestyle and diet to eliminate or reduce contributory factors like obesity or a high sodium diet. Smoking cessation and reduction of alcohol use—one drink a day for women and two drinks a day for men—are important steps for the reduction of blood pressure.
Your doctor will probably recommend regular aerobic exercise which has a beneficial effect on blood pressure. Evidence shows that brisk walking for at least 30 minutes daily several times a week is beneficial for blood pressure reduction.
There are also a number of different medication classes available for the treatment of hypertension. The JNC 8 recommendations for treatment of blood pressure are based on evidence from multiple studies in many different populations. People with stage II hypertension may need initial treatment with two medications or a combination drug.
Follow-up is important. If your blood pressure goal has not been achieved after a month of treatment, your healthcare provider may increase your dose or add a different class of medication. After you reach your blood pressure goal, you must continue to monitor your response to treatment and development of any other conditions in order to prevent the progression of problems.
There are significant consequences to chronic hypertension:
- Heart attack
- Heart failure
- Kidney failure
- Damage to blood vessels
- Cognitive and memory problems
- Eye damage and vision loss
- Metabolic syndrome
The damage is cumulative over time. High blood pressure is rarely associated with symptoms, so it is often left untreated or overlooked until permanent and devastating organ damage has occurred. When blood pressure is increased, the walls of the arteries may become injured or stretched. Damage to the blood vessels can create weak regions that give rise to aneurysms or rupture.
Damage to the heart muscle can also cause atrial fibrillation over time. Atrial fibrillation is an irregular heart rate that puts you at risk for stroke. High blood pressure can also tear the inner layer of the arteries, allowing the buildup of scar tissue that attracts cholesterol debris and platelets (blood cells that form clots). Cholesterol build-up in damaged blood vessels is called a plaque. These plaques cause a narrowing of the arteries, which results in more work for the heart to pump adequate blood through the body.
Plaque can rupture under high pressure. This causes platelets to adhere and form a clot that can break off and travel throughout blood circulation, blocking oxygenated blood from reaching critical tissues. Additionally, these clots may break off and travel to other parts of the body, blocking blood flow and causing heart attacks or stroke. Clot formation also narrows the artery, making the heart work harder to pump blood with oxygen throughout the body.
Damage to the arteries from high blood pressure, including scarring and cholesterol build-up, results in a stiffening of the arteries. This causes the heart to work harder to push blood throughout the body. The heart is a muscle, and over time, it will become damaged and floppy as a result of high blood pressure. The chambers of the heart will enlarge and the muscular fibers will not be able to contract adequately to compensate, resulting in heart failure.
A Word From Verywell
Hypertension is a serious chronic disorder that can cause many harmful health effects over time. If you are an adult over the age of 20, you should have your blood pressure checked by your healthcare provider at your regular health visit. If you are over the age of 40, it’s important to have your blood pressure checked annually. Remember, the reading you get from a manual machine or at the pharmacy may not be accurate.
Detecting high blood pressure early can prompt you to make healthy changes in your diet and lifestyle that will reduce your risk of serious disorders like stroke or heart attack. If you fall in a high-risk category, have your blood pressure checked today.
HEALTH A-Z-HIGH BLOOD PRESSURE
STAY IN CONTROL OF YOUR DIABETES
There are four things you need to do every day to lower high blood sugar:
- Eat healthy food
- Get regular exercise
- Take your diabetes medicine
- Test your blood sugar
If you have diabetes, you should try to keep your blood sugar level as close as possible to that of someone who doesn’t have diabetes. This may not be possible or right for everyone. Check with your doctor about what the right range of blood sugar is for you.
You will get plenty of help in learning how to do this from your health care team, which is made up of your doctor, nurses, and dietitian.
Bring a family member or friend with you when you see your doctor. Ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.
Eat Healthy Food
The foods on your diabetes eating plan are the same ones that are good for everyone. Try to stick to things that are low in fat, salt, and sugar and high in fibre, like beans, fruits, vegetables, and grains.
- Eating right will help you:
- Reach and stay at a weight that is good for you
- Keep your blood sugar in a good range
- Prevent heart and blood vessel disease
Ask your doctor for the name of a dietitian who can work with you on an eating plan for you and your family. Your dietitian can help you plan meals with foods that you and your family like and that are good for you.
