What is pediatric hypertension? Does it really affect children? How can you know if your child is hypertensive?

Understanding Pediatric Hypertension

Hypertension is the sustained elevation in blood pressure, meaning it is diagnosed when one’s blood pressure is higher than normal on repeated measurements over time. In childhood and adolescence, blood pressure normally increases with age and height. So, a normal blood pressure value for your child will change each year, just as the normal values for their height and weight will change.

A child or adolescent is diagnosed with hypertension when their average blood pressure is at or above the 95th percentile for their age, sex and height when measured multiple times over three visits or more.

The Rise of Pediatric Hypertension

Yes, children can indeed develop hypertension, and it is a growing concern. Over the last 30 to 40 years, pediatric hypertension in the United States has increased fourfold. Currently up to 4.5 percent — or 3.34 million — of children in the United States have this condition. Recent American Heart Association heart disease and stroke statistics suggest the number affected may be higher, estimating that 15 percent of adolescents have abnormal blood pressure.

While the reason for the increase in pediatric hypertension is not entirely clear, many consider it to be due to the coincident obesity epidemic. Since 1980, the prevalence of obesity among children and adolescents has almost tripled. Thirty-two percent of children in the United States are now overweight or obese. Further, when only considering this group of at-risk children, the estimated proportion of children afflicted with hypertension is much greater, ranging from 20 percent to 47 percent.

Identifying Hypertension in Children

How can you know if your child is hypertensive? Your child should have his or her blood pressure measured at least once yearly, ideally at every well-child visit. This is because normal blood pressure values change as a child grows, so it’s important to compare your child’s readings to the appropriate age, sex, and height-specific percentiles.

The Importance of Regular Monitoring

Regular blood pressure monitoring is crucial, as hypertension in children often has no obvious symptoms. Many children with high blood pressure feel completely well and have no outward signs of the condition. If left undiagnosed and untreated, pediatric hypertension can lead to serious complications down the road, such as heart disease, stroke, and kidney damage.

Treatment and Management

The good news is that pediatric hypertension is often treatable. Lifestyle modifications, such as weight loss, increased physical activity, and a healthy diet, can be effective first-line treatments. In some cases, medication may also be necessary to control blood pressure. It’s important to work closely with your child’s healthcare provider to develop the right treatment plan.

Preventing Pediatric Hypertension

Given the rising prevalence of pediatric hypertension, prevention is key. Encouraging healthy habits early on, such as maintaining a balanced diet, engaging in regular physical activity, and maintaining a healthy weight, can go a long way in keeping your child’s blood pressure in the normal range. Regular checkups and monitoring with your child’s healthcare provider are also essential for catching any issues early.

What should you do if you suspect your child may be hypertensive?

If you suspect your child may have high blood pressure, the most important thing to do is to have their blood pressure checked regularly by their healthcare provider. This is the only way to accurately diagnose and monitor hypertension in children. Don’t hesitate to discuss any concerns you have about your child’s blood pressure with their doctor.

How can obesity contribute to pediatric hypertension?

Obesity is a major risk factor for the development of hypertension in children. Excess weight, particularly around the abdomen, can increase the workload on the heart and lead to high blood pressure. The rise in pediatric hypertension has largely coincided with the increase in childhood obesity rates over the past few decades.

What are the potential complications of untreated pediatric hypertension?

If left undiagnosed and untreated, pediatric hypertension can lead to serious long-term health consequences, including an increased risk of heart disease, stroke, and kidney damage later in life. That’s why regular monitoring and early intervention are so important.

How can lifestyle changes help manage pediatric hypertension?

For many children with hypertension, lifestyle modifications like weight loss, increased physical activity, and a healthy diet can be effective first-line treatments. These changes can help lower blood pressure and reduce the risk of complications. Working closely with your child’s healthcare provider is key to developing the right management plan.

AAP Pediatric Hypertension Guidelines – MDCalc

IMPORTANT

This tool has been developed in partnership with the American Academy of Pediatrics. The authors, editors, and contributors are expert authorities in the field of pediatrics. No commercial involvement of any kind has been solicited or accepted in the development of the content of this tool. Advertising does not influence editorial decisions or content. The appearance of advertising on MDCalc sites is neither a guarantee nor an endorsement by the AAP of the product, service, or company, or the claims made for the product in such advertising.

INSTRUCTIONS

Use in children aged 1-17 years. Not for use in patients with low blood pressure. Recommendations are based on AAP’s 2017 Clinical Practice Guideline (Table 3). Note that cutoffs reported in the calculator may vary slightly from the published tables, as the calculator accommodates for ages between whole numbers (e.g. 5.5 years), and the tables use simplified values to account for ages between whole numbers. For children ≥13 years of age, this calculator has been adjusted to meet definitions presented in the 2017 AHA/ACC hypertension guidelines for adults. 

