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Usually, high blood pressure in older children, as in adults, has no identifiable cause. In children younger than 6 years, an identifiable cause is often identified.
During childhood, most children with high blood pressure have no symptoms, although symptoms may develop later.
Doctors measure blood pressure several times with a blood pressure cuff (also called a sphygmomanometer, a soft rubber cuff connected to a rubber bulb that is used to inflate the cuff and either a stethoscope or a machine that registers the pressure of the cuff). Blood pressure can also be measured at home using an ambulatory blood pressure monitor, which is a blood pressure cuff and monitor that is worn for 24 or more hours.
If younger children have high blood pressure, doctors often do tests to look for possible causes.
Treatment usually starts with lifestyle changes, but medications are sometimes needed.
When blood pressure is checked, 2 values are recorded. The higher value reflects the highest pressure in the arteries when the heart is contracting (systolic). The lower value reflects the lowest pressure in the arteries, which is reached just before the heart begins to contract again (diastolic). Blood pressure is written as systolic pressure/diastolic pressure—for example, 120/80 mm Hg (millimeters of mercury), referred to as 120 over 80.
High blood pressure often begins during childhood. In the United States, about 2 to 4% of children have hypertension. About 16% have blood pressure that is classified as elevated, but is not considered hypertension. Worldwide, about 4% of children are estimated to have high blood pressure. The percentage of children with high blood pressure seems to be increasing, probably because more and more children have overweight or obesity.
In children under 13 years of age, the values that are considered high vary based on sex, age, and height. Thus, there is no single blood pressure reading that indicates high blood pressure for all children. In children under 13, blood pressure is classified as follows:
Normal: At or lower than 90% of others of the same age, gender, and height
Elevated: Higher than 90% of others of the same age, gender, and size, but not height enough to qualify for stage 1
Stage 1: Higher than 95% of others of the same age, gender, and height, but not high enough to qualify for stage 2 hypertension
Stage 2: 12 mm Hg higher than stage 1 level
In adolescents (13 years of age or over), blood pressure is classified as it is in adults:
Normal: Lower than 120 systolic blood pressure and lower than 80 diastolic blood pressure
Elevated: 120 to 129 systolic blood pressure and lower than 80 diastolic blood pressure
Stage 1 (mild) high blood pressure: 130/80 to 139/89)
Stage 2 high blood pressure: 140/90 or higher
Children under 13 use the adult thresholds for classifying BP if that number is lower than their age, gender, and size-based threshold.
Although individual blood pressure measurements may be high, hypertension is only diagnosed if the blood pressure is elevated at multiple visits, or if the average blood pressure on an ambulatory (home) BP monitor is high.
The body has many mechanisms to control blood pressure. The body can change the following:
Pumping force of the heart
Diameter and muscle tone of arteries
Volume of blood in the bloodstream
To increase blood pressure, the heart can pump more blood by pumping more forcefully. Small arteries can narrow (constrict), forcing the blood from each heartbeat through a narrower space than normal. Because the space in the arteries is narrower, the same amount of blood passing through them increases the blood pressure. Veins can constrict to reduce their capacity to hold blood, forcing more blood into the arteries. As a result, blood pressure increases. The kidneys can add more fluid to the bloodstream by excreting less water and sodium (salt). As a result, blood volume and thus blood pressure are increased.
To decrease blood pressure, the heart can pump less forcefully or rapidly, small arteries and veins can widen (dilate), and the kidneys can remove fluid and sodium from the bloodstream.
Causes of High Blood Pressure in Children
High blood pressure may be:
Primary (no known cause)
Secondary (caused by another disorder such as a kidney disorder)
In children 6 years of age and older, primary high blood pressure is the most common cause, particularly among adolescents. In children under 6 years of age, especially those under 3 years, secondary high blood pressure is more common.
Primary hypertension
Primary hypertension is more common among children who have the following risk factors:
Overweight or obesity (the most important risk factor)
Family history of high blood pressure
Male sex
Hispanic, Black, or Asian-American ancestry (in the United States)
Low level of physical activity
Excessive amount of salt and calories in their diet
Underweight at birth or premature birth
Social risk factors such as child abuse, violence among family members, or food and/or housing insecurity
Smoking tobacco or using any nicotine-containing product (such as or using any nicotine-containing product (such asvaping products) and exposure to secondhand smoke may also contribute to high blood pressure.
