PEDIATRIC HYPERTENSION: SHOULD YOUR CHILD BE TREATED?
The prevalence of hypertension in children is increasing and is often undertreated. In the United States, 3.34 million children have this condition. While there is no clear cause, many consider this to be related to the obesity epidemic. Most research studies are limited, and treatment guidelines are based on those for adults.
BP category | Age <13 y* | Age ≥13 y |
Normal BP | <90th percentile for age, sex, and height | <120/<80 mm Hg |
Elevated BP | 90th–<95th percentile for age, sex, and height | ≥120/<80 to 129/<80 mm Hg |
Stage 1 hypertension | ≥95th percentile–95th percentile plus 11 mm Hg | 130–139/80–89 mm Hg |
Stage 2 hypertension | ≥95th percentile plus 12 mm Hg | ≥140/≥90 mm Hg |
BP indicates blood pressure.
*
Hypertension in children is often not treated for several reasons, including using the wrong cuff size; parents and clinicians often blame high readings on stress. Treatment with medication should be started in children who have symptoms and when there is evidence of end-organ damage. This includes enlargement of the left side of the heart. This can be detected through an echocardiogram. Blood and urine tests can also detect damage. Children with diabetes mellitus or chronic kidney disease should receive treatment.
Lifestyle modification is reasonable with mild hypertension; however, if blood pressure is still not adequately controlled after 6 months, medication should be started.
RISK FACTORS
Children over the age of 6 who are overweight or obese are at higher risk of developing hypertension. This also puts them at risk of developing heart disease and diabetes in adulthood. Other risks include:
Prematurity
Low birth weight
Congenital heart disease
Kidney disease
Family history
Diet high in salt
Black/Hispanic
Male
Exposure to secondhand smoke
Certain medication; stimulants, corticosteroids
SYMPTOMS
Hypertension is, known as the silent disease; however, symptoms that indicate a hypertensive emergency and need emergency treatment include:
Headache
Seizures
Chest pain
Vomiting
Fast heart rate
Shortness of breath
TREATMENT
Treatment goals are to reduce blood pressure to below the 90th percentile. Many types of medications are used, and each works in different ways. It is not unusual for more than one medication to be prescribed. It is important to be aware of side effects, proper administration, and the need for close follow-up with your healthcare provider. Referrals to heart and/or kidney specialists are often made if treatment goals are not met.
CONCLUSIONS
Children with high blood pressure are more likely to have this condition as adults. If left untreated, serious complications such as stroke, heart attack, heart failure, or kidney disease can occur. Consumption of fruits, vegetables, nuts, and grains and reduced intake of processed foods, salt, and sugar are associated with improved cardiovascular health. Increased physical activity and reduced screen time lower blood pressure in children with obesity.
REFERENCES
Ferguson MA. Medication Treatment of High Blood Pressure in Children [Internet]. Merck Manual Consumer Version. Merck Manuals; 1446 [cited 2026 Jul 4]. Available from: https://www.merckmanuals.com/home/children-s-health-issues/high-blood-pressure-in-children/medication-treatment-of-high-blood-pressure-in-children?query=medications%20for%20hypertension%20in%20children&_gl=1
Slpete H. id hypertension undertreated in pediatrics. medscape.com. 2026.
High blood pressure in children [Internet]. mayoclinic.org. 2021 [cited 2026 Jun 15]. Available from: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure-in-children/symptoms- causes/syc-20373440
Pediatric Hypertension [Internet]. www.hopkinsmedicine.org. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/high-blood-pressure-hypertension/pediatric-hypertension
Faulkner, Bonita. Pediatric primary hypertension: an underrecognized condition: a scientific statement from the American Heart Association. ahajournals.org. 2023.
