An elevated blood pressure level in a child is defined as a blood pressure that is above the 90th percentile for age and sex. Although the finding of an elevated blood pressure on physical examination constitutes an abnormal sign, it does not mean that hypertension (i.e., sustained blood pressure elevation) is persistent. Most pediatricians recommend that for a child to be diagnosed with hypertension the blood pressure must be abnormal (above the 95th percentile rank of age and sex) on at least 3 separate examinations over a 6- to 12-month interval (see table). The only exception is if at the time of the initial examination the child has signs and/or symptoms commonly found with severe hypertension (e.g., heart muscle enlargement, headache, dizziness, seizures, eye and vision damage).
|Age (years)||Systolic BP||Diastolic BP||Systolic BP||Diastolic BP|
Once a child is diagnosed with hypertension, its cause must be determined. The two major types of hypertension are as follows:
A thorough history and physical examination is essential in evaluating a child with secondary hypertension
In the history, the following significant points should be addressed:
The physical examination should include the following:
The only routine laboratory tests that should be performed are as follows: urine dipstick, blood electrolytes, blood urea nitrogen, and creatinine. Other laboratory tests should be ordered based on both the history and the physical examination.
All children with significant, sustained hypertension should be treated. The treatment of hypertension is divided into two major categories: hypertensive crisis and chronic hypertension.
Until recently, diuretics and beta-blockers were the most commonly used drugs to treat childhood hypertension. However, most pediatricians are now reluctant to use them because of evidence suggesting that these agents may adversely affect plasma lipids and insulin sensitivity. Beta-blockers also can cause depression and impair school performance.
Other antihypertensive agents used to treat refractory hypertension include centrally-acting drugs (e.g., Clonidine, Guanabenz), alpha-blockers, and vasodilators (e.g., hydralazine, minoxidil).
The goal of therapy is to keep the child's blood pressure below the 90th percentile for age and sex. Parents must be taught not only to monitor their child's blood pressure at home, but also to monitor for signs of medication-induced side effects.
Successful therapy should not interfere with the child's academic performance, involvement in sports, or interest in social activities. Participation in team sports should be encouraged unless there is clear evidence of heart dysfunction.
Once the child's blood pressure is under good control, the child should be evaluated (at least) on an annual basis to assess cardiac status, physical growth and development, and sexual maturation patterns.
Report of the Second Task Force on Blood Pressure Control in Children. Pediatrics 1987;79(1):1-25.
Sinaiko AR. Pharmacologic management of childhood hypertension. Pediatr Clin North Am 1993;40(1):195-212.
Falkner B. Management of hypertensive children and adolescents. In: Izzo JL, Black HR, eds. Hypertension primer: the essentials of high blood pressure. 2nd ed. American Heart Association, 1999:424.
About the Author
Dr. Rocchini received both his bachelor of science degree in chemical engineering and his medical degree from the University of Pittsburgh. He completed his pediatric residency at the University of Minnesota and his pediatric cardiology fellowship at the Children's Hospital of Boston. Dr. Rocchini is currently a professor of pediatrics and serves as director of pediatric cardiology at the University of Michigan. His research interests include interventional cardiac catheterization and obesity-induced hypertension.
Copyright 2012 Albert P. Rocchini, M.D., All Rights Reserved
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