If You Use Insulin
- Give yourself an insulin shot.
- Eat about the same amount of food each day at about the same time.
- Don’t skip meals, especially if you’ve already given yourself an insulin shot. Your blood sugar may go too low.
If You Don’t Use Insulin
- Follow your meal plan.
- Don’t skip meals, especially if you take diabetes pills. Your blood sugar may go too low.
- Skipping a meal can make you eat too much at the next meal. It may be better to eat several small meals each day instead of one or two big ones.
Get Regular Exercise
- Being active each day is good for everyone. Good ways to do it include:
- Playing sports
- Cleaning your house or working in your garden count, too.
- Getting active is especially good for people with diabetes because:
- It helps keep your weight down.
- Your insulin may lower your blood sugar more easily.
- It helps your heart and lungs work better.
Exercise gives you more energy.
Before you start, talk with your doctor. If you have high blood pressure or eye problems, some exercises, like weightlifting, may not be safe. Your doctor or nurse will help you find safe exercises.
Try to exercise at least three times a week for about 30 to 45 minutes each time. If you haven’t been active in a while, ease in. Start with 5 to 10 minutes, then work up from there.
If you haven’t eaten for more than an hour or if your blood sugar level is less than 100-120, have something like an apple or a glass of milk before you exercise.
When you’re being active, carry a snack with you in case your blood sugar drops. Make sure to carry an identification tag or card that says you have diabetes.
If You Use Insulin
- Exercise after eating, not before.
- Test your blood sugar before, during, and after. Don’t exercise when it’s higher than 240.
- Avoid exercise right before you sleep. It could cause low blood sugar during the night.
If You Don’t Use Insulin
- See your doctor before starting an exercise program.
- Test your blood sugar before and after exercising if you take diabetes pills. You want it no lower than 70 or no higher than 240.
Take Your Diabetes Medicine Every Day
Insulin and diabetes pills and shots are the kinds of medicines used to lower blood sugar. These can include:
Exenatide Extended Release (Bydureon)
If You Need Insulin
This is you if your body has stopped making insulin or if it doesn’t make enough. Everyone with insulin-dependent diabetes (or type 1 diabetes) needs insulin, and many people with type 2 diabetes also need it.
Insulin can’t be taken as a pill. You will have to give yourself shots every day. Some people give themselves one a day. Some people give themselves two or more a day. Never skip a shot, even if you are sick.
Insulin is injected with a needle. Your doctor will tell you what kind of insulin to use, how much, and when to give yourself a shot. Talk to your doctor before changing the type or amount of insulin you use or when you give your shots. Your doctor or the diabetes educator will show you how to draw up insulin in the needle. They’ll also show you the best places on your body to give yourself a shot. Ask someone to help you with your shots if your hands are shaky or you can’t see well.
Good places on your body for a shot are:
- The outside part of your upper arms
- Around your waist and hips
- The outside part of your upper legs
- Avoid areas with scars and stretch marks.
- Ask your doctor or nurse to check your skin where you give your shots.
At first, you may be a little afraid to give yourself a shot. But most people find that the shots hurt less than they expected. The needles are small and sharp and do not go deep into your skin. Always use your own needles, and never share them with anyone else.
Your doctor or diabetes educator will tell you how to throw away used needles safely.
Keep extra insulin in your refrigerator in case you break the bottle you’re using. Don’t keep insulin in the freezer or in hot places like your glove compartment. Also, keep it away from bright light. Too much heat, cold, or bright light can damage insulin.
If your body makes insulin but it doesn’t lower your blood sugar, you may have to take diabetes pills or some other injectable. These only work in people who have some insulin of their own. Some are taken once a day, and others are taken more often. Ask your doctor when you should take yours.
Diabetes medications are safe and easy to take. Be sure to tell your doctor if yours make you feel bad or if you have any other problems.
Remember, you’ll still have to follow an eating plan and exercise to help lower your blood sugar.
Sometimes, people who take diabetes pills may need insulin shots for a while. This may happen if you get very sick, need to go to a hospital, or become pregnant. You may also need them if the diabetes pills no longer lower your blood sugar.
You may be able to stop taking diabetes pills if you lose weight. Losing even a little bit can help lower your blood sugar.
