Does This Child Have High Blood Pressure?

High blood pressure has been considered an adult disease but is increasingly seen in young people. High blood pressure during childhood is highly correlated with hypertension in adulthood, making screening, diagnosing and managing pediatric hypertension more important than ever.

Blood pressure screening is a required component of Texas Health Steps preventive medical checkups beginning at age 3 years. Taking accurate measurements for children and adolescents requires proper technique and use of appropriately sized blood pressure cuffs. Taking an accurate reading is just the first step in determining whether a young person needs further evaluation and potential treatment for hypertension.

Pediatric hypertension should not be diagnosed after just one blood pressure reading. Staging of pediatric blood pressure is based on readings taken on at least three different occasions and is based on age, height and sex percentiles from the American Academy of Pediatrics “Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents” (AAP, 2017).

The following table provides a quick screening tool to determine if further evaluation is needed. Review the table and then take the Quick Quiz.

Blood Pressure Screening Values that Require Further Evaluation for Boys and Girls

Age in Years	Blood Pressure, mm Hg
	Boys		Girls
	Systolic	Diastolic	Systolic	Diastolic
1	98	52	98	54
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

Quick Quiz

Your staff routinely takes blood pressure readings as part of medical checkups. You receive the following measurements for three young patients:

Adam 4-year-old boy

111/65

Brianna9-year-old girl

107/70

Christina12-year-old girl

118/78

Based on the AAP chart shown above, which of the children require additional evaluation for potential high blood pressure?

Adam

This answer is correct, but there is also another child to consider.

Adam and Christina have readings >90^th percentile for their age and sex. You should make arrangements to take additional readings during the appointment to determine whether their blood pressure is truly elevated and to define the blood pressure category.

Brianna

This answer is incorrect.

Brianna’s reading, while elevated for a boy at the same age, is considered in the normal range for her age and height.

Christina

This answer is correct, but there is also another child to consider.

Why It Matters

Early identification of elevated blood pressure and appropriate management, including lifestyle interventions and medication when indicated, can prevent serious chronic health conditions from developing. Your understanding of blood pressure screening, staging and management can help young people and their families live healthier lives.