Hypertension in Children

ByMichael A. Ferguson, MD, Harvard Medical School

Reviewed ByMichael SD Agus, MD, Harvard Medical School

Reviewed/Revised Apr 2025 | Modified May 2025

v49872358

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Hypertension is sustained elevation of resting systolic blood pressure, diastolic blood pressure, or both. Hypertension with no known cause (primary) is most common, as with adults. Hypertension with an identified cause (secondary hypertension) is relatively uncommon in children, although it occurs more frequently in younger children (< 6 years). Usually, children have no symptoms or complications of hypertension during childhood, although these may develop later or with more severe blood pressure elevation. Diagnosis is by sphygmomanometry, including ambulatory blood pressure monitoring. Tests may be performed to look for causes of secondary hypertension. Treatment involves lifestyle changes, medications, and management of treatable causes.

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It has become clear over time that hypertension in adults is affected by both intrauterine and neonatal conditions and often begins in childhood. Also, sequelae of hypertension in adulthood occur earlier in patients who were hypertensive as children. Additionally, there is evidence that hypertension in childhood and adolescence is directly associated with increased risk of cardiovascular disease in adulthood (1, 2, 3). Thus, it is important to identify and treat hypertension in children.

In the United States, the prevalence of hypertension in children ranges between 2 and 4% with elevated blood pressure (previously called prehypertension) noted in 16%. Worldwide, prevalence is less clear because of regional differences in definitions, reference data, and methodology but is estimated at about 4%. In addition, the prevalence appears to be increasing, likely due to the increased incidence of overweight and obesity in children; obesity is now four times as common among adolescents as it was 60 years ago (4) (see Obesity in Adolescents). Obese adolescents are more likely than their peers to have hypertension (5).

Definition of hypertension in children

Because outcomes data for hypertension in children are limited, hypertension in children < 13 years of age is classified normatively, ie, in comparison to blood pressure measurements in a large group of children. Normative blood pressure values in children < 13 years of age vary by age, sex, and height (see blood pressure percentile level tables for boys and girls) (6). Blood pressure value interpretation in older children and young adults (> 13 years) aligns with American College of Cardiology/American Heart Association guidelines for adults (7).

Table

Blood Pressure (BP) Percentile Levels for Boys by Age and Height (Measured and Percentile)

Table

Blood Pressure (BP) Percentile Levels for Boys by Age and Height (Measured and Percentile)