Secondary hypertension
Secondary hypertension has an identifiable cause. Sometimes when the cause is treated, blood pressure returns to normal.
The most common causes of secondary hypertension in children are:
A kidney disorder, such as maldevelopment of the kidneys or urinary tract, acute or chronic glomerulonephritis, a kidney infection, a blockage in the urinary tract, polycystic kidney disease, or a disorder that affects blood vessels to the kidneys
Heart and other blood vessel disorders, such as coarctation of the aorta or arteriovenous fistula
Hormonal disorders, such as an overactive thyroid gland (hyperthyroidism)
Other causes of secondary hypertension include:
Increased pressure within the skull (increased intracranial pressure)
Medications, such as corticosteroids, anabolic steroids, calcineurin inhibitors, oral contraceptives (birth control pills), nicotine, caffeine, stimulant medications, and certain illicit drugs
Certain genetic syndromes that cause kidney problems (tuberous sclerosis or neurofibromatosis type 1) or blood vessel abnormalities (Williams syndrome or Alagille syndrome)
Chronic stress or pain
Stress or pain tends to cause blood pressure to increase temporarily, and blood pressure usually returns to normal after the stress or pain ends. Chronic stress or pain, however can contribute to hypertension.
Other conditions that temporarily increase blood pressure include recent consumption of a caffeinated beverage, recent physical activity, and white coat hypertension, which is caused by the stress of visiting a doctor's office. Masked hypertension, on the other hand, is when the blood pressure is normal at the doctor's office but abnormal in other settings.
Symptoms of High Blood Pressure in Children
Usually, high blood pressure causes no symptoms in children. High blood pressure typically causes symptoms only after a vital organ is damaged, usually not for many years after blood pressure becomes high.
Thus, problems due to high blood pressure tend not to develop during childhood.
Sometimes the symptoms are those of a disorder that causes high blood pressure.
Rarely, high blood pressure in children severely damages vital organs because of a sudden hypertensive emergency. The organs that may be affected include the following:
Brain, which can result in deterioration of brain function, with drowsiness, confusion, seizures, and even coma
Heart, which can result in heart failure
Eyes, which can result in papilledema (swelling of the optic nerve) and bleeding in the retina, changes in vision, or loss of vision
Kidneys, which can result in kidney failure
If untreated, a hypertensive emergency can be fatal.
Diagnosis of High Blood Pressure in Children
Measurement of blood pressure
Sometimes tests to identify the cause
Because the definition of high blood pressure in children under 13 years old depends on a child's age, sex, and height, there is no one value that is considered high. Consequently, doctors use charts or online calculators that enable them to diagnose high blood pressure and to classify how severe it is. In adolescents, doctors diagnose high blood pressure using the same values as are used in adults.
To be sure that high blood pressure is not a temporary condition (such as after consumption of caffeine), doctors measure blood pressure at least 2 times during 3 separate visits.
For the most accurate readings, blood pressure is measured after children sit quietly in a chair for 3 to 5 minutes. Their back should be supported, and ideally their feet should be on the floor.
Blood pressure is usually measured with a sphygmomanometer (a soft rubber cuff connected to a rubber bulb that is used to inflate the cuff and a meter that registers the pressure of the cuff). Doctors make sure the cuff fits the child's arm. The cuff is inflated enough to stop blood flow. Then doctors deflate the cuff and use a stethoscope placed over the artery below the cuff to listen for the first pulse and then for the sound of no blood flowing (when the heart relaxes, between beats). Sometimes, doctors use an instrument called an oscillometer to measure blood pressure rather than using a sphygmomanometer and a stethoscope. The oscillometer records blood pressure automatically and quickly. If there is an abnormality, blood pressure is measured again using a sphygmomanometer and a stethoscope to confirm the measurement.
Doctors recommend that routine blood pressure measurements be taken at annual health screening visits beginning when children are 3 years old. If younger children have risk factors that increase their risk of high blood pressure (such as having a kidney or heart disorder, or having been born very prematurely), blood pressure monitoring should begin as early as early infancy.
