What is hypertension?
Table: Levels of Severe Hypertension (95th Percentile) for Boys and Girls
What causes hypertension?
How is secondary hypertension diagnosed?
How is childhood hypertension treated?
What is the goal of hypertension treatment?
Albert P. Rocchini, M.D.
Professor of Pediatrics
University of Michigan
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).
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
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
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
Other antihypertensive agents used to treat refractory hypertension include centrally-acting
drugs (e.g., Clonidine, Guanabenz), alpha-blockers, and vasodilators (e.g., hydralazine,
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
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
Sinaiko AR. Pharmacologic management of childhood hypertension. Pediatr Clin North
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
Copyright 2012 Albert P. Rocchini, M.D., All Rights Reserved