		Systolic BP (mm Hg)							Diastolic BP (mm Hg)
Age (year)	BP Percentile*	Measured Height (in bold) or Height Percentile							Measured Height (in bold) or Height Percentile
		5th	10th	25th	50th	75th	90th	95th	5th	10th	25th	50th	75th	90th	95th
1	Measured height (cm)	77.2	78.3	80.2	82.4	84.6	86.7	87.9	77.2	78.3	80.2	82.4	84.6	86.7	87.9
	50th	85	85	86	86	87	88	88	40	40	40	41	41	42	42
	90th	98	99	99	100	100	101	101	52	52	53	53	54	54	54
	95th	102	102	103	103	104	105	105	54	54	55	55	56	57	57
	95th + 12 mm Hg	114	114	115	115	116	117	117	66	66	67	67	68	69	69
2	Measured height (cm)	86.1	87.4	89.6	92.1	94.7	97.1	98.5	86.1	87.4	89.6	92.1	94.7	97.1	98.5
	50th	87	87	88	89	89	90	91	43	43	44	44	45	46	46
	90th	100	100	101	102	103	103	104	55	55	56	56	57	58	58
	95th	104	105	105	106	107	107	108	57	58	58	59	60	61	61
	95th + 12 mm Hg	116	117	117	118	119	119	120	69	70	70	71	72	73	73
3	Measured height (cm)	92.5	93.9	96.3	99	101.8	104.3	105.8	92.5	93.9	96.3	99	101.8	104.3	105.8
	50th	88	89	89	90	91	92	92	45	46	46	47	48	49	49
	90th	101	102	102	103	104	105	105	58	58	59	59	60	61	61
	95th	106	106	107	107	108	109	109	60	61	61	62	63	64	64
	95th + 12 mm Hg	118	118	119	119	120	121	121	72	73	73	74	75	76	76
4	Measured height (cm)	98.5	100.2	102.9	105.9	108.9	111.5	113.2	98.5	100.2	102.9	105.9	108.9	111.5	113.2
	50th	90	90	91	92	93	94	94	48	49	49	50	51	52	52
	90th	102	103	104	105	105	106	107	60	61	62	62	63	64	64
	95th	107	107	108	108	109	110	110	63	64	65	66	67	67	68
	95th + 12 mm Hg	119	119	120	120	121	122	122	75	76	77	78	79	79	80
5	Measured height (cm)	104.4	106.2	109.1	112.4	115.	118.6	120.3	104.4	106.2	109.1	112.4	115.7	118.6	120.3
	50th	91	92	93	94	95	96	96	96	51	52	53	54	55	55
	90th	103	104	105	106	107	108	108	63	64	65	65	66	67	67
	95th	107	108	109	109	110	111	112	66	67	68	69	70	70	71
	95th + 12 mm Hg	119	120	121	121	122	123	124	78	79	80	81	82	82	83
6	Measured height (cm)	110.3	112.2	115.3	118.9	122.4	125.6	127.5	110.3	112.2	115.3	118.9	122.4	125.6	127.5
	50th	93	93	94	95	96	97	98	54	54	55	56	57	57	58
	90th	105	105	106	107	109	110	110	66	66	67	68	68	69	69
	95th	108	109	110	111	112	113	114	69	70	70	71	72	72	73
	95th + 12 mm Hg	120	121	122	123	124	125	126	81	82	82	83	84	84	85
7	Measured height (cm)	116.1	118	121.4	125.1	128.9	123.4	134.5	116.1	118	121.4	125.1	128.9	132.4	134.5
	50th	94	94	95	97	98	98	99	56	56	57	58	58	59	59
	90th	106	107	108	109	110	111	111	68	68	69	70	70	71	71
	95th	110	110	111	112	114	115	116	71	71	72	73	73	74	74
	95th + 12 mm Hg	122	122	123	124	126	127	128	83	83	84	85	85	86	86
8	Measured height (cm)	121.4	123.5	127	131	135.1	138.8	141	121.4	123.5	127	131	135.1	138.8	141
	50th	95	96	97	98	99	99	100	57	57	58	59	59	60	60
	90th	107	108	109	110	111	112	112	69	70	70	71	72	72	73
	95th	111	112	112	114	115	116	117	72	73	73	74	75	75	75
	95th + 12 mm Hg	123	124	124	126	127	128	129	84	85	85	86	87	87	87
9	Measured height (cm)	126	128.3	132.1	136.3	140.7	144.7	147.1	126	128.3	132.1	136.3	140.7	144.7	147.1
	50th	96	97	98	99	100	101	101	57	58	59	60	61	62	62
	90th	107	108	109	110	112	113	114	70	71	72	73	74	74	74
	95th	112	112	113	115	116	118	119	74	74	75	76	76	77	77
	95th + 12 mm Hg	124	124	125	127	128	130	131	86	86	87	88	88	89	89
10	Measured height (cm)	130.2	132.7	136.7	141.3	145.9	150.1	152.7	130.2	132.7	136.7	141.3	145.9	150.1	152.7
	50th	97	98	99	100	101	102	103	59	60	61	62	63	63	64
	90th	108	109	111	112	113	115	116	72	73	74	74	75	75	76
	95th	112	113	114	116	118	120	121	76	76	77	77	78	78	78
	95th + 12 mm Hg	124	125	126	128	130	132	133	88	88	89	89	90	90	90
11	Measured height (cm)	134.7	137.3	141.5	146.4	151.3	155.8	158.6	134.7	137.3	141.5	146.4	151.3	155.8	158.6
	50th	99	99	101	102	103	104	106	61	61	62	63	63	63	63
	90th	110	111	112	114	116	117	118	74	74	75	75	75	76	76
	95th	114	114	116	118	120	123	124	77	78	78	78	78	78	78
	95th + 12 mm Hg	126	126	128	130	132	135	136	89	90	90	90	90	90	90
12	Measured height (cm)	140.3 101	143 101	147.5 102	152.7 104	157.9 106	162.6 108	165.5 109	140.3 61	143 62	147.5 62	152.7 62	157.9 62	162.6 63	165.5 63
	50th	101	101	102	104	106	108	109	61	62	62	62	62	63	63
	90th	113	114	115	117	119	121	122	75	75	75	75	75	76	76
	95th	116	117	118	121	124	126	128	78	78	78	78	78	79	79
	95th + 12 mm Hg	128	129	130	133	136	138	140	90	90	90	90	90	91	91
13	Measured height (cm)	147	150	154.9	160.3	165.7	170.5	173.4	147	150	154.9	160.3	165.7	170.5	173.4
	50th	103	104	105	108	110	111	112	61	60	61	62	63	64	65
	90th	115	116	118	121	124	126	126	74	74	74	75	76	77	77
	95th	119	120	122	125	128	130	131	78	78	78	78	80	81	81
	95th + 12 mm Hg	131	132	134	137	140	142	143	90	90	90	90	92	93	93
14	Measured height (cm)	153.8	156.9	162	167.5	172.7	177.4	180.1	153.8	156.9	162	167.5	172.7	177.4	180.1
	50th	105	106	109	111	112	113	113	60	60	62	64	65	66	67
	90th	119	120	123	126	127	128	129	74	74	75	77	78	79	80
	95th	123	125	127	130	132	133	134	77	78	79	81	82	83	84
	95th + 12 mm Hg	135	137	139	142	144	145	146	89	90	91	93	94	95	96
15	Measured height (cm)	159	162	166.9	172.2	177.2	181.6	184.2	159	162	166.9	172.2	177.2	181.6	184.2
	50th	108	110	112	113	114	114	114	61	62	64	65	66	67	68
	90th	123	124	126	128	129	130	130	75	76	78	79	80	81	81
	95th	127	129	131	132	134	135	135	78	79	81	83	84	85	85
	95th + 12 mm Hg	139	141	143	144	146	147	147	90	91	93	95	96	97	97
16	Measured height (cm)	162.1	165	169.6	174.6	179.5	183.8	186.4	162.1	165	169.6	174.6	179.5	183.8	186.4
	50th	111	112	114	115	115	116	116	63	64	66	67	68	69	69
	90th	126	127	128	129	131	131	132	77	78	79	80	81	82	82
	95th	130	131	133	134	135	136	137	80	81	83	84	85	86	86
	95th + 12 mm Hg	142	143	145	146	147	148	149	92	93	95	96	97	98	98
17	Measured height (cm)	163.8	166.5	170.9	175.8	180.7	184.9	187.5	163.8	166.5	170.9	175.8	180.7	184.9	187.5
	50th	114	115	116	117	117	118	118	65	66	67	68	69	70	70
	90th	128	129	130	131	132	133	134	78	79	80	81	82	82	83
	95th	132	133	134	135	137	138	138	81	82	84	85	86	86	87
	95th + 12 mm Hg	144	145	146	147	149	150	150	93	94	96	97	98	98	99
* The 90th percentile is 1.28 standard deviations (SDs) and the 95th percentile is 1.645 SDs over the mean.
Adapted from Flynn JT, Kaelber DC, Baker-Smith CM, et al: Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140(3):e20171904, 2017. doi: 10.1542/peds.2017-1904

Table

Blood Pressure (BP) Percentile Levels for Girls by Age and Height (Measured and Percentile)

Table

Blood Pressure (BP) Percentile Levels for Girls by Age and Height (Measured and Percentile)