If You Don’t Use Insulin or Take Diabetes Pills
Everyone with diabetes needs to follow their doctor’s advice about eating and getting enough exercise.
Test Your Blood Sugar Every Day
You need to know how well you are taking care of your diabetes. You need to know if you are lowering your blood sugar. The best way to find out is to test your blood. If it has too much or too little sugar in it, your doctor may need to change your eating, exercise, or medicine plan.
Some people test their blood once a day. Others do it three or four times a day. Your doctor may want you to test before eating, before bed, and sometimes in the middle of the night. Ask your doctor how often and when you should test your blood sugar.
How to Test Your Blood Sugar
You need a small needle called a lancet. You also need special blood testing strips that come in a bottle. Your doctor or diabetes educator will show you how to test your blood. Here are the basic steps to follow:
Depending on your monitoring device, prick your finger or another area of your body with the lancet to get a drop of blood.
Place the blood on the end of the strip.
Put the strip into the meter. The meter will display a number for your blood sugar, like 128.
Pricking your finger with a lancet may hurt a little. It’s like sticking your finger with a pin. Use the lancet only once, and be careful when you throw away used ones. Ask your doctor or nurse how to get rid of them safely.
You can buy lancets, strips, and meters at a drugstore. Ask your doctor or diabetes educator for advice on what kind to buy. Take your blood testing items with you when you see your doctor or nurse so that you can learn how to use them the right way.
Other Tests for Your Diabetes
Urine Tests: You may need to test your urine or blood for ketones when you are sick or if your blood sugar is over 240 before eating a meal. Your body makes ketones when there is not enough insulin in your blood. They can make you very sick.
You can buy strips for testing urine ketones at a drugstore. Also, some blood glucose meters can detect ketones with specialized strips. Your doctor or diabetes educator will show you how to use testing monitors correctly.
Call your doctor right away if you find ketones when you test. You may have something called ketoacidosis. If not treated, it can cause death.
Signs of ketoacidosis are:
- Fast breathing
- A sweet smell on the breath
NOTE: Ketoacidosis is more likely to happen in people with insulin-dependent diabetes.
The Haemoglobin A1c Test: This shows what your average blood sugar was for the past 3 months. It shows how much sugar is sticking to your red blood cells. The doctor does this test to see what level your blood sugar is most of the time.
To do the test, the doctor or nurse takes a sample of your blood. The blood is tested in a laboratory. The laboratory sends the results to your doctor.
See your doctor for a haemoglobin A1c test every 3 months.
Keep Daily Records
Write down the results of your blood tests every day in a record book or notebook. You may also want to include what you eat, how you feel, and how much you’ve exercised.
By keeping daily records of your blood and urine tests, you can tell how well you are taking care of your diabetes. Show your book to your doctor. She can use your records to see if you need to make changes in your insulin shots or diabetes pills or in your eating plan. Ask your doctor or nurse if you don’t know what your test results mean.
Things to write down every day in your notebook are:
- If you had very low blood sugar
- If you ate more or less food than you usually do
- If you felt sick or very tired
- What kind of exercise you did and for how long
TAKING CARE OF YOUR DIABETES EVERY DAY – STAY IN CONTROL OF YOUR DIABETES
By Mark Stibich, PhD
Controlling blood pressure and losing weight can make a difference
A study published in The Lancet called INTERSTROKE confirmed that people can reduce their risk of having a stroke by making lifestyle changes. The study found that modifiable risk factors are responsible for 88 percent of stroke risk. The excellent news here is the “modifiable” part of the equation — most of these factors can be completely avoided, or at least modified.
That’s great, you say until you look at the list. Most of us know that stopping smoking and losing weight are no-brainers for improving your health, and many of us would have done these things years ago if we knew how to go about it strategically. Learning how important lifestyle changes are for reducing stroke risk can be motivational.
Major health improvements can be made if the goals are specific, measurable, attainable, realistic and time-based, also known as S.M.A.R.T. goals for lifestyle change.
Here are the top 10 ways to cut your risk of stroke by almost 90 percent.
- Control Your Blood Pressure
While there are medications to control hypertension (high blood pressure), lifestyle change is a key component of keeping blood pressure down. Following the DASH Diet and avoiding salt can help.
