Diagnosing Hypertension in Children

Shobha Natarajan, MD


May 02, 2016

Editorial Collaboration

Medscape &

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My name is Dr Shoba Natarajan, a cardiologist at The Children's Hospital of Philadelphia (CHOP). At our recent conference, Cardiology 2016, I had the opportunity to speak about evaluation and management of systemic hypertension in the pediatric patient.

Hypertension, along with such significant risk factors as obesity, diabetes, and hypercholesterolemia, puts adults at risk for significant adverse events, including heart attack and stroke. Unfortunately, obesity is a growing problem in children, and along with this trend, hypertension is increasing in children and adolescents.

In addition, hypertension places patients with certain chronic medical conditions (eg, solid organ transplantation, congenital heart defects, cancer treatment survivors, Kawasaki disease with coronary artery involvement) at risk for accelerated atherosclerosis and other complications.

Fortunately, if we diagnose hypertension early, we can treat it and hopefully improve long-term outcomes. Therefore, it is important to measure right arm blood pressure at every well-child visit. Blood pressures above the 90th or 95th percentile on three separate occasions can be a sign of [prehypertension or] hypertension. In addition, symptomatic, or stage 2, high blood pressure is diagnostic of hypertension. The appropriate workup and treatment can be initiated, as well as evaluation for target organ damage.

Tables for normal blood pressure by age, sex, and height are available in "The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents."[1]

A healthy, low-salt diet and regular exercise are key components of the treatment of hypertension, especially in the setting of obesity. These lifestyle changes require the whole family to be involved in helping the child reach these goals. Anti-hypertension medication should be initiated in those who fail nonpharmacologic therapy, have target organ damage, or have symptomatic stage 2 hypertension.

Hypertension is on the rise in children and adolescents, and early recognition leads to successful treatment. Long-term studies are needed to follow these children into adulthood and to understand the full impact of our efforts.