High blood pressure - children
Hypertension - children; HBP - children; Pediatric hypertension
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. High blood pressure (hypertension) is an increase in this force. This article focuses on high blood pressure in children, which is often a result of being overweight.
Blood pressure readings are given as two numbers. Blood pressure measurements are written this way: 120/80. One or both of these numbers can be too high.
- The first (top) number is the systolic blood pressure.
- The second (bottom) number is the diastolic pressure.
High blood pressure in children up to age 13 is measured differently than in adults. This is because what is considered normal blood pressure changes as a child grows. A child's blood pressure numbers are compared with the blood pressure measurements of other children the same age, height, and sex.
Normal blood pressure ranges in children ages 1 to 13 years are published by the National Heart, Lung and Blood Institute, a US government agency. You can also ask your health care provider. Abnormal blood pressure readings are described as follows:
- Elevated blood pressure
- Stage 1 high blood pressure
- Stage 2 high blood pressure
Children older than age 13 follow the same guidelines for high blood pressure as adults.
Carrying a lot of extra weight around your middle or sprinkling too much salt onto your food at each meal can cause high blood pressure, otherwise known as hypertension. Stress and your genes can also bring your blood pressure up. Sometimes when your blood pressure is high, your doctor might not be able to find any direct cause for it. That's what's called essential hypertension. When your doctor talks to you about your blood pressure, he's referring to the force of your blood pushing against your artery walls. The top number in your blood pressure is called the systolic blood pressure. That's the pressure in your blood vessels while your heart is pumping. The bottom number is called the diastolic blood pressure and that's the pressure when your heart rests between beats. You want your blood pressure to stay at 120 over 80 or less. A blood pressure of 140 over 90 or more is considered high. Why is high blood pressure a problem, you ask? Well, you can think of high blood pressure as being like a river that's rushing too hard, eventually it's going to damage its banks. With high blood pressure, the extra force of your blood pushing against your artery walls eventually damages them. It can also damage your heart, your kidneys, and other organs. So, how do you know if you have high blood pressure? Often you don't know, because high blood pressure doesn't have symptoms like a fever or cough. Usually there are no symptoms at all, and you won't be able to find out that you have high blood pressure unless you've had it checked, or you've developed complications like heart disease or kidney problems. You can check your blood pressure yourself with a home monitor, or have it checked at your doctor's office. If it's high, you and your doctor will set a blood pressure goal. You can achieve that goal in different ways, like eating a healthy diet, exercising for at least 30 minutes a day, quitting smoking, eating less than 1,500 milligrams of salt per day, and using programs like meditation and yoga to relieve your stress. But if these lifestyle changes aren't enough, your health care provider might prescribe one or more medicines to lower your blood pressure. The reason why doctors are so serious about a patients' blood pressure is that having uncontrolled blood pressure can cause a lot of serious health problems, including heart attack, stroke, kidney disease, and loss of vision. When it comes to your blood pressure, it's best to be proactive. Call your doctor for a check-up if you haven't had one in a while, and get your blood pressure checked. If it's high, follow your doctor's advice for bringing it back into a healthy range.
Causes
Many things can affect blood pressure, including:
- Hormone levels
- The health of the nervous system, heart, and blood vessels
- The health of the kidneys
Most of the time, no cause of high blood pressure is found. This is called primary (essential) hypertension.
However, certain factors can increase the risk of high blood pressure in children:
- Being overweight or obese
- Family history of high blood pressure
- Race -- African Americans are at increased risk for high blood pressure
- Having type 2 diabetes or high blood sugar
- Having high cholesterol
- Problems breathing during sleep, such as snoring or sleep apnea
- Kidney disease
- History of preterm birth or low birth weight
In most children, high blood pressure is related to being overweight.
High blood pressure can be caused by another health problem. It can also be caused by a medicine your child is taking. Secondary causes are more common in infants and young children. Common causes include:
- Thyroid problems
- Heart problems
- Kidney problems
- Certain tumors
- Sleep apnea
- Medicines such as steroids, birth control pills, NSAIDs, and some common cold medicines
High blood pressure will return to normal once the medicine is stopped or the condition is treated.
The healthiest blood pressure for children is based on a child's sex, height, and age. Your health care provider can tell you what your child's blood pressure should be.
Symptoms
Most children do not have any symptoms of high blood pressure. High blood pressure is often discovered during a checkup when a provider checks your child's blood pressure.