When to Use

Pearls/Pitfalls

Why Use

Age

Decimal values recommended (e.g. for a child who is 5 years and 6 months, enter 5.5)

Sex

Female

Height

Systolic BP

Normal values are age-dependent; do not use this calculator in patients with hypotension

Diastolic BP

Normal values are age-dependent; do not use this calculator in patients with hypotension

Result:

Please fill out required fields.

Dr. Bernard Rosner

About the Creator

Bernard Rosner, PhD, is a professor of biostatistics at the Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women’s Hospital. His work has had cardiovascular, pulmonary, ophthalmologic, oncologic, and nutritional applications. Dr. Rosner’s primary research interests involve statistical modeling of longitudinal data, analysis of clustered continuous, binary, and ordinal data, and methods for the adjustment of regression models to address measurement error.

To view Dr. Bernard Rosner’s publications, visit PubMed

Dr. Joseph T. Flynn

About the Creator

Joseph T. Flynn, MD, MS, is a professor of pediatrics at the University of Washington School of Medicine, where he holds the Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology. He is also chief of the division of nephrology at Seattle Children’s Hospital, and has served as president of the American Society of Pediatric Nephrology, on the Working Group of the National High Blood Pressure Education Program, and as co-chair of an American Academy of Pediatrics committee focused on childhood hypertension. Dr. Flynn’s research interests involve the epidemiology and treatment of childhood hypertension, as well as cardiovascular complications of pediatric chronic kidney disease.

To view Dr. Joseph T. Flynn’s publications, visit PubMed

About the Creator

Dr. Bernard Rosner

Are you Dr. Bernard Rosner?

Dr. Joseph T. Flynn

Are you Dr. Joseph T. Flynn?

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Content Contributors

• Sneha Daya, MD

Pediatric Hypertension | Johns Hopkins Medicine

What is hypertension?

Hypertension is the sustained elevation in blood pressure, meaning it is diagnosed when one’s blood pressure is higher than normal on repeated measurements over time. In childhood and adolescence, blood pressure normally increases with age and height. So, a normal blood pressure value for your child will change each year, just as the normal values for their height and weight will change.

A child or adolescent is diagnosed with hypertension when their average blood pressure is at or above the 95th percentile for their age, sex and height when measured multiple times over three visits or more.

Do children really get hypertension?

Yes, and pediatric hypertension is on the rise. Over the last 30 to 40 years, pediatric hypertension in the United States has increased fourfold. Currently up to 4.5 percent — or 3.34 million — of children in the United States have this condition. Recent American Heart Association heart disease and stroke statistics suggest the number affected may be higher, estimating that 15 percent of adolescents have abnormal blood pressure.

While the reason for the increase in pediatric hypertension is not entirely clear, many consider it to be due to the coincident obesity epidemic. Since 1980, the prevalence of obesity among children and adolescents has almost tripled. Thirty-two percent of children in the United States are now overweight or obese. Further, when only considering this group of at risk children, the estimated proportion of children afflicted with hypertension is much greater, ranging from 20 percent to 47 percent.

How do I know if my child is hypertensive?

Your child should have his or her blood pressure measured at least once yearly, ideally at each health care encounter. If your child’s blood pressure is at or above the 90th percentile, testing should be repeated three times, ideally by manual auscultation (using a stethoscope and a blood pressure cuff inflated by hand). If the average of these three measurements is at or above the 95th percentile, your child should return to his or her health care provider for repeat measurements to confirm that their blood pressure is high. If the average blood pressure is less than the 95th percentile but greater than or equal to the 90th percentile (or greater than or equal to 120/80), then your child is prehypertensive and is at risk for developing hypertension. He or she should return in six months for repeat blood pressure measurements to screen for the development of hypertension.

Any child with an average blood pressure at or above the 95th percentile from multiple readings taken over several visits has hypertension.

Does being overweight impact my child’s blood pressure?

Yes. Children who are overweight or obese are more likely to be hypertensive. In addition, being overweight is sometimes the sole cause of a child or adolescent being hypertensive. Individuals who are overweight are also more likely to have other risk factors for heart disease like high cholesterol, diabetes and left ventricular hypertrophy (abnormal thickening of the heart). It is for this reason that ALL children with hypertension should develop heart healthy behaviors.

Why do children with hypertension have to see a nephrologist?

Hypertension in children is often a symptom of another condition or illness. Because of this, all children with hypertension should undergo an evaluation to search for an underlying cause. Kidney disease is a main cause of high blood pressure and hypertension in children, which is why nephrologists are the providers who evaluate and treat this condition in children.

Children who are diagnosed with hypertension should undergo blood and urine testing and kidney and bladder imaging, as well as imaging of the heart.