		Systolic BP (mm Hg)							Diastolic BP (mm Hg)
Age (year)	BP Percentile*	Measured Height (in bold) or Height Percentile							Measured Height (in bold) or Height Percentile
		5th	10th	25th	50th	75th	90th	95th	5th	10th	25th	50th	75th	90th	95th
1	Measured height (cm)	75.4	76.6	78.6	80.8	83	84.9	86.1	75.4	76.6	78.6	80.8	83	84.9	86.1
	50th	84	85	86	86	87	88	88	41	42	42	43	44	45	46
	90th	98	99	99	100	101	102	102	54	55	56	56	57	58	58
	95th	101	102	102	103	104	105	105	59	59	60	60	61	62	62
	95th + 12 mm Hg	113	114	114	115	116	117	117	71	71	72	72	73	74	74
2	Measured height (cm)	84.9	86.3	88.6	91.1	93.7	96	97.4	84.9	86.3	88.6	91.1	93.7	96	97.4
	50th	87	87	88	89	90	91	91	45	46	47	48	49	50	51
	90th	101	101	102	103	104	105	106	58	58	59	60	61	62	62
	95th	104	105	106	106	107	108	109	62	63	63	64	65	66	66
	95th + 12 mm Hg	116	117	118	118	119	120	121	74	75	75	76	77	78	78
3	Measured height (cm)	91	92.4	94.9	97.6	100.5	103.1	104.6	91	92.4	94.9	97.6	100.5	103.1	104.6
	50th	88	89	89	90	91	92	93	48	48	49	50	51	53	53
	90th	102	103	104	104	105	106	107	60	61	61	62	63	64	65
	95th	106	106	107	108	109	110	110	64	65	65	66	67	68	69
	95th + 12 mm Hg	118	118	119	120	121	122	122	76	77	77	78	79	80	81
4	Measured height (cm)	97.2	98.8	101.4	104.5	107.6	110.5	112.2	97.2	98.8	101.4	104.5	107.6	110.5	112.2
	50th	89	90	91	92	93	94	94	50	51	51	53	54	55	55
	90th	103	104	105	106	107	108	108	62	63	64	65	66	67	67
	95th	107	108	109	109	110	111	112	66	67	68	69	70	70	71
	95th + 12 mm Hg	119	120	121	121	122	123	124	78	79	80	81	82	82	83
5	Measured height (cm)	103.6	105.3	108.2	111.5	114.9	118.1	120	103.6	105.3	108.2	111.5	114.9	118.1	120
	50th	90	91	92	93	94	95	96	52	52	53	55	56	57	57
	90th	104	105	106	107	108	109	110	64	65	66	67	68	69	70
	95th	108	109	109	110	111	112	113	68	69	70	71	72	73	73
	95th + 12 mm Hg	120	121	121	122	123	124	125	80	81	82	83	84	85	85
6	Measured height (cm)	110	111.8	114.9	118.4	122.1	125.6	127.7	110	111.8	114.9	118.4	122.1	125.6	127.7
	50th	92	92	93	94	96	97	97	54	54	55	56	57	58	59
	90th	105	106	107	108	109	110	111	67	67	68	69	70	71	71
	95th	109	109	110	111	112	113	114	70	71	72	72	73	74	74
	95th + 12 mm Hg	121	121	122	123	124	125	126	82	83	84	84	85	86	86
7	Measured height (cm)	115.9	117.8	121.1	124.9	128.8	132.5	134.7	115.9	117.8	121.1	124.9	128.8	132.5	134.7
	50th	92	93	94	95	97	98	99	55	55	56	57	58	59	60
	90th	106	106	107	109	110	111	112	68	68	69	70	71	72	72
	95th	109	110	111	112	113	114	115	72	72	73	73	74	74	75
	95th + 12 mm Hg	121	122	123	124	125	126	127	84	84	85	85	86	86	87
8	Measured height (cm)	121	123	126.5	130.6	134.7	138.5	140.9	121	123	126.5	130.6	134.7	138.5	140.9
	50th	93	94	95	97	98	99	100	56	56	57	59	60	61	61
	90th	107	107	108	110	111	112	113	69	70	71	72	72	73	73
	95th	110	111	112	113	115	116	117	72	73	74	74	75	75	75
	95th + 12 mm Hg	122	123	124	125	127	128	129	84	85	86	86	87	87	87
9	Measured height (cm)	125.3	127.6	131.3	135.6	140.1	144.1	146.6	125.3	127.6	131.3	135.6	140.1	144.1	146.6
	50th	95	95	97	98	99	100	101	57	58	59	60	60	61	61
	90th	108	108	109	111	112	113	114	71	71	72	73	73	73	73
	95th	112	112	113	114	116	117	118	74	74	75	75	75	75	75
	95th + 12 mm Hg	124	124	125	126	128	129	130	86	86	87	87	87	87	87
10	Measured height (cm)	129.7	132.2	136.3	141	145.8	150.2	152.8	129.7	132.2	136.3	141	145.8	150.2	152.8
	50th	96	97	98	99	101	102	103	58	59	59	60	61	61	62
	90th	109	110	111	112	113	115	116	72	73	73	73	73	73	73
	95th	113	114	114	116	117	119	120	75	75	76	76	76	76	76
	95th + 12 mm Hg	125	126	126	128	129	131	132	87	87	88	88	88	88	88
11	Measured height (cm)	135.6	138.3	142.8	147.8	152.8	157.3	160	135.6	138.3	142.8	147.8	152.8	157.3	160
	50th	98	99	101	102	104	105	106	60	60	60	61	62	63	64
	90th	111	112	113	114	116	118	120	74	74	74	74	74	75	75
	95th	115	116	117	118	120	123	124	76	77	77	77	77	77	77
	95th + 12 mm Hg	127	128	129	130	132	135	136	88	89	89	89	89	89	89
12	Measured height (cm)	142.8	145.5	149.9	154.8	159.6	163.8	166.4	142.8	145.5	149.9	154.8	159.6	163.8	166.4
	50th	102	102	104	105	107	108	108	61	61	61	62	64	65	65
	90th	114	115	116	118	120	122	122	75	75	75	75	76	76	76
	95th	118	119	120	122	124	125	126	78	78	78	78	79	79	79
	95th + 12 mm Hg	130	131	132	134	136	137	138	90	90	90	90	91	91	91
13	Measured height (cm)	148.1	150.6	154.7	159.2	163.7	167.8	170.2	148.1	150.6	154.7	159.2	163.7	167.8	170.2
	50th	104	105	106	107	108	108	109	62	62	63	64	65	65	66
	90th	116	117	119	121	122	123	123	75	75	75	76	76	76	76
	95th	121	122	123	124	126	126	127	79	79	79	79	80	80	81
	95th + 12 mm Hg	133	134	135	136	138	138	139	91	91	91	91	92	92	93
14	Measured height (cm)	150.6	153	156.9	161.3	165.7	169.7	172.1	150.6	153	156.9	161.3	165.7	169.7	172.1
	50th	105	106	107	108	109	109	109	63	63	64	65	66	66	66
	90th	118	118	120	122	123	123	123	76	76	76	76	77	77	77
	95th	123	123	124	125	126	127	127	80	80	80	80	81	81	82
	95th + 12 mm Hg	135	135	136	137	138	139	139	92	92	92	92	93	93	94
15	Measured height (cm)	151.7	154	157.9	162.3	166.7	170.6	173	151.7	154	157.9	162.3	166.7	170.6	173
	50th	105	106	107	108	109	109	109	64	64	64	65	66	67	67
	90th	118	119	121	122	123	123	124	76	76	76	77	77	78	78
	95th	124	124	125	126	127	127	128	80	80	80	81	82	82	82
	95th + 12 mm Hg	136	136	137	138	139	139	140	92	92	92	93	94	94	94
16	Measured height (cm)	152.1	154.5	158.4	162.8	167.1	171.1	173.4	152.1	154.5	158.4	162.8	167.1	171.1	173.4
	50th	106	107	108	109	109	110	110	64	64	65	66	66	67	67
	90th	119	120	122	123	124	124	124	76	76	76	77	78	78	78
	95th	124	125	125	127	127	128	128	80	80	80	81	82	82	82
	95th + 12 mm Hg	136	137	137	139	139	140	140	92	92	92	93	94	94	94
17	Measured height (cm)	152.4	154.7	158.7	163.0	167.4	171.3	173.7	152.4	154.7	158.7	163.0	167.4	171.3	173.7
	50th	107	108	109	110	110	110	111	64	64	65	66	66	66	67
	90th	120	121	123	124	124	125	125	76	76	77	77	78	78	78
	95th	125	125	126	127	128	128	128	80	80	80	81	82	82	82
	95th + 12 mm Hg	137	137	138	139	140	140	140	92	92	92	93	94	94	94
* The 90th percentile is 1.28 standard deviations (SDs) and the 95th percentile is 1.645 SDs over the mean.
Adapted from Flynn JT, Kaelber DC, Baker-Smith CM, et al: Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140(3):e20171904, 2017. doi: 10.1542/peds.2017-1904

