High Blood Pressure in Children

How does high blood pressure affect children?

Your blood pressure is the measurement of pressure or force inside your blood vessels as blood pushes through. High blood pressure means the force is higher than normal levels. High blood pressure is also called hypertension. High blood pressure in children and teens is called pediatric hypertension.

About 1 in 25 kids ages 12 to 19 have hypertension. About 1 in 10 has elevated blood pressure (formerly known as prehypertension).

High blood pressure is more common in boys and children assigned male at birth (AMAB) than girls and children assigned female at birth (AFAB). It’s also more common in Hispanic and non-Hispanic Black children compared to non-Hispanic white children.

High blood pressure is more common in children older than 12.

Over time, high blood pressure can damage a child’s organs because their heart and blood vessels aren’t delivering blood to their organs the way they should. This can damage a number of organs, including their heart, kidneys and eyes. Because of this, it’s essential to diagnose and treat pediatric hypertension as soon as possible.

What are the symptoms of high blood pressure in children and teens?

While hypertension can cause symptoms in severe cases, most children with high blood pressure have no symptoms. Healthcare providers usually discover it when checking a child’s blood pressure during a routine checkup.

This is one of the many reasons why it’s important for your child to have regular medical checkups, especially if they have risk factors for high blood pressure.

What causes high blood pressure in children and teens?

There are two main types, or causes, of pediatric high blood pressure:

• Primary hypertension.
• Secondary hypertension.

Primary hypertension in children

Primary hypertension is high blood pressure that doesn’t have one distinct cause. It’s also known as idiopathic or essential hypertension. General characteristics of children with primary hypertension include:

• Being age 6 or older.
• A family history of high blood pressure (biological parent or grandparent).
• Having overweight (a body mass index, or BMI, greater than 25) or obesity (a BMI greater than 30).

Primary hypertension is the most common form of high blood pressure in children.

Secondary hypertension in children

Secondary hypertension happens when there’s an underlying condition causing it.

Kidney (renal) disease and renovascular disease (the narrowing of the artery to one or both kidneys) are the most common causes of secondary hypertension in children. Specific kinds of kidney disease include:

• Renal parenchymal diseases, like glomerulonephritis, reflux nephropathy or pyelonephritis.
• Renal structural issues, like obstructive uropathy, polycystic kidney disease or dysplastic kidney.

These account for about 34% to 79% of secondary pediatric hypertension cases.

Other causes of pediatric secondary hypertension include:

• Congenital heart conditions, such as aortic coarctation.
• Hormonal imbalances (endocrine hypertension), like hyperthyroidism or catecholamine excess.
• Obstructive sleep apnea.
• Certain medications. Common prescription medications associated with a rise in blood pressure include birth control pills, central nervous system stimulants and corticosteroids.
• Genetic mutations (monogenic hypertension), such as Liddle syndrome or neurofibromatosis type 1.
• Environmental exposures, including exposure to lead, cadmium, mercury and phthalates.

What are the risk factors for high blood pressure in children?

Risk factors for high blood pressure in children and teens include:

• Overweight or obesity: Increased body fat may increase blood pressure by physically compressing your kidneys. Approximately 3.8% to 24.8% of youth with overweight or obesity have high blood pressure.
• Family history of high blood pressure: Your genetics can affect your blood pressure. Having one or more close biological family members with high blood pressure before the age of 60 means you have two times the risk of having it also.
• High-sodium diet: Salt (sodium) makes your body hold onto water. If you have excess amounts of salt in your diet, the extra water in your blood means there’s extra pressure on your blood vessel walls. This increases blood pressure.
• Lack of physical exercise: Regular exercise makes your heart stronger, which means it can pump more blood with less effort. If you don’t get regular exercise, your heart has to work harder to pump blood throughout your body. This can increase your blood pressure.
• Diabetes: Long-term high blood sugar can damage your blood vessels and kidneys, which can lead to an increase in blood pressure. Between 4% and 16% of children and adolescents with Type 1 diabetes have high blood pressure. Between 12% and 31% of children and adolescents with Type 2 diabetes have high blood pressure.
• Preterm birth and low birth weight: Recent research shows that these may be associated with high blood pressure in children.

If your child has no risk factors for high blood pressure, their provider will likely start measuring it at annual checkups, beginning at age 3. If your child does have risk factors, their provider may start checking blood pressure when your child is an infant.

How is high blood pressure in children diagnosed?

Healthcare providers diagnose high blood pressure differently in children than in adults because healthy blood pressure levels change as a child grows. High blood pressure in children occurs when a child’s blood pressure is equal to or higher than that of 95% of other children of the same age, sex assigned at birth and height.

Providers diagnose high blood pressure in children with multiple blood pressure readings. Most children should have their blood pressure taken at each well-care visit and some other problem-based visits.

To check blood pressure, a healthcare provider wraps a cuff called a sphygmomanometer on your child’s arm and places a stethoscope underneath it. The provider pumps the cuff full of air and then takes the reading as the air leaves the cuff.

Providers take several measurements before making a diagnosis of high blood pressure. This is because the stress of being in a provider’s office can cause blood pressure to rise in some people. It’s called white coat syndrome.

