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Screening & Treating Kids for High Blood Pressure: AAP Report Explained

​We usually think of high blood pressure—also known as hypertension—as a problem that affects adults. But, in fact, the condition can be present at any age.

An estimated 3.5% of all children and teens in the United States have high blood pressure, however, the condition often goes undetected and untreated.

Early Detection is Key

If high blood pressure isn't identified at a young age, it could go undiagnosed for years—eventually leading to organ damage and other health problems, like coronary artery disease, in adulthood.

The American Academy of Pediatrics (AAP) report, Clinical Practice Guidelines for the Screening and Management of High Blood Pressure in Children and Adolescents, gives pediatricians a simpler screening table to follow that identifies blood pressures needing further evaluation.

How blood pressure is measured?

The term blood pressure actually refers to two separate measurements:

  • Systolic blood pressure is the highest pressure reached in the arteries as the heart pumps blood out for circulation through the body.

  • Diastolic blood pressure is the much lower pressure that occurs in the arteries when the heart relaxes to take blood in between beats.

If either or both measurements are above the range found in healthy people of the same age and sex, it's called hypertension.

Screening Kids for High Blood Pressure 

It's a difficult diagnosis in kids since blood pressure can be affected by many factors, such as height, age and sex. The AAP and the National Heart, Lung and Blood Institute both recommend that children have yearly screenings for high blood pressure, starting at age 3, at their annual well-child visits.

  • If your child's blood pressure is high, he or she will typically be asked to come back a week later to see if the high readings persist.

  • If your child has elevated readings in three consecutive visits, he or she should have an evaluation for the cause of hypertension and risk of organ injury.

Infants who were preterm, or of low birth weight, who had a difficult or long hospital stay may need blood pressure screenings sooner than age 3. Children who have congenital heart disease, who are receiving medications that might increase blood pressure, or who have other medical conditions may also be at a greater risk of high blood pressure.

Tip for parents: Remember to ask your pediatrician if he or she measured your child's blood pressure, and if so, if it was a concerning reading.

What are the Causes?

High blood pressure in children is almost always asymptomatic—that is, without any symptoms or noticeable discomfort.

In many cases, high blood pressure seems to develop with age. As a result, a child may show no signs of high blood pressure as an infant, but may develop the condition as he or she grows.

By age 7, more than 50% of hypertension is due to obesity; this rises to 85-95% by the teenage years. Thus, good eating habits (without overeating and emphasizing foods low in sodium, low in added sugar and high in fruits and vegetables) and plenty of physical activity are important throughout the early years of childhood (and for the rest of life).

When high blood pressure becomes severe in children, it may be a symptom of another serious problem, such as kidney disease or abnormalities of the heart or of the nervous or endocrine (gland) system.

Diagnosing High Blood Pressure in Children​

If your child's blood pressure is high, your pediatrician may recommend tests to see if there is an underlying medical problem causing it. These tests include studies of the urine and blood. Sometimes, ultrasounds are used to examine the heart or the kidneys. If no medical problem can be found, your child will be diagnosed with essential hypertension—the word essential refers only to the fact that no cause could be found.

About essential hypertension:

In most children and adolescents, no specific cause is found for hypertension. Doctors take into account the child's medical history (other diagnoses like kidney disease), family history (heritability of hypertension is about 50%),  risk factors such as low weight at birth, and whether the child is currently overweight.

Management & Treatment 

The first-line treatment for high blood pressure in children remains lifestyle changes.

  • If obesity is a possible cause, the first step will be to have your child lose weight. This will need to be very closely monitored by your pediatrician. Not only will weight loss lower blood pressure, it can provide many other health benefits as well.

  • Limit the salt in your child's diet. Giving up the use of table salt and restricting salty foods can lower blood pressure in some patients. Common sources of salty foods include bread, deli meats, pizza, and foods prepared outside the home.   

  • Use caution when shopping for packaged foods. Most canned and processed foods contain a great deal of salt, so check labels carefully to make sure the items have little or no salt added.

  • Help your child get more aerobic exercise. Aerobic physical activity can lower blood pressure, because of its effect on blood vessels and the heart—even when patients do not lose weight. The AAP recommends 60 minutes of physical activity each day.

About blood pressure-lowering medications:

If lifestyle changes do not work, or if the blood pressure is very high, a more aggressive approach is needed. The AAP guidelines recommend pediatricians start blood pressure-lowering medications if lifestyle changes fail to reduce your child's blood pressure, or your child has another condition like diabetes or kidney disease.

There are a variety of anti-hypertensive medications that have been tested and proven to be safe in the short- and long-term. The number of children who will end up with prescriptions for anti-hypertensive medications is small, about 1% or less.

Long-term care:

Once your pediatrician knows your child has high blood pressure, he or she will want to check it frequently to make sure the hypertension is not becoming more severe. Depending on how high the blood pressure is, your pediatrician may refer your child to a specialist—usually a pediatric nephrologist (kidney specialist) or pediatric cardiologist (heart specialist).

Additional Information & Resources:

Last Updated
American Academy of Pediatrics (Copyright © 2017)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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