Pediatric Hypertension

Background

Hypertension in the pediatric population is now commonly observed. Hypertension is known to be a major cause of morbidity and mortality in the United States and in many other countries, and the long-term health risks to children with hypertension may be substantial. In the United States, extensive normative data on blood pressure (BP) in children are available.

The Task Force on Blood Pressure Control in Children, commissioned by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), developed standards for BP by using the results of 11 surveys of more than 83,000 person-visits of infants and children (including approximately equal numbers of boys and girls). The percentile curves were first published in 1987 and describe age-specific distributions of systolic and diastolic BP in infants and children, with corrections for height and weight.

The Third Report of the Task Force, published in 1996, provided further details regarding the diagnosis and treatment of hypertension in infants and children.
In 2004, the Fourth Report added normative data and adapted the data to growth charts from the Centers for Disease Control and Prevention (CDC) for 2000.
In accordance with the recommendations of the Task Force, BP is considered normal when the systolic and diastolic values are less than the 90th percentile for the child’s age, sex, and height.

The Fourth Report introduced a new category, prehypertension, which is diagnosed when a child’s average BP is above the 90th percentile but below the 95th. Any adolescent whose BP is greater than 120/80 mm Hg is also given this diagnosis, even if the BP is below the 90th percentile. This classification was created to align the categories for children with the categories for adults from the recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7).

Stage I hypertension is diagnosed if a child’s BP is greater than the 95th percentile but less than or equal to the 99th percentile plus 5 mm Hg. Stage II hypertension is diagnosed if a child’s BP is greater than the 99th percentile plus 5 mm Hg. It may be categorized as prehypertension if the BP is between 90th to 95th percentile.

If the systolic and diastolic pressures give rise to a discrepancy with respect to classification, the child’s condition should be categorized by using the higher value. Table 1 (see below) serves as a guide to the practicing physician. Full blood pressure tables for children and adolescents are available from the NHLBI.

Table 1. Ninety-Fifth Blood Pressure Percentiles for 50th and 75th Height Percentiles in Children and Adolescents
(Open Table in a new window)