Blood pressure in children ≥ 13 years of age is classified based on actual blood pressure values (see table Classification of Blood Pressure (BP) in Children).

Table

Classification of Blood Pressure (BP) in Children

Classification	Age 1 to < 13 Years, BP	Age ≥ 13 Years, BP
Normal	< 90th percentile*	< 120/< 80
Elevated	≥ 90th percentile (or ≥ 120/80, whichever is lower) to < 95th percentile	120–129/< 80
Stage 1 hypertension	≥ 95th percentile to < 95th percentile + 12 mm Hg OR 130/80 to 139/89, whichever is lower	130/80 to 139/89
Stage 2 hypertension	≥ 95th percentile + 12 mm Hg OR ≥ 140/90, whichever is lower	≥ 140/90
* Percentiles refer to systolic BP.
Adapted from Flynn JT, Kaelber DC, Baker-Smith CM, et al: Clinical practice guideline for screening and management of high blood pressure in children and adolescents, table 3. Pediatrics 140(3):e20171904, 2017. doi: 10.1542/peds.2017-1904

Clinical Calculators

Blood pressure percentiles, 0 to 17 years (2017 standard)

General references

1. Jacobs DR Jr, Woo JG, Sinaiko AR, et al. Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events. N Engl J Med 2022;386(20):1877-1888. doi:10.1056/NEJMoa2109191
2. Robinson CH, Hussain J, Jeyakumar N, et al. Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension [published correction appears in JAMA Pediatr. 2024 Oct 1;178(10):1086. doi: 10.1001/jamapediatrics.2024.3393.]. JAMA Pediatr 2024;178(7):688-698. doi:10.1001/jamapediatrics.2024.1543
3. Yang L, Magnussen CG, Yang L, Bovet P, Xi B. Elevated Blood Pressure in Childhood or Adolescence and Cardiovascular Outcomes in Adulthood: A Systematic Review. Hypertension 2020;75(4):948-955. doi:10.1161/HYPERTENSIONAHA.119.14168
4. Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity [published correction appears in Pediatrics 2024 Jan 1;153(1):e2023064612. doi: 10.1542/peds.2023-064612]. Pediatrics 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640
5 Bell CS, Samuel JP, Samuels JA. Prevalence of Hypertension in Children. Hypertension 2019;73(1):148-152. doi:10.1161/HYPERTENSIONAHA.118.11673
6. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents [published correction appears in Pediatrics 2017 Dec;140(6):e20173035. doi: 10.1542/peds.2017-3035.] [published correction appears in Pediatrics 2018 Sep;142(3):e20181739. doi: 10.1542/peds.2018-1739.]. Pediatrics 2017;140(3):e20171904. doi:10.1542/peds.2017-1904
7. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension 2018 Jun;71(6):e140-e144. doi: 10.1161/HYP.0000000000000076.]. Hypertension 2018;71(6):e13-e115. doi:10.1161/HYP.0000000000000065

Etiology of Hypertension in Children

Hypertension may be

Primary (no known cause, a diagnosis of exclusion)
Secondary (caused by another disorder, eg, kidney disease)

After age 6 years, primary hypertension is the dominant etiology, and this is even more true for adolescents and young adults. Before age 6, secondary hypertension is more common (1).

Primary hypertension

By definition, the cause of primary hypertension is not known, which is why it is a diagnosis of exclusion. However, it is known to be more common among children who (2, 3):

Have overweight or obesity (most important risk factor for primary hypertension)
Have a family history of hypertension
Are male
Are Hispanic, non-Hispanic Black, or Asian-American (in the United States)
Have a sedentary lifestyle
Have unhealthy dietary habits (eg, high salt and calorie intake)
Had various intrauterine factors (eg, resulting in low birth weight, prematurity, or small for gestational age)
Have social risk factors (eg, child abuse, family and/or interpersonal violence, food and/or housing insecurity—the number, duration, and severity of these factors have a cumulative effect)
Smoking and secondhand smoke exposure (4)

Secondary hypertension

Secondary hypertension has an identifiable cause; the hypertension may be reversible if the cause is resolved.