- Stop Smoking
Smoking not only increases the risk of stroke, it is estimated to subtract 10 years from one’s lifespan. Getting tips, strategies, stories, and encouragement from people who have successfully quit smoking can be inspirational. And if that doesn’t help, consider how smoking results in premature aging.
- Lose Weight, Especially Around Your Abdomen
You might be surprised at how easy it is to incorporate easy weight loss methods into your life. Not only can you find yourself dropping pounds, but by slowing down and being more mindful of your food, you may also find yourself enjoying meals much more.
- Manage Your Diabetes
People with diabetes are at a higher risk of stroke than the general population. This risk is much higher when the diabetes is poorly-managed and blood glucose levels are elevated over long periods. It is important to take your diabetes seriously (even if you don’t feel “bad” from high blood sugar), which involves sticking to your treatment strategies, among other things. This will not only go a long way in reducing your risk of stroke but also will help bring down the likelihood of other complications.
- Get Active
We know we should be exercising, but many of us simply don’t like it and when you don’t like to do something, it is very easy to find lots of excuses not to do it. Instead of starting from a place of trying to do something you simply hate to do, why don’t you wipe the slate clean and look at exercise from a new perspective? Learn to like, even love, exercise, and it will be much easier to commit to an exercise habit.
- Improve Your Diet
There are many opinions about what exactly constitutes a healthy diet, which often leaves the average person confused to the point that they give up. However, there are some things that are pretty universal here — more vegetables, less trans fats, fewer trips through fast food restaurants. Add fruit to increase your longevity and adopt an overall longevity diet plan.
- Limit Alcohol, Avoid Binge Drinking
Clearly, drinking heavily is bad for your health, but much research shows that two or fewer drinks per day can be good for you, especially red wine. Any more than that starts working against you and harming your health. Heavy drinking also increases stroke risk by 45 percent and there is a link between alcohol and brain aging.
- Improve Your Good Cholesterol
The idea here is to improve your HDL (good cholesterol) to LDL (bad cholesterol) ratio more HDL and less LDL is the idea. The goal is to have your HDL/LDL ratio above 0.3, with the ideal being above 0.4. Of course, there are medications, such as statins, that can help you do this, but there are some lifestyle changes to be made as well, even fun ones, such as eating more dark chocolate or fish.
- Manage Heart Disease
As we age, our hearts have to adapt to our changing bodies our arteries lose flexibility, our heart walls thicken and it becomes harder for our hearts to keep up with increased demand. All of these things (and others) are made worse when we have heart diseases, such as coronary artery disease, angina or other problems that can lead to heart attacks. There are several approaches to managing heart disease, which involves medications, diet, and exercise many of the same things that will also reduce the risk of stroke.
- Avoid Stress, Treat Depression
We know that we feel worse when we are “stressed,” but there is also significant evidence that stress impacts the frequency of negative health events, like a stroke. Depression also has serious physical consequences and can lead to victims neglecting their health.
By taking steps to improve in these areas, you will no doubt feel better along the way. In addition to reducing your risk for stroke, you will also reduce your risk of heart attacks.
WAYS TO REDUCE YOUR RISK OF HAVING A STROKE
Written By: Cure HBP
Drugs that treat high blood pressure are either short-acting or long-acting. The former won’t control blood pressure throughout the day. To do this, you have to increase the dosage or take it several times a day.
In contrast, long-acting drugs can control your blood pressure much longer much longer or as much as 24 hours. You simply take one tablet at the prescribed time each day and get on with your life.
At first, doctors thought it didn’t matter whether you took one or the other. After all, both of these drugs lowered blood so what more could a physician ask?
However, recent studies show that not all antihypertensive can protect you from the complications of hypertension even if they lower blood pressure. While short-acting agents can make your blood pressure drop, the effects of these drugs vary greatly throughout the day – like a Ping-Pong ball bouncing up and down. Obviously, that’s to be expected when you’re playing Ping-Pong – but not when you’re treating hypertension.
These concerns were aired during the 16th Scientific Meeting of the International Society of Hypertension (ISH) in Glasgow in the United Kingdom. Dr. John P. Chalmers, ISH president, said the “Ping-Pong effect could lead to a rapid fall in blood pressure (hypotension), tachycardia (rapid heart beat), and other cardiac problems.
