Hypertension in Children: Causes, Management, and Outlook

The Centers for Disease Control and Prevention (CDC) shares that roughly 1 in 25 kids in the United States — about 1.3 million — ages 12 to 19 have hypertension. This number increases to 1 in 10 if you include elevated blood pressure, previously called prehypertension. Kids in this age group tend to have high blood pressure due to lifestyle factors, like diet and physical activity.

Other researchers estimate that between 4.7 and 19.4 percent of children have high blood pressure. This number depends on a child’s sex, race, body mass index, genetic predisposition, and other factors. For example, studies show that 20 percent of children with obesity may have hypertension.

Statistics regarding pediatric hypertension may change over time as the clinical definition of hypertension has evolved over the years. Researchers agree, though, that rates of childhood obesity are closely linked to rates of childhood hypertension in the United States.

The clinical definition of hypertension in children varies depending on a child’s age, height, and sex. For your child to be diagnosed with hypertension, their blood pressure reading must greater than or equal to the 95th percentile of kids of the same age, height, and sex. Not only that, but the reading must meet that mark at three separate office visits.

Adolescents ages 13 and older share the same diagnostic criteria as adults. So, in this group, blood pressure readings must be 130/80 mm Hg or higher to be diagnosed.

Note: The first (or top) number is the systolic pressure, or the pressure inside artery walls when the heart is beating. The second (or bottom) number is the diastolic pressure, or the pressure inside artery walls between heartbeats.

There are two types of hypertension in children.

Primary hypertension is becoming increasingly common in children, but it’s still more likely to affect teens and adults. It’s often due to lifestyle factors or genetics. Older and heavier children are more likely to have primary hypertension.

Risk factors for primary hypertension in children include:

There is evidence that Black children and teens (especially boys) are at higher risk of hypertension, just like Black adults.

Your child will need further evaluation to determine the cause of hypertension. This may include a visit to a cardiologist for an electrocardiogram (EKG) or echocardiogram. They may also require testing like urinalysis or bloodwork to check for kidney function.

Secondary hypertension is more common in children than adults. In these cases, underlying health conditions or certain medications elevate your child’s blood pressure.

Associated conditions include:

Drugs or medications that can contribute to high blood pressure include:

Untreated high blood pressure can lead to various health complications as your child grows. The CDC explains that any cardiovascular disease that begins in childhood may be more likely to continue into adulthood.

Complications in adults include:

High blood pressure doesn’t always produce signs or symptoms. In fact, experts say it’s rare to have symptoms with hypertension. Some sources even give high blood pressure the moniker “silent killer” as a result.

That said, when blood pressure is very high (hypertensive crisis), your child may experience any of the following symptoms:

• headache
• seizures
• visual issues
• nausea or vomiting
• chest tightness or pain
• heart palpitations

When is it an emergency?

A hypertensive crisis is a medical emergency. If your child is experiencing these symptoms, it’s important to get medical care as soon as possible.

The treatment goal with hypertension is to get a child’s blood pressure under the 90th percentile for age, height, and sex. For teens, the goal is to get blood pressure under 130/80 mm Hg.

To treat primary hypertension, your child’s pediatrician may first recommend lifestyle changes over 3 to 6 months. They may suggest:

• weight loss
• regular exercise
• a healthy diet
• a lower sodium intake

Antihypertensive medication is another option your pediatrician may suggest if lifestyle changes alone do not lower your child’s blood pressure. Options include:

• angiotensin-converting enzyme (ACE) inhibitors
• angiotensin receptor blockers
• calcium channel blockers
• thiazide diuretics

These drugs are considered safe for children.

Experts share that there is no consensus on the exact drug to start with when treating high blood pressure in children. Instead, doctors choose on a case-by-case basis. Your child’s pediatrician will usually start with the lowest dose possible and increase it every 2 to 4 weeks as necessary.

Treatment for secondary hypertension may need other evaluations and treatment by specialists.

You can’t always prevent hypertension. Some cases are the result of underlying health issues or medication use. If your child has risk factors for health conditions that cause hypertension, be sure to speak with your doctor about monitoring your child’s blood pressure to catch issues sooner rather than later.

In cases where high blood pressure is due to obesity, diet, or inactivity, the following lifestyle measures may help:

• Eat a balanced diet. The CDC recommends a diet with plenty of fresh fruits and vegetables and less sugar and excess fats. Reducing sodium intake may also help, but speak with a doctor about the appropriate salt intake for your child based on age and weight.
• Engage in physical activity. Activities like walking, running, biking, and playing sports help keep kids moving each day. How much exercise to get is based on age. In general, kids between the ages of 6 and 17 should aim for at least an hour of active time each day.
• Maintain a moderate weight. Speak with your child’s doctor if you have concerns about your child’s weight. Your doctor can help create a plan to help your child achieve a weight within the recommended range for their age, height, and sex.

If you have questions or concerns about your child’s blood pressure, consider writing them down and taking them to your next appointment.

How often should I check my child’s blood pressure?

The American Heart Association recommends checking your child’s blood pressure every year starting at age 3. This can happen during their annual physical exam. Some doctors may take your child’s blood pressure reading at each visit.

You may also speak with your pediatrician about checking your child’s blood pressure more frequently if needed. You may want this if your child has an underlying health condition, is on certain medications, or has other risk factors.

If taking your child’s blood pressure at home, it’s important to use the correct sized cuff. A poor-fitting cuff may skew the results.

Does high blood pressure run in families?

Yes. Hypertension can be a genetically inherited condition, which means it can run in families. When it does, doctors refer to it as familial hypertension. Beyond that, the CDC suggests that people in the same household may be more likely to develop hypertension due to shared lifestyle factors, like diet, physical activity, and sleep habits.

Why does my child need to see a kidney specialist if they have hypertension?

High blood pressure affects the kidneys. Also, high blood pressure is a common symptom in children with chronic kidney disease.

Over time, hypertension may affect kidney function, making it difficult to flush bodily fluids and waste products. This may create a cycle of increased blood pressure levels and further reduced kidney function.

If your child’s blood pressure is high, a pediatrician may suggest making an appointment with a kidney specialist (nephrologist) for further evaluation.

Hypertension is a medical issue that increasingly affects children in the United States. High blood pressure may have no symptoms, so it’s important to have a yearly screening at your child’s checkup. You may want to measure their blood pressure more regularly if your child has additional risk factors.

With prompt treatment and lifestyle modifications, you can help your child avoid further health issues associated with high blood pressure as they grow.