The most common causes of secondary hypertension in children are:

Renal parenchymal disease (eg, glomerulonephritis, pyelonephritis, reflux nephropathy) or congenital anomalies of the kidneys and urinary tract (eg, obstructive uropathy, polycystic kidney disease, dysplastic kidneys)
Renovascular disease (eg, renal artery stenosis, renal vein thrombosis)
Cardiovascular disease (eg, coarctation of the thoracic aorta, midaortic syndrome [rare vascular condition characterized by segmental or diffuse narrowing of the distal thoracic and/or abdominal aorta, often involving the renal and mesenteric arteries], arteriovenous fistula)
Endocrine disease (eg, hyperthyroidism, mineralocorticoid excess, corticosteroid excess, catecholamine excess)

Other causes of secondary hypertension include the following:

Sleep-disordered breathing
Neurologic causes (eg, increased intracranial pressure)
Medications and substances (eg, glucocorticoids, anabolic steroids, calcineurin inhibitors, stimulants, oral contraceptives, nicotine, caffeine, certain illicit drugs)
Psychologic stress or pain
Other causes (eg, neuroblastoma, Wilms tumor)

Syndromes commonly associated with hypertension include the following:

Neurofibromatosis type 1 (renovascular disease, midaortic syndrome, pheochromocytoma)
Williams syndrome (renovascular disease, midaortic syndrome)
Alagille syndrome (renovascular disease)
Tuberous sclerosis (renal angiomyolipomas)

Etiology references

1. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents [published correction appears in Pediatrics 2017 Dec;140(6):e20173035. doi: 10.1542/peds.2017-3035.] [published correction appears in Pediatrics 2018 Sep;142(3):e20181739. doi: 10.1542/peds.2018-1739.]. Pediatrics 2017;140(3):e20171904. doi:10.1542/peds.2017-1904
2. Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity [published correction appears in Pediatrics 2024 Jan 1;153(1):e2023064612. doi: 10.1542/peds.2023-064612.]. Pediatrics 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640
3. Rao G. Diagnosis, Epidemiology, and Management of Hypertension in Children. Pediatrics 2016;138(2):e20153616. doi:10.1542/peds.2015-3616
4. Levy RV, Brathwaite KE, Sarathy H, Reidy K, Kaskel FJ, Melamed ML. Analysis of Active and Passive Tobacco Exposures and Blood Pressure in US Children and Adolescents. JAMA Netw Open 2021;4(2):e2037936. doi:10.1001/jamanetworkopen.2020.37936

Pathophysiology of Hypertension in Children

As in adults, blood pressure is determined by the balance between cardiac output (affected by myocardial contractility, heart rate, and vascular volume) and vascular resistance (affected by vascular tone, structure, and function). The renin-angiotensin-aldosterone system, sympathetic nervous system, sodium transport, and other factors play a role (for further information, see pathophysiology of hypertension). In children, adolescents, and younger adults, cardiac output and volume status are more likely to be the prominent driving forces of hypertension than in older adults; with aging, vascular structural changes with increased vessel wall thickness and stiffness (which increase vascular resistance) play a more important role.

Complications of pediatric hypertension

Complications of pediatric hypertension can be

Acute
Chronic

Acute complications of hypertension in children are relatively uncommon and are usually related to hypertensive emergencies, in which target organ (also called end organ) dysfunction or damage is present. Affected organs include the central nervous system (causing encephalopathy, including seizures, lethargy, and/or coma), heart (causing heart failure), eyes (causing papilledema, retinal hemorrhages), and kidneys (causing renal insufficiency and/or proteinuria).

Chronic complications of hypertension in children are rare and when present typically do not occur until late adolescence or early adulthood. The complications of chronic hypertension in adults, including coronary artery disease, heart failure, ischemic stroke, peripheral vascular disease, and hypertensive end-stage renal disease, rarely, if ever, occur in children. However, precursors to these complications, including adverse changes in carotid intima-media thickness (cIMT), pulse wave velocity, left ventricular hypertrophy (LVH), and neurocognition, may be identified in children with hypertension. In children with chronic kidney disease, the degree of hypertension is associated with a steeper decline in kidney function and increased urinary albumin excretion, a marker of kidney damage. In addition to an association of childhood and adolescent hypertension with precursors or proxy markers, there is mounting evidence of a direct association with cardiovascular disease, events, and even mortality in adulthood (1, 2, 3).

Pathophysiology references

1. Jacobs DR Jr, Woo JG, Sinaiko AR, et al. Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events. N Engl J Med 2022;386(20):1877-1888. doi:10.1056/NEJMoa2109191
2. Robinson CH, Hussain J, Jeyakumar N, et al. Long-Term Cardiovascular Outcomes in Children and Adolescents With Hypertension [published correction appears in JAMA Pediatr 2024 Oct 1;178(10):1086. doi: 10.1001/jamapediatrics.2024.3393]. JAMA Pediatr 2024;178(7):688-698. doi:10.1001/jamapediatrics.2024.1543
3. Yang L, Magnussen CG, Yang L, Bovet P, Xi B. Elevated Blood Pressure in Childhood or Adolescence and Cardiovascular Outcomes in Adulthood: A Systematic Review. Hypertension 2020;75(4):948-955. doi:10.1161/HYPERTENSIONAHA.119.14168

Symptoms and Signs of Hypertension in Children

Hypertension in children, with the rare exception of hypertensive emergencies, is usually asymptomatic.