Determining the cause of high blood pressure

Your child’s healthcare provider will also try to determine the underlying cause of their high blood pressure. They’ll perform a physical exam and ask questions about your child’s medical history and lifestyle, such as your child’s:

• Existing medical conditions (if applicable).
• Symptoms (if applicable).
• Diet and eating patterns.
• Physical activity level.
• Family history of high blood pressure.

They may order certain tests to confirm or rule out underlying causes, such as:

• Blood tests, like a comprehensive metabolic panel (CMP), kidney function tests and hormone tests.
• Electrocardiogram (EKG) to assess your child’s heart health.
• Imaging tests to look at your child’s heart and/or kidneys.

What is normal blood pressure for kids?

For adolescents 13 years or older, normal blood pressure is when the systolic number (top number) is less than 120 and the diastolic number (bottom number) is less than 80 (120/80 mm Hg).

For younger children, normal blood pressure is when it’s less than the 90th percentile based on the child’s sex assigned at birth, age and height.

What is high blood pressure for kids?

Healthcare providers organize abnormal blood pressure into three categories:

• Elevated (formerly known as prehypertension).
• Stage 1 (moderate hypertension).
• Stage 2 (severe hypertension).

For children age 13 or older:

What’s considered high blood pressure in children 12 or younger depends on their age and other factors. Your child’s healthcare provider will have additional information on healthy blood pressure ranges for your child as they grow.

How is high blood pressure in children treated?

Treatment for high blood pressure depends on your child’s unique situation and the cause. In some cases, treating the underlying condition can also treat the high blood pressure.

The main treatment options are lifestyle changes and medication.

Lifestyle changes for pediatric hypertension

In most cases, healthcare providers first recommend lifestyle changes to treat high blood pressure in children, including:

• Eating a DASH diet: DASH stands for Dietary Approaches to Stop Hypertension. The DASH diet includes multiple servings of fresh vegetables and fruits, whole grains, nuts and legumes with some servings of lean protein foods. It involves limiting foods high in sodium, sugars and saturated fats. Your child’s provider will likely refer you to a registered dietitian for help with this.
• Increasing physical activity: Moderate to vigorous aerobic physical activity lasting 40 minutes a day for at least three to five days a week can help lower blood pressure.
• Managing stress: Stress, especially chronic stress, can increase blood pressure. Stress management tools like breathing exercises and meditation can help lower blood pressure.

Medication for pediatric hypertension

If the blood pressure is high enough or if lifestyle changes don’t lower your child’s blood pressure, your child’s provider may refer your child to a specialist or recommend medication to manage the condition. They typically start with the lowest dose possible. Medications include:

• ACE inhibitors.
• Angiotensin II receptor blockers (ARBs).
• Calcium channel blockers.
• Beta-blockers.
• Diuretics.

Each of these medications has certain side effects. Talk to your child’s healthcare provider about what to expect.

How can I prevent high blood pressure in my child?

There are a few steps your child can take to try to prevent high blood pressure, including:

• Maintaining a weight that’s healthy for them: Talk to your child’s healthcare provider about healthy weight ranges for your child’s age, sex assigned at birth and height.
• Limiting foods high in salt, saturated fat and sugar: Consistently consuming large amounts of these dietary substances can increase your child’s risk for high blood pressure.
• Aiming for 60 minutes a day of moderate to vigorous physical activity: This can help manage your child’s weight and helps reduce their risk of high blood pressure.
• Getting quality sleep: Encourage a healthy sleep routine for your child. Quality sleep is essential to overall health. If you suspect your child may have a sleep disorder, talk to their healthcare provider.
• Avoiding smoking, vaping (e-cigarettes) and secondhand smoke: Smoking and vaping increase blood pressure. Long-term exposure to secondhand smoke can also raise blood pressure.

Unfortunately, there’s nothing you can do to change certain risk factors, like family history. If you have a family history of high blood pressure, be sure to tell your child’s provider. They’ll likely recommend closer monitoring of your child’s blood pressure.

What can I expect if my child has high blood pressure?

In most cases, lifestyle changes and/or medication work well to manage blood pressure.

Untreated high blood pressure can damage your child’s organs, including their brain, heart and kidneys. High blood pressure can also continue into adulthood. Over time, this damage can lead to such complications as:

• Heart attack.
• Heart failure.
• Kidney failure.
• Stroke.

When should my child see their healthcare provider about high blood pressure?

If your child has received a high blood pressure diagnosis, they’ll need to see their healthcare provider regularly to monitor how well their treatment is working.

If you have any concerns about your child’s health, be sure to contact their provider.

What questions should I ask my child’s provider?

If your child has high blood pressure, you may want to ask your child’s provider the following questions:

• What caused my child’s high blood pressure?
• How serious is high blood pressure at this age?
• What’s the right treatment for my child?
• What can we do at home to lower my child’s blood pressure?

A note from Cleveland Clinic

You may be worried to learn that your child has high blood pressure. The good news is that it’s manageable with lifestyle changes and/or medication. Know that your child’s healthcare provider will be there to support you and your family to make healthy changes.