The same view is shared by Dr. Henry L. Elliot of the Department of Medicine and Therapeutics at the Gardiner Institute in Glasgow who said that short-acting drugs don’t seem to offer any protection against overnight hypertension and the subsequent rise in cardiovascular risk during the waking and early working part of the day.
This is bad news for people with hypertension since those with greater blood pressure (BP) variability appear to be at higher risk for end-organ damage, according to Dr. Gianfranco Parati, associate professor of cardiology at the University of Milan in Italy. Parati said that the more your BP varies throughout the day, the greater your chances of suffering from cardiovascular complications.
To avoid this problem, the U.S. Food and Drug Administration (FDA) said that drugs used to treat hypertension should not only lower BP but, more importantly, prevent fluctuations in BP which appear to be related to cardiovascular complications.
Because of their limited effects, short-acting drugs don’t meet these criteria. The FDA also warned against the use of high doses of short-acting antihypertensive to maintain smooth blood pressure levels for 24 hours since this could counteract the benefits of lower pressure.
Experts say the ideal antihypertensive should be long-acting with a continuous therapeutic effect that can be given once a day yet control BP for 24 hours before the next dose is taken. This will ensure that your BP levels remain stable throughout the day.
Since obesity is a factor in hypertension, it pays to lose weight. To help you shed those unwanted pounds, take Zyroxin, a safe and natural supplement that will maximize your weight loss through its unique fat-burning ingredients. For details, visit http://www.zyroxin.com.
Sharon Bell is an avid health and fitness enthusiast and published author. Many of her insightful articles can be found at the premier online news magazine http://www.HealthLinesNews.com
Cancer is a leading cause of death for children and adolescents around the world and approximately 300,000 children aged 0 to 19 years old are diagnosed with cancer each year. 
The most common categories of childhood cancers include leukemias, brain cancers, lymphomas and solid tumours, such as neuroblastoma and Wilms tumour. [1-2]
In high-income countries, more than 80% of children with cancer are cured, but in many low- and middle-income countries (LMICs) only about 20% are cured. [2-3]
Childhood cancer generally cannot be prevented or screened.
Improving outcomes for children with cancer requires early and accurate diagnosis followed by effective treatment.
Most childhood cancers can be cured with generic medicines and other forms of treatments including surgery and radiotherapy. Treatment of childhood cancer can be cost-effective in all income settings. 
Avoidable deaths from childhood cancers in LMICs result from lack of diagnosis, misdiagnosis or delayed diagnosis, obstacles to accessing care, abandonment of treatment, death from toxicity, and higher rates of relapse.
Childhood cancer data systems are needed to drive continuous improvements in the quality of care, and to drive policy decisions.
Cancer is a leading cause of death for children and adolescents worldwide. In high-income countries, more than 80% of children with cancer are cured, but in many LMICs, only 20% are cured [2-3].
The reasons for lower survival rates in LMICs include an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and excess relapse, in part due to lack of access to essential medicines and technologies addressing each of these gaps improves survival and can be highly cost-effective [2-3].
What causes cancer in children?
Cancer occurs in people of all ages and can affect any part of the body. It begins with genetic changes in a single cell that then grows out of control. In many cancers, this results in a mass (or a tumour). If left untreated, cancer generally expands, invades other parts of the body and causes death.
Unlike cancer in adults, the vast majority of childhood cancers do not have a known cause. Many studies have sought to identify the causes of childhood cancer, but very few cancers in children are caused by environmental or lifestyle factors. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult.
Some chronic infections are risk factors for childhood cancer and have major relevance in low- and middle-income countries. For example, HIV, Epstein-Barr virus and malaria increase the risk of some childhood cancers. Other infections can increase the child’s risk of developing cancer as an adult, so it is important to be vaccinated and other pursue other methods such as early diagnosis or screening to decrease chronic infections that lead to cancer, whether in childhood or later.
Current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors. Ongoing research is needed to identify factors impacting cancer development in children.
Improving outcomes of childhood cancer
Because it is generally not possible to prevent cancer in children, the most effective strategy to reduce the burden of cancer in children is to focus on a prompt, correct diagnosis followed by effective therapy.
When identified early, cancer is more likely to respond to effective treatment and result in a greater probability of survival, less suffering, and often less expensive and less intensive treatment. Significant improvements can be made in the lives of children with cancer by detecting cancer early and avoiding delays in care. A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy.