The physical examination may be normal (other than the elevated blood pressure), but signs of hypertension and/or its causes are sometimes present and should be specifically sought, including:

Eyes: Proptosis (hyperthyroidism), hypertensive retinopathy (arteriolar spasm, hemorrhages, exudates, and rarely papilledema)
Head and face: Moon facies (corticosteroid excess, such as Cushing syndrome), tonsillar hypertrophy (sleep apnea)
Neck: Thyroid enlargement and/or tenderness (hyperthyroidism)
Heart: Murmur or diminished lower extremity pulses (coarctation of the aorta), friction rub (collagen vascular disease), apical heave (left ventricular hypertrophy)
Abdomen: Mass (tumor, cystic kidney disease, hydronephrosis), bruit (midaortic syndrome, renovascular disease)
Extremities: Edema (kidney disease), joint swelling (collagen vascular disease), lower extremity traction or cast (orthopedic-related hypertension), diminished or delayed lower extremity pulses (coarctation of the aorta)
Genitalia: Ambiguous/virilization (adrenal hyperplasia), advanced puberty (intracranial tumor)
Skin: Pallor/flushing (catecholamine excess), acne/hirsutism/striae (Cushing syndrome, corticosteroid therapy, polycystic ovarian syndrome), café-au-lait spots/neurofibromas (neurofibromatosis), ash-leaf spots/adenoma sebaceum (tuberous sclerosis complex), rash (systemic lupus erythematosus, immunoglobulin A–associated vasculitis)
Neurologic: Muscle weakness (hyperaldosteronism, Liddle syndrome)
General: Obesity (primary hypertension), growth retardation (chronic kidney disease)
Vital signs: Tachycardia (hyperthyroidism, catecholamine excess), blood pressure difference between the extremities (coarctation of the aorta, midaortic syndromes).

Diagnosis of Hypertension in Children

Sphygmomanometry (auscultation)
Oscillometric devices
Ambulatory blood pressure monitoring

Because blood pressure (BP) values vary based on age, sex, and height, hypertension is defined based on normative values (see BP percentile level tables for boys and girls). Hypertension should typically not be diagnosed until high BP values (as defined in table Classification of Blood Pressure in Children) have been identified on 3 separate visits in order to exclude transient causes of BP elevation, such as recent consumption of caffeinated beverages or white coat hypertension (ie, BP elevation due to the anxiety of a doctor visit). Ambulatory BP monitoring can also be useful in diagnosing white coat hypertension as well as masked hypertension, in which blood pressure is normal in the office setting but elevated in other settings.

BP must be measured using proper technique. Children should be sitting quietly in a chair with their back supported and feet on the floor for 3 to 5 minutes before measurement. It is critical to use a cuff of the correct size; a range of cuff sizes, including a thigh cuff, should be available. The cuff width should be at least 40% of the circumference of the middle of the upper arm and the length of the inflatable bladder should be 80 to 100% of that circumference. A cuff that is too small results in an erroneously high measurement. If the child is between cuff sizes, the larger cuff size should be used because this is less likely to result in an incorrect measurement. In general, at least 2 measurements should be taken at each visit, particularly if the initial measurement is high.

Blood pressure screening

Pediatric normative blood pressure values are based on measurement by manual auscultation. Today, most BP screening is performed using oscillometric devices because they are easy to use, reduce observer bias, and are better tolerated by younger children and infants. Measurements taken with an oscillometric device are usually higher than measurements obtained by auscultation, so any measurement ≥ the 90th percentile needs to be confirmed by auscultation.

According to the American Academy of Pediatrics' (AAP) guidelines, routine BP monitoring should be performed annually beginning at age 3 years (1). If BP is below the 90th percentile or below the BP value requiring additional evaluation per AAP guidelines, measurement is continued annually. Children with risk factors for hypertension, such as kidney disease, cardiac disease, or a significant neonatal history, should be evaluated earlier and more frequently—at each visit.

Elevated BP is generally underdiagnosed in children (2, 3, 4). Interpretation of BP values is particularly important in children < age 13 years in whom signification elevations in BP are less obvious because normal values vary widely by age, gender, and size. To simplify screening, the AAP guidelines provide BP values for each age that, although not diagnostic of hypertension, indicate need for further evaluation (see table Screening Blood Pressure Values in Children That Need Additional Evaluation). These values represent the 90th percentile BP for the smallest height cohort at each age 1 through 12 years, so clinicians do not need to determine precise BP percentiles in every child. Further evaluation typically begins with repeat measurements and calculation of actual BP percentile (see table Classification of Blood Pressure (BP) in Children), and then follow up with a physician (ie, if screening performed by other personnel). Health information technology can increase adherence to clinical guidelines with respect to BP screening, medication prescribing, and BP management. (5). There are available normative BP values available for infants < 1 year of age relative to gestational age, birthweight, and post-conceptional age (6).

Table

Screening Blood Pressure Values in Children That Need Additional Evaluation*

Age (years)	Boys		Girls
	Systolic	Diastolic	Systolic	Diastolic
1	98	52	98	57
2	100	55	101	58
3	101	58	102	60
4	102	60	103	62
5	103	63	104	64
6	105	66	105	67
7	106	68	106	68
8	107	69	107	69
9	107	70	108	71
10	108	72	109	72
11	110	74	111	74
12	113	75	114	75
≥ 13	120	80	120	80
* Note, these values are not intended to diagnose or classify hypertension and should be used only for screening to identify children whose blood pressure requires a more thorough evaluation.
Adapted from Flynn JT, Kaelber DC, Baker-Smith CM, et al: Clinical practice guideline for screening and management of high blood pressure in children and adolescents, table 6. Pediatrics 140(3):e20171904, 2017. doi: 10.1542/peds.2017-1904

Children with BP between the 90th and 95th percentiles should be rechecked by auscultation within 6 months because in 50 to 70% BP returns to the normal range. If BP remains elevated after 6 months, lifestyle changes (eg, diet, activity, weight loss if needed) should be recommended and upper and lower extremity BP measurements should be taken. If BP remains elevated over the next 6 months, 24-hour ambulatory BP monitoring could be performed, if possible, or the patient could be referred to a specialist. However, if during this time BP returns to below the 90th percentile, the annual monitoring schedule can be resumed.

If measurements are consistently ≥ 95th percentile but < 95th percentile + 12 mm Hg, children should be considered to have stage 1 hypertension (see also table Classification of Blood Pressure in Children). Measurements that are ≥ 95th percentile + 12 mm Hg or ≥ 140/90, whichever is lower, represent stage 2 hypertension.