How do you treat hypertension in children?

Treatment of hypertension in children should focus on the underlying cause and on the institution of a heart healthy lifestyle. Children and their families should adopt a lifestyle that includes the following:

• Weight loss if overweight
• Daily aerobic exercise:
  • Aim for 60 minutes or more of moderate to vigorous activity every day — choose an activity that gets your heart pumping like running, soccer, tennis or jumping jacks.
• Minimal sedentary activities:
  • Limit activities such as computer/video/tablet games and TV watching to less than two hours per day.
• Regular daily intake of fresh vegetables, fruits and low-fat dairy
• Minimal to no sugar-sweetened drinks:
  • Eliminate empty calorie drinks like juice, soda and sweet tea.
  • Increase water intake.
• Avoidance of foods high in salt:
  • Aim for no more than 1,500 mg sodium per day.
  • Take the salt shaker off the table!
• Choose low cholesterol food options:
  • Limit cholesterol intake to less than 300 mg each day.
• Stop smoking.

Some children will require medication to treat their blood pressure as well. Children who require blood pressure medication are those with a secondary cause identified, those who are symptomatic from their hypertension, those who also have a diagnosis of diabetes or evidence of organ damage from the hypertension (i.e., left ventricular hypertrophy — abnormal heart thickening) and those who continue to have hypertension after six months of implementing lifestyle changes.

What can I do to prevent my child from developing hypertension?

Because hypertension in children is often secondary to an underlying disease or condition, hypertension can often only be prevented in as much as the underlying condition can be prevented. In many other cases, hypertension can be prevented by adhering to a heart healthy lifestyle that includes a low-fat, low-sodium diet rich in fruits and vegetables, with regular physical activity, avoidance of smoking and maintenance of a healthy body weight.

BP Conference 2023 — BP Conference 2023

18-20 APRIL 2023

Social partnership: pedagogical support for subjects of education

IX Interregional Scientific and Practical Conference 20

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We solve global problems online:

A regular meeting of educators, experts, business and the parent community to share experiences, innovative practices, search for resources and reliable partnerships.

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10 years of work.
more than 700 participants

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8 countries of the world.
18 regions of Russia

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8 compilations
310 scientific articles

OUR PURPOSE is to improve the quality of life and education of people with orphan experience. Since 2013, we have been bringing together leading experts from different countries, sharing discoveries, discussing and solving problems, accumulating experience and identifying new growth points.

What awaits the participants?

Information., Communication., Partnership.

Exchange of knowledge and practices

introduction to the best educational practices

Trends in the development of socio-pedagogical technologies

experience in solving educational problems in the field of orphanhood

Opportunities for social partnership

collaboration with experts and specialists in related fields

Who will be interested?

teachers of different levels of education

exchange of professional experience, communication with colleagues from different countries

young professionals

acquaintance and interaction with future colleagues and partners in solving common problems

active parent community

finding the best methods for the development, education and support of their own children

employees of non-profit organizations and social services

teamwork with colleagues in the sector

media

coverage of education issues for people in difficult life situations

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BIG CHANGE

ORPHAN SUPPORT

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Irina Ryazanova

Founder and Executive Director of the Charitable Foundation “Big Change”

Nina Nikolaevna Mikhailova

Ph. D. Sciences, Scientific Consultant of the Educational Center “Big Change”

Svetlana Lobyntseva

Candidate Ped. Sci., Deputy Director of the Educational Center “Big Change”

I hope that the conference will again have an open, lively dialogue, an informal exchange of views that will lead to the creation of long-term deep partnerships.

Irina Ryazanova

founder and executive director of the Big Change Charitable Foundation

EXPERTS

Oksana Oracheva

CEO of the Vladimir Potanin Charitable Foundation

Veronika Misyutina

Advisor to the Center for Wealth Management and Philanthropy of the Skolkovo Business School.

Sergey Kosaretskiy

Director of the Center for General and Additional Education of the Institute of Education of the Higher School of Economics National Research University, Candidate of Psychological Sciences, Associate Professor.

Irina Khromova

Associate Professor of the Department of Pedagogy and Psychology of the IIHSE Novosibirsk State Pedagogical University

Sergey Polyakov

Dr. ped. Sci., Professor, Department of Psychology, Ulyanovsk State Pedagogical University named after I.I. I.N. Ulyanova

Andrey Tsarev

Director of the State Budgetary Institution “Center for Curative Pedagogics and Differentiated Education”

Anna Bitova

Chairman of the Board of the RBOO “Center for Curative Pedagogics”, Member of the Council under the Government of the Russian Federation for Guardianship in the Social Sphere

Boris Kramarenko

Assistant Professor quarrels of the Department of Social and age pedagogy of the Kokshetau University. Sh. Ualikhanov”

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