Early diagnosis consists of 3 components:
awareness by families and accessing care
clinical evaluation, diagnosis and staging (determining the extent to which a cancer has spread)
access to treatment
Early diagnosis is relevant in all settings and improves survival for many cancers.6 Programmes to promote early and correct diagnosis have been successfully used in countries of all income levels, often through collaborative efforts of governments, civil society, and non-governmental organizations, with vital roles played by parent groups. Childhood cancer is associated with a range of warning symptoms that can be detected by families and by trained primary health care providers.6
Screening is generally not helpful for childhood cancers. In some select cases, it can be considered in high-risk populations. For example, some eye cancers in children can be caused by a mutation that is inherited, so if that mutation is identified in the family of a child with retinoblastoma, genetic counselling can be offered and siblings monitored with regular eye examination early in life. Genetic causes of childhood cancers are relevant in only a handful of children with cancer. There is no high-quality evidence to support population-based screening programmes in children.
A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy. Access to effective diagnosis, essential medicines, pathology, blood products, radiation therapy, technology and psychosocial and supportive care are variable and inequitable around the world.
However, a cure is possible for more than 80% of children with cancer, in most cases with inexpensive generic medications that are listed on the WHO List of Essential Medicines (EML). WHO EML for children, defined as those meeting the priority health care needs of the population, includes 22 cytotoxic or adjuvant medicines and 4 hormone treatments for childhood cancer. Children who complete treatment require ongoing care to monitor for cancer recurrence and to manage any possible treatment-related toxicity.
Palliative care relieves symptoms caused by cancer and improves the quality of life of patients and their families. Not all children with cancer can be cured, but relief of suffering is possible for everyone. Paediatric palliative care should be appropriately considered as a core component of comprehensive care starting when the illness is diagnosed and continued regardless of whether or not a child receives treatment with curative intent.7
Palliative care programmes can be delivered through community- and home-based care to provide pain relief and psychosocial support to patients and their families. Adequate access to oral morphine and other pain should be provided for the treatment of moderate to severe cancer pain, which affects more than 80% of cancer patients in the terminal phase.
In 2018, WHO launched the Global Initiative for Childhood Cancer with partners to provide leadership and technical assistance to support governments in building and sustaining high-quality childhood cancer programmes. The goal is to achieve at least 60% survival for all children with cancer globally by 2030. This represents an approximate doubling of the current cure rate and will save an additional one million lives over the next decade. The objectives are to:
Increase capacity of countries to deliver best practices in childhood cancer care
Prioritize childhood cancer and increase available funding at the national and global levels
WHO and the International Agency for Research on Cancer (IARC) collaborate with the International Atomic Energy Agency (IAEA) and other UN organizations and partners, to:
increase political commitment for childhood cancer diagnosis and treatment;
support governments to develop high-quality cancer centres and regional satellites to ensure early and accurate diagnosis and effective treatment for children with cancer;
develop standards and tools to guide the planning and implementation of interventions for early diagnosis, treatment and palliative and survivorship care inclusive of the needs of childhood cancers;
improve access to affordable and essential medicines and technologies;
support governments to safeguard families of children with cancer from financial ruin and social isolation as a result of cancer care.
This initiative is part of the implementation of the World Health Assembly Resolution Cancer Prevention and Control through an Integrated Approach (WHA70.12), which urges governments and WHO to accelerate action to achieve the targets specified in the Global Action Plan and 2030 UN Agenda for Sustainable Development to reduce premature mortality from cancer.
Steliarova-Foucher E, Colombet M, Ries LAG, et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. 2017;18(6):719-731.
Gupta S, Howard SC, Hunger SP, et al. Treating Childhood Cancer in Low- and Middle-Income Countries. In: Disease Control Priorities, volume 3. http://dcp-3.org/chapter/900/treating-childhood-cancers-low-and-middle-income-countries
Howard SC, Zaidi A, Cao X, et al. The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries. Lancet Oncol. 2018;19(5):e252-e266.
Zhang J, Walsh MF, Wu G, Edmonson MN, Gruber TA, et al. Germline Mutations in Predisposition Genes in Pediatric Cancer. N Engl J Med. 2015 Dec 10;373(24):2336-2346.
CANCER IN CHILDREN