If elevated blood pressure is diagnosed, doctors recheck blood pressure within 6 months. If blood pressure is still high, lifestyle changes, such as an improved diet, more physical activity, and weight loss (if needed), are started. If blood pressure remains high over the next 6 months, children may be given an ambulatory blood pressure monitor, if possible, or could be referred to a specialist. An ambulatory blood pressure monitor is a portable battery-operated device, connected to a blood pressure cuff, worn on the arm. This monitor repeatedly records blood pressure throughout the day and night over a 24-hour period. The readings help doctors determine whether high blood pressure is present, how often elevated readings occur, and how severe the elevation is, if present.
If stage 1 hypertension is diagnosed, doctors recheck blood pressure within 1 to 2 weeks. If blood pressure remains at stage 1, blood pressure measurements are taken in an arm and in a leg to see whether there is a difference between them, a urinalysis is done, and lifestyle changes are recommended. Doctors recheck blood pressure in 2 to 3 months, and, if it is still at stage 1, medication is started, additional diagnostic evaluation may be done, and the child may be referred to a specialist. For stage 1 hypertension with symptoms, treatment and evaluation will proceed more rapidly.
If stage 2 hypertension is diagnosed and confirmed, diagnostic evaluations should be undertaken and initiation of treatment should be considered, or the child should see a specialist within 1 week. Children with stage 2 hypertension and symptoms, or if the blood pressure is 30 mm Hg above the stage 1 threshold, should referred immediately to an emergency department or to a specialist for possible hospitalization.
Measuring Blood Pressure
Several instruments can measure blood pressure quickly and with little discomfort. A sphygmomanometer is commonly used. It consists of a soft rubber cuff connected to a rubber bulb that is used to inflate the cuff and a meter that registers the pressure of the cuff. The meter may be a dial or a glass column filled with mercury. Blood pressure is measured in millimeters of mercury (mm Hg) because the first instrument used to measure it was a mercury column. When a sphygmomanometer is used, a person sits with legs uncrossed and back supported. An arm is bared (if a sleeve is rolled up, caution is needed to ensure that it is not tight around the arm), bent, and resting on a table, so that the arm is about the same level as the heart. The cuff is wrapped around the arm. Using a cuff that is proportional to the size of the arm is important. If the cuff is too small, the blood pressure reading will be too high. If the cuff is too large, the reading will be too low. Listening with a stethoscope placed over the artery below the cuff, a health care professional inflates the cuff by squeezing the bulb until the cuff compresses the artery tightly enough to temporarily stop blood flow, usually to a pressure that is about 30 mm Hg higher than the person's usual systolic pressure (the pressure exerted when the heart beats). Then the cuff is gradually deflated. The pressure at which the health care professional first hears a pulse in the artery is the systolic pressure. The cuff continues to be deflated, and at some point, the sound of blood flowing stops. The pressure at this point is the diastolic pressure (the pressure exerted when the heart relaxes, between beats). Instruments to measure blood pressure are available for home use by people who have high blood pressure. |
Doctors also take a medical history, which includes questions about the child's current symptoms, diet (including, salt intake, calorie intake in children who have overweight, consumption of caffeine and energy drinks), activity level, and any medications the child takes. To identify conditions that may be causing or contributing to high blood pressure (risk factors), doctors ask whether family members have disorders that increase the risk of high blood pressure, such as certain kidney problems or heart failure. Doctors try to determine whether the child smokes tobacco or uses any nicotine-containing product or drinks alcohol.
A thorough physical examination and standard blood and urine tests are done. Tests to evaluate kidney function and to check for high cholesterol are also done. Other tests may be done to check for specific disorders based on information from the history and physical examination.
Treatment of High Blood Pressure in Children
Weight loss, if needed
Changes in diet
Increased physical activity
Sometimes medications
In children with high blood pressure, treatment may include increased physical activity, changes in diet to reduce salt and calorie consumption, weight loss, and sometimes medications, depending on how severe the high blood pressure is. Treatment is most effective when the parents, child, and doctor communicate well and discuss the treatment program.
Usually, treatment of high blood pressure begins with changes in lifestyle that can help lower blood pressure, such as diet and, if needed, weight loss. The number of calories is limited based on activity level, age, and sex, and salt consumption is limited. The DASH (Dietary Approaches to Stop Hypertension) diet can be helpful. This diet emphasizes eating lots of fruits and vegetables and using low-fat dairy products. It includes poultry, fish, whole grains, and nuts and limits consumption of red meats, sweets, and salt. The diet is also low in saturated fat and cholesterol.
