Hypertension in Children

What is hypertension? 

Hypertension is a medical condition where a person’s blood pressure is too high. Blood pressure is an important measure of health. Blood pressure is the force of blood pushing against the walls of blood vessels and is responsible for the delivery of oxygen and nutrients to organs and tissues throughout the body. A normal blood pressure reading is essential for the organs to work well and avoid damage.  

Hypertension can harm blood vessels and lead to health problems. Hypertension increases the chance of health problems such as heart attacks, kidney disease and strokes.  

Causes of hypertension in children 

About 1 to 2 percent of healthy children have hypertension, and it occurs more often in children with obesity, kidney disease and other chronic diseases. Without treatment, children with hypertension are more likely to have hypertension and preventable health problems as adults. 

Fortunately, heart attacks and strokes are very uncommon in children with hypertension, but that does not mean that high blood pressure does not affect children. Studies show that children with hypertension can have changes in blood vessels that may lead to adult cardiovascular disease. 

Diagnosing hypertension 

Assessing blood pressure plays an important role in keeping children healthy throughout their life. The early detection, accurate diagnosis and effective treatment of high blood pressure may improve the long-term health of children and adolescents. 

Normal blood pressure in younger children depends on the child’s height, age and gender. Normal blood pressure increases as children get older and grow taller. Hypertension in children is defined as repeated blood pressure measures, over multiple encounters, that consistently exceed the 95th percentile for age, height and gender (see a table of blood pressure ranges here). For children 13 years of age and over, hypertension is defined as a blood pressure that is consistently above 130/80 mmHg, the same value that defines high blood pressure in adults. 

Testing for hypertension 

Your child will need to have their blood pressure measured on a regular basis to accurately diagnose and treat hypertension. Measures of blood pressure can vary greatly and are influenced by the setting (doctor’s office, hospital, etc.), equipment and technique, and individual factors such as pain, anxiety, medications, food, and other factors. It is important to measure blood pressure in a consistent way using proper equipment and technique to get an accurate measure of a child’s blood pressure. 

The American Academy of Pediatrics recommends that all children 3 years and older have their blood pressure measured at least once a year. When a screening blood pressure is high, your child’s provider will usually confirm the high blood pressure measure by getting a series of blood pressure measures over several days. 

There are several options for getting repeated blood pressure measurements, including: 

1. Repeated visits to a health care setting (office visits).
2. Repeated visits to the school nurse.
3. In-home monitoring (self-monitored blood pressure).
4. Ambulatory blood pressure monitoring (ABPM) study – usually requires referral to specialty center. 

To establish a blood pressure profile for a child, we recommend checking blood pressure at least 3 to 4 times a week for 2 weeks. The time of day can vary, but use proper technique at each setting. We recommend getting 3 different blood pressure readings, separated by 3 to 5 minutes, each time you check. The average of all the readings is better than any single reading.  

It is important to record the blood pressure measures so you can review them with your provider at your appointment.  You can keep a written record or keep an electronic record in a mobile app [link to table]. Some blood pressure monitors have apps that can be used with the device. 

Equipment for measuring blood pressure 

Blood pressure measurement equipment consists of an inflatable cuff and a monitoring device.   Monitoring devices are either manual, such as the traditional method that uses a stethoscope, or automated. Automated devices are usually best for self-monitoring blood pressure because they are the easiest to use. 

Automated devices should be validated as accurate (see a list here) and have an inflatable cuff that is appropriately sized for the child’s arm. Learn how to measure your child’s arm to ensure you are using an appropriately sized cuff.

Blood pressure devices

Mobile apps for tracking blood pressure

Treatment for hypertension 

When a child has hypertension, the goal is to bring the blood pressure back to normal values.  Treatments include healthy lifestyle changes and when appropriate, blood pressure lowering medications. In general, medications are more effective in lowering blood pressure when combined with lifestyle modifications. Lifestyle modifications may also have a positive impact on other health risk factors such as high cholesterol, excess weight, snoring, etc. Children who embrace healthy habits at a young age are more likely to continue them into adulthood. 

Lifestyle modifications include a healthy eating plan, such as the DASH diet, and consistent exercise.    

Your child may need medications if their blood pressure is very high or if a trial of lifestyle modifications does not improve their blood pressure to normal ranges. Your primary care provider will likely refer you to a specialist if your child needs blood pressure lowering medications.