Exams and Tests
In most cases, the only sign of high blood pressure is the blood pressure measurement itself. For healthy weight children, blood pressure should be taken every year starting at age 3. To get an accurate reading, your child's provider will use a blood pressure cuff that fits your child properly.
If your child's blood pressure is elevated, the provider should measure blood pressure twice and take the average of the two measurements.
Blood pressure should be taken at every visit for children who:
- Are obese
- Take medicine that raises blood pressure
- Have kidney disease
- Have problems with the blood vessels leading to the heart
- Have diabetes
The provider will measure your child's blood pressure many times before diagnosing your child with high blood pressure.
The provider will ask about family history, your child's sleep history, risk factors, and diet.
The provider will also do a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your child's body.
Other tests your child's provider may want to do include:
- Blood and urine tests
- Blood sugar test
- Echocardiogram
- Ultrasound of the kidneys
- Sleep study to detect sleep apnea
Treatment
The goal of treatment is to reduce high blood pressure so that your child has a lower risk of complications. Your child's provider can tell you what your child's blood pressure goals should be.
If your child has elevated high blood pressure, your provider will recommend lifestyle changes to help lower your child's blood pressure.
Healthy habits can help your child not gain any more weight, lose extra weight, and lower blood pressure. Working together as a family is the best way to help your child lose weight. Work together to help your child:
- Follow the DASH diet, which is low in salt with plenty of fruits and vegetables, lean meats, whole grains, and low-fat or non-fat dairy
- Cut back on sugary drinks and foods with added sugar
- Get 30 to 60 minutes of exercise every day
- Limit screen time and other sedentary activities to less than 2 hours a day
- Get plenty of sleep
Your child's blood pressure will be checked again at 6 months. If it remains high, blood pressure will be checked in your child's limbs. Then blood pressure will be rechecked at 12 months. If blood pressure remains high, then the provider may recommend blood pressure monitoring continuously over 24 to 48 hours. This is called ambulatory blood pressure monitoring. Your child also may need to see a heart or kidney doctor.
Other tests may also be done to look for:
- High cholesterol level
- Diabetes (A1C test)
- Heart disease, using tests such as an echocardiogram or electrocardiogram
- Kidney disease, using tests such as a basic metabolic panel and urinalysis or ultrasound of the kidneys
The same process will occur for children with stage 1 or stage 2 high blood pressure. However, follow-up testing and specialist referral will take place in 1 to 2 weeks for stage 1 high blood pressure, and after 1 week for stage 2 high blood pressure.
If lifestyle changes alone don't work, or your child has other risk factors, your child may need medicines for high blood pressure. Blood pressure medicines used most often for children include:
- Angiotensin-converting enzyme inhibitors
- Angiotensin receptor blockers
- Beta-blockers
- Calcium channel blockers
- Diuretics
Your child's provider may recommend that you monitor your child's blood pressure at home. Home monitoring can help show if lifestyle changes or medicines are working.
Outlook (Prognosis)
Most of the time, high blood pressure in children can be controlled with lifestyle changes and medicine, if needed.
Possible Complications
Untreated high blood pressure in children may lead to complications in adulthood, which may include:
- Stroke
- Heart attack
- Heart failure
- Kidney disease
When to Contact a Medical Professional
Contact your child's provider if home monitoring shows that your child's blood pressure is still high.
Prevention
Your child's provider will measure your child's blood pressure at least once a year, starting at age 3.
You can help prevent high blood pressure in your child by following lifestyle changes designed to bring blood pressure down.
A referral to a pediatric nephrologist may be recommended for children and adolescents with hypertension.
References
Baker-Smith CM, Flinn SK, Flynn JT, et al. Subcommittee on screening and management of high BP in children. Diagnosis, evaluation, and management of high blood pressure in children and adolescents. Pediatrics. 2018;142(3):e2018-e2096. PMID: 30126937
Coleman DM, Eliason JL, Stanley JC. Renovascular and aortic developmental disorders. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 132.
Hanevold CD, Flynn JT. Hypertension in children: diagnosis and treatment. In: Bakris GL, Sorrentino MJ, eds. Hypertension: A Companion to Braunwald's Heart Disease. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 17.
Macumber IR, Flynn JT. Systemic hypertension. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 472.
Version Info
Last reviewed on: 7/3/2022
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
