What is pediatric hypertension?

High blood pressure isn’t only a problem among adults. Children and adolescents can have high blood pressure too. It’s known as pediatric hypertension.

Between 2% to 4% of children and teens have it, according to the American Academy of Pediatrics (AAP).

Here’s what it means if your child has higher than normal blood pressure.

What Is Pediatric Hypertension?

In children and adolescents, a hypertension diagnosis may be considered when they have stage 1 or stage 2 hypertension range manual blood pressure (BP) readings at three different visits. A hypertension diagnosis may be confirmed by a BP specialist through the use of ambulatory blood pressure monitoring.

BP Measurements with your Pediatrician

If your child is otherwise healthy, their pediatrician will take their blood pressure as part of their annual wellness checkup beginning at age three. Their pediatrician will use the AAP clinical practice guidelines to determine whether your child has high blood pressure.

For children ages one to 12

The AAP guidelines define BP levels based on BP readings from healthy and normal weight children. Your child’s BP is then compared to the clinical practice guideline BP levels appropriate for their age, sex, and height and categorized into one of the following four categories:

  • Normal BP. This is BP below the 90th percentile.
  • Elevated BP. Whichever of these is lower: Greater than or equal to the 90th percentile up to the 95th percentile or below 120/80 mm Hg.
  • Stage 1 Hypertension. Whichever of these is lower: Greater than or equal to the 95th percentile up to the 95th percentile + 12 mm Hg or 130/80 mm Hg to 139/89 mm Hg.
  • Stage 2 Hypertension. Whichever of these is lower: Greater than or equal to the 95th percentile + 12 mm Hg or greater than or equal to 140/90 mm Hg.

For children 13 and over

For this age group, doctors use guidelines for adults set by the American Heart Association and American Academy of Cardiology.

  • Normal BP. This is when the systolic BP is less than 120 mm Hg and the diastolic BP is less than 80 mm Hg.
  • Elevated BP. This is when the systolic BP ranges from 120 to 129 mm Hg and the diastolic BP is less than 80 mm Hg.
  • Stage 1 Hypertension. This is when the systolic BP is between 130 and 139 mm Hg or the diastolic BP is between 80 and 90 mm Hg.
  • Stage 2 Hypertension. This is when the systolic BP is greater than or equal to 140 mm Hg or the diastolic BP is greater than or equal to 90 mm Hg.

Diagnosing Hypertension in Children

If your child has BP readings in the elevated BP, stage 1 hypertension, or stage 2 hypertension ranges, their pediatrician will likely ask your child to return for repeat BP measurements. The timing of repeat BP readings will differ based on the BP category.

If your child has elevated BP level readings for more than one year or stage 1 and/or stage 2 hypertension BP readings on at least three different visits, your pediatrician may refer your child to a BP specialist for confirmation of a hypertension diagnosis.

Common risk factors

Any child can develop high BP, but some things can increase their risk or can cause an increase in BP. Common risk factors include:

  • Children and adolescents who are obese. For youth, obesity means having a body mass index, or BMI, greater than or equal to the 95th percentile.
  • Older youths.
  • Boys.
  • Those with certain chronic conditions, such as diabetes, chronic kidney disease, and sleep-disordered breathing.
  • Those who were born pre-term.
  • Those with a family history of hypertension and early cardiovascular disease (CVD).

Potential causes

Compared to adults, children and adolescents are at higher risk to have specific conditions that cause hypertension, otherwise known as secondary hypertension.

The following may cause pediatric hypertension:

  • Having kidney disease or kidney or urinary tract abnormalities.
  • Having narrow kidney arteries.
  • Having coarctation of the aorta, which is a congenital heart anomaly.
  • Having an excess of certain hormones.
  • Having increased intracranial pressure.
  • Having genetic disorders such as neurofibromatosis type 1, Turner Syndrome, or Williams Syndrome.

Exposure to various substances can also increase BP including:

  • Exposure to environmental toxins, particularly lead, cadmium, mercury, and phthalates.
  • Medications including decongestants, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDS), stimulants for attention deficit hyperactivity disorder (ADHD), hormonal contraceptives, and tricyclic antidepressants. Some herbal and dietary supplements can also increase BP.
  • Too much caffeine.
  • Illicit drug use, especially amphetamines and cocaine.

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Complications from Pediatric Hypertension

Pediatric hypertension can increase a child’s risk of having hypertension and metabolic syndrome as an adult. It can also set the stage for developing CVD as an adult. Even during childhood, more significant hypertension can cause changes to various organs including thickened and/or enlarged heart muscles.

Evaluating Pediatric Hypertension

If your child is suspected to have hypertension, their doctor may recommend blood and urine laboratory tests and imaging. Your child may also be referred to a BP specialist (typically a nephrologist or cardiologist) to conduct a more in-depth BP test called 24-hour ambulatory blood pressure monitoring. Depending on the results, their specialists may order additional tests.

How Is Pediatric Hypertension Treated?

Just like for adults, treatment for children with hypertension may include lifestyle changes and medications.

Lifestyle changes

If your child receives a diagnosis of pediatric hypertension, their doctor may recommend making lifestyle changes to lower their BP. Lifestyle changes include:

  • Helping your child maintain a healthy weight for their age and height.
  • Following the DASH Diet.
  • Reducing their sodium intake.
  • Getting regular physical activity. Children ages three through five should be physically active throughout the day for growth and development. For children ages 6 to 17, the CDC recommends one hour or more of moderate-to-vigorous exercise daily. The AAP pediatric hypertension guidelines recommend moderate to vigorous physical activity at least three to five days per week (30-60 minutes per session).

Medications to treat pediatric hypertension

If lifestyle changes aren’t enough to lower your child’s BP, your doctor may recommend medications to help lower it. First line antihypertensive drugs include angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and thiazide diuretics. These medications and typically prescribed by BP specialists, and the class of drugs is typically tailored for your child’s condition and lifestyle.

Between lifestyle changes and medications, pediatric hypertension is typically a very treatable condition. Please be sure to ask your doctors any questions you or your child may have.

Sources

High Blood Pressure in Kids and Teens. Centers for Disease Control and Prevention. Link.

How Much Physical Activity Do Children Need? Centers for Disease Control and Prevention. Link.

Hypertension Among Youths — United States, 2001–2016. Morbidity and Mortality Weekly Report. July 13, 2018. Centers for Disease Control and Prevention. Link.

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. American Academy of Pediatrics. September 2017. Link

New American Academy of Pediatrics Hypertension GuidelineWho Is Up and Who Is Down. Hypertension. American Heart Association Journal. November 2018. https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.118.11819

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.