Experts recommend:
For children who are 6 to 17 years old: 30 to 60 minutes of moderate to vigorous physical activity each day or at least 3 to 5 days a week
For children under 6 years old: Physical activity throughout the day
If blood pressure goals have not been reached after about 6 months of lifestyle changes, treatment with medications also may be needed in some children. On the other hand, successful implementation of lifestyle changes may prevent the need for medication, or allow a child to stop taking medication after it has been started. The lifestyle changes work best as habits that continue throughout the person's lifetime.
Children typically are referred to a specialist if their doctor requires help with prescribing medications or if children have either of the following:
Stage 1 hypertension especially with symptoms, organ damage, diabetes, or a kidney disorder; or, stage 1 hypertension that does not respond to initial treatment as expected
Stage 2 (severe) hypertension
Medication treatment of high blood pressure in children
Immediate medication treatment (plus lifestyle changes) is typically started if any of the following apply:
High blood pressure, regardless of severity, causes symptoms.
Stage 1 hypertension causes organ dysfunction or damage or does not improve with lifestyle changes.
Stage 2 hypertension is present.
Children have chronic kidney disease, diabetes, or heart disease regardless of the stage of high blood pressure.
Children who have milder forms of high blood pressure that are not controlled after about 6 months of lifestyle changes will need treatment with medication.
Medications that are used in the treatment of high blood pressure are called antihypertensive medications. Any antihypertensive medication can have side effects, so parents should be alert for them. If side effects develop, parents or the child should tell the doctor, who can adjust the dose or substitute another medication.
Doctors typically start antihypertensive medications, given by mouth, at a low dose and increase the dose as needed to lower blood pressure until the maximum dose of the medication is reached or side effects occur. If blood pressure is still too high, doctors may give children a second medication or switch medications.
There are many types of antihypertensive medications. Categories include:
The different types of antihypertensive medications work in different ways, so there are many options for treatment. It is not unusual for someone who has high blood pressure to be prescribed more than one of these medications.
For a more detailed discussion of these types of medications, see Medication Treatment of High Blood Pressure in Children.
Prevention of High Blood Pressure in Children
Weight reduction
Exercise
Reducing salt (sodium) intake
Obesity (determined by body mass index (BMI)), lack of physical activity, and a diet high in salt and/or calories are risk factors for high blood pressure (and for coronary artery disease). That is, these factors can contribute to or cause high blood pressure. Thus, modifying them can help prevent high blood pressure.
More and more children have overweight or obesity.
Children should be physically active. Experts recommend:
For children who are 6 to 17 years old: 30 to 60 minutes of moderate to vigorous physical activity each day or at least 3 to 5 days per week
For children under 6 years old: Physical activity throughout the day
Sodium increases blood pressure. When people consume too much salt (sodium), the body retains more fluid, leading to increased blood pressure. In the United States, most children consume more salt than is recommended. In the United States, children 6 to 18 years old are estimated to consume about 3,300 milligrams of sodium a day, not counting the salt that is added at the table. Experts recommend that children should eat less than 2,300 milligrams of sodium a day, and even less for children under 13 years of age.
Smoking tobacco or using any nicotine-containing product is another risk factor for high blood pressure. If children or adolescents smoke, doctors may recommend a smoking cessation program.
Parents can help prevent high blood pressure in their children by:
Providing healthful, lower-calorie foods such as fruits and vegetables at meals and as snacks
Providing foods that are low in salt
Making water always available (instead of sugary beverages, including energy drinks) and limiting fruit juice
Encouraging their children to be more physically active
Learning about what is considered overweight and obese
Helping their children maintain a healthy weight
Eating healthful foods and exercising each day themselves to be a role model for their children
More Information
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
American Academy of Pediatrics: Healthy Children: Screening and Treating Kids for High Blood Pressure: AAP Report Explained. Updated August 21, 2017. Accessed March 11, 2025.
U.S. Department of Agriculture and U.S. Department of Health and Human Services: 2020–2025 Dietary Guidelines for Americans
Drugs Mentioned In This Article
