Puzzled over bp and pulse

[Golfmom0322]

My 13 year old son's blood pressure has always been low for him at 90/60 and pulse of 70.  He was always in great shape playing soccer and golf.  He recently stopped playing soccer this past jan.   He has been on Vyvanse for 4 yrs now for his ADHD.  He is going through a growth spurt., eating more, sleeping more and he grew 1 3/4 inch in the past month.  At his last exam, the doc said his bp was 110/85 and pulse was 115.  We went through a list of things he could of eaten to make it come up but nothing could be found.  No choc, caff., cold meds., etc. His doc said she would keep an eye on him.  I have been taking his bp and pulse and they have been around 108/82 and pulse of 92.  I realize this is considered normal but his doctor said it is not "his" normal.  He says he feels fine.  No pain, pressure or dizziness.  Any ideas why his "normal" isn't normal anymore? Should I be worried.  

[Jeffrey R Boris, M.D.]

Dear Golfmom,

Without seeing your son and getting more information, I can't say exactly what is happening with him.  However, there are a couple of things to know.  First, blood pressure norms are based on gender, age, and height.  Considering he has been having his adolescent growth spurt, it is certainly reasonable that his BP is readjusting upward.  

Second is that with growth, the autonomic nervous system (the part of the nervous system that automatically controls heart rate, blood pressure, and other independent body systems) gets a little off balance due to growth and hormonal changes.  This can lead to relatively insufficient blood pressure with a compensatory increase in heart rate. For your son, it may be that although he is asymptomatic, his elevated heart rate may be making up for the fact that his blood pressure may be a bit lower than it should be in order to maintain appropriate blood flow through the system.  To counter that, he should make sure that he drinks 32-48 ounces of fluid (water/milk) daily plus have a salty snack.  

Third, Vyvanse and the other stimulants absolutely can increase heart rate and blood pressure.  In the aggregate, that elevation can be modest.  But, individual children, that range can be higher.

Finally, if he is not playing sports anymore and is deconditioned (sorry, golf doesn't really count as cardio!), his BP and heart rate may be elevated, as well, as both of these measures naturally decrease with routine strenuous activity.

In the end, if he is not symptomatic, I would start with the simple approach--try the fluid and salt, and continue to monitor his BP and heart rate.

[oldie]

i'm not an MD. But I recall pulse tests  made at Westpoint and varied bewteen 40 and 110. All in healthy cadets.