Children with stage 1 hypertension should be rechecked within 1 to 2 weeks. If BP remains at stage 1, upper and lower extremity BP measurements should be taken, a urinalysis performed, and lifestyle changes recommended. BP should be rechecked in 2 to 3 months and if still at stage 1, children should be referred to a specialist for evaluation, including determination of cause. Children with stage 2 hypertension or stage 1 hypertension with symptoms should be referred immediately to an emergency department or a pediatric specialist for possible hospitalization.

Ambulatory blood pressure monitoring (ABPM)

Clinical practice guidelines emphasize the use of ABPM in the evaluation of children and adolescents with persistently elevated blood pressure. ABPM should be performed in all children and adolescents with office BP in the elevated BP category for 1 year or with stage 1 hypertension over 3 clinic visits. ABPM helps to identify spuriously elevated BP due to measurement anxiety and to assess circadian BP patterns, both of which are important in assessing for white coat or masked hypertension (7, 8).

Routine performance of ABPM should be strongly considered in children and adolescents with high-risk conditions, including:

Chronic kidney disease
Diabetes mellitus
Solid organ transplant
Obesity
Sleep-disordered breathing
Genetic syndromes associated with hypertension

Guidelines for the performance and interpretation of ambulatory blood pressure monitoring in children and young adults are available. ABPM has been validated in children > 5 years of age and age and height based normative data are available.

Evaluation of cause

In patients with confirmed hypertension, specific testing should assess for disorders suspected based on the history and physical examination (eg, thyroid function tests if hyperthyroidism is suspected).

Most clinicians also perform an initial laboratory evaluation that includes measurement of serum blood urea nitrogen (BUN), creatinine, and electrolytes; a fasting lipid profile; a urinalysis; and, especially in those with hypertension at a young age or those with a history of abnormal urinalyses or renal function, renal ultrasound. However, a more targeted approach can be taken based on age, symptoms, and risk factors (1).

Children ≥ 6 years of age and adolescents who have asymptomatic stage 1 hypertension and a positive family history of hypertension, who have overweight or obesity, and who do not have a suggestive history or physical examination findings do not require an extensive evaluation for secondary hypertension. Initial testing for these children can be simplified to include measurement of BUN, creatinine, electrolytes, and calcium and an in-office screening urine dipstick test. If these results are normal and there is no difference between upper and lower extremity BP measurements, diet and lifestyle changes (eg, activity, weight loss if needed) should be started and children should be reevaluated in 6 months. If BP remains elevated and weight is unchanged or has increased after 6 months, further evaluation should be undertaken to look for other causative factors for hypertension. Children who have asymptomatic stage 1 hypertension for 3 readings but without a family history and who are not overweight should have this evaluation performed within a month or two. Children and adolescents who have stage 2 hypertension or stage 1 hypertension with symptoms should have immediate evaluation.

Further evaluation includes the following tests:

Fasting complete metabolic panel (including glucose, liver enzymes, and lipid panel), and glycosylated hemoglobin (HbA1c—for prediabetes)
Echocardiography (for left ventricular hypertrophy)
Urinary albumin:creatinine ratio and urinalysis
Renal ultrasound

If test results are normal, diet and lifestyle changes are continued for another 6 months, and consultation with a nutritionist can be suggested. However, if there is evidence of a comorbid condition, BP remains elevated, and weight has not decreased, pharmacologic therapy should be considered.

Children < 6 years of age who are not overweight and who lack a significant family history of hypertension, all children ≤ 3 years of age, and those with stage 1 hypertension with symptoms or stage 2 hypertension should have a more complete initial evaluation, keeping in mind that the higher the BP and the younger the child, the more likely a cause of secondary hypertension will be found. These children should have the following tests:

Comprehensive metabolic panel
Complete blood count
Urinalysis
Urinary albumin:creatinine ratio
Plasma renin activity and aldosterone levels
Thyroid function tests
Evaluation of catecholamine activity (eg, by measuring plasma free metanephrines)
Renal ultrasound with Doppler flow
Echocardiography

The other option for these children is an early referral to a pediatric nephrologist because most of the common causes of secondary hypertension in children are kidney related. A pediatric nephrologist would do this same evaluation along with other renal imaging such as a technetium-99m-labeled dimercaptosuccinic acid (DMSA) renal scan (to look for renal scarring) and/or digital subtraction angiography (to evaluate for renal vascular disease).

Diagnosis references

1. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents [published correction appears in Pediatrics 2017 Dec;140(6):e20173035. doi: 10.1542/peds.2017-3035] [published correction appears in Pediatrics 2018 Sep;142(3):e20181739. doi: 10.1542/peds.2018-1739]. Pediatrics 2017;140(3):e20171904. doi:10.1542/peds.2017-1904
2. Beacher DR, Chang SZ, Rosen JS, et al. Recognition of elevated blood pressure in an outpatient pediatric tertiary care setting. J Pediatr 2015;166(5):1233-1239.e1. doi:10.1016/j.jpeds.2015.02.006
3. Brady TM, Solomon BS, Neu AM, Siberry GK, Parekh RS. Patient-, provider-, and clinic-level predictors of unrecognized elevated blood pressure in children. Pediatrics 2010;125(6):e1286-e1293. doi:10.1542/peds.2009-0555
4. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007;298(8):874-879. doi:10.1001/jama.298.8.874
5. Zachariah JP, Singh T, Collinson S, et al. Pediatric High Blood Pressure Recognition Associated With Electronic Decision Support: A Cohort Analysis. Hypertension 2024;81(12):2501-2509. doi:10.1161/HYPERTENSIONAHA.124.23532
6. Dionne JM, Abitbol CL, Flynn JT. Hypertension in infancy: diagnosis, management and outcome [published correction appears in Pediatr Nephrol. 2012 Jan;27(1):159-60]. Pediatr Nephrol 2012;27(1):17-32. doi:10.1007/s00467-010-1755-z
7. Flynn JT, Daniels SR, Hayman LL, et al. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 2014;63(5):1116-1135. doi:10.1161/HYP.0000000000000007
8. Flynn JT, Urbina EM, Brady TM, et al. Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association. Hypertension 2022;79(7):e114-e124. doi:10.1161/HYP.0000000000000215

Treatment of Hypertension in Children

Therapeutic lifestyle modifications (including dietary modification, weight loss, and exercise)
Sometimes medication

Therapeutic lifestyle modifications that can help lower BP, including dietary improvement and exercise, are advised in all children with elevated BP. The keys to weight reduction in childhood are healthy eating habits and increased physical activity. A diet higher in fruits, vegetables, legumes, and low-fat dairy products and lower in salt, such as the DASH (Dietary Approaches to Stop Hypertension) diet, has been associated with lower BP (1,2). Dietary changes also should include a calorie limit based on activity level, age, and sex. Salt intake should be < 2300 mg/day in children over 13 years of age and < 2 to 3 mEq/kg/day in younger children. Children ages 6 to 17 years should be doing 30 to 60 minutes of moderate to vigorous physical activity each day or at least 3 to 5 days a week. Younger children should be physically active throughout the day.

Treatment goals are typically a BP of < 90th percentile or, in older children, < 130/80, whichever is lower; sometimes the treatment goal is < 120/80. For children with kidney disease, the goal is a mean 24-hour BP below the 50th percentile. Children with stage 2 hypertension, or stage 1 hypertension with symptoms, evidence of target organ damage, diabetes, or kidney disease should be referred to a specialist to begin a more rapid and/or directed therapy.

Pharmacologic therapy for hypertension in children

Immediate pharmacologic therapy is typically started (along with therapeutic lifestyle modification) for children with:

Symptomatic hypertension at any stage or level
Stage 1 hypertension with any evidence of target organ dysfunction or damage
Stage 2 hypertension even with an obvious, modifiable risk factor (eg, obesity), which should be addressed while BP is being controlled
Any stage of hypertension if they have chronic kidney disease, diabetes, or cardiac disease

If the severity of hypertension is such that it is life-threatening and could cause (or has caused) significant target organ damage, then it is classified and treated as acute severe hypertension.

In children with elevated blood pressure or stage 1 hypertension (See Classification of Blood Pressure in Children) without symptoms or target organ dysfunction, lifestyle changes are initiated, and if these do not sufficiently lower BP within about 6 months, medication treatment may be necessary (3).

When antihypertensive therapy is indicated, a stepped-care approach to the initiation and escalation of drug dosing is typically recommended. A first-line agent should be started at the lowest recommended dose range with ongoing BP monitoring. If the BP remains above the desired range, the dose is gradually increased until adequate BP control is achieved or until the maximum recommended dose is reached, at which time a medication from a different class should be added.

Although specific medications may be preferred in individual clinical settings based on putative benefits or predicted response, considerable variation exists in the choice of a first agent. Most clinicians begin with an angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), a calcium channel blocker, or a thiazide diuretic. These classes of medications can be given as a single daily dose. ACE inhibitors and/or ARBs should be used in patients with chronic kidney disease or diabetes because they have been shown to slow progression of kidney disease (3). Alternatives to these classes should be considered in girls who have reached menarche and are, or may be, sexually active without reliable contraception because ACE inhibitors and ARBs have significant teratogenic effects. All patients require monitoring for response as well as medication-related adverse effects, which may be dose-limiting and require either the addition of a second agent or replacement of the first agent altogether.

Classes of oral medications used to treat hypertension include:

Adrenergic modifiers (beta- and alpha-antagonist, alpha-2-agonist, beta-blocker)
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Calcium channel blockers
Thiazide diuretics
Vasodilators

For a more detailed discussion of each class and its specific medications, see Medications for Hypertension in Children.

Treatment references

1. Couch SC, Saelens BE, Khoury PR, et al. Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure. Hypertension 2021;77(1):241-251. doi:10.1161/HYPERTENSIONAHA.120.16156
2. Zafarmand MH, Spanjer M, Nicolaou M, et al. Influence of Dietary Approaches to Stop Hypertension-Type Diet, Known Genetic Variants and Their Interplay on Blood Pressure in Early Childhood: ABCD Study. Hypertension 2020;75(1):59-70. doi:10.1161/HYPERTENSIONAHA.118.12292
3. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents [published correction appears in Pediatrics 2017 Dec;140(6):e20173035. doi: 10.1542/peds.2017-3035] [published correction appears in Pediatrics 2018 Sep;142(3):e20181739. doi: 10.1542/peds.2018-1739]. Pediatrics 2017;140(3):e20171904. doi:10.1542/peds.2017-1904

Prevention

Weight reduction
Exercise
Reducing salt intake
Reduction of cardiovascular risk factors

Childhood obesity is a major contributor to hypertension. Clinicians should encourage healthy diets and regular exercise in all pediatric patients. A diet higher in fruits, vegetables, legumes, and low-fat dairy products and lower in sodium, such as the DASH (Dietary Approaches to Stop Hypertension) diet (1), may both help and treat prevent obesity and hypertension. It is recommended that children consume less than 2300 mg of sodium per day (even less for children < 13 years) (2).

Children ages 6 to 17 should be doing 30 to 60 minutes of moderate to vigorous physical activity at least 3 to 5 days per week. Younger children should be physically active throughout the day.

It is important to screen for smoking in children and, where necessary, help implement a smoking cessation program. In addition, it is important to screen for use of caffeine (including energy drinks), alcohol, and drugs, all of which can play a role in hypertension.

Prevention references

1. U.S. Department of Agriculture and U.S. Department of Health and Human Services: 2020–2025 Dietary Guidelines for Americans. Accessed March 4, 2025.
2. Yang Q, Zhang Z, Kukline EV, et al: Sodium intake and blood pressure among US children and adolescents. Pediatrics 130(4): 611–619, 2012. doi: 10.1542/peds.2011-3870

Key Points

Most hypertension in children is primary.
Confirm diagnosis of hypertension with readings on 3 different visits or with ambulatory blood pressure monitoring.
Exclude secondary causes of hypertension by physical examination, and, as indicated by patient characteristics, by laboratory tests and diagnostic imaging.
Initiate treatment with lifestyle changes, primarily diet and exercise.
If lifestyle changes are insufficient, or if symptoms or target organ damage is present, initiate treatment with medications, beginning with either a calcium channel blocker, an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, or a thiazide diuretic.
Titrate medication doses and modify therapeutic agents until optimal blood pressure is reached.

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: Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (2017)
U.S. Department of Agriculture and U.S. Department of Health and Human Services: 2020–2025 Dietary Guidelines for Americans

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