High Blood Pressure in Children and Adolescents

(Affirmation of Value, February 2018)

The guideline, Screening and Management of High Blood Pressure in Children and Adolescents was developed by the American Academy of Pediatrics and categorized as Affirmation of Value by the American Academy of Family Physicians.

Key Recommendations:

Children and adolescents three years of age or older should have their blood pressured measured annually. Blood pressure checks should be performed at every health care encounter for children and adolescents who are obese, take medications that raise blood pressure, have renal disease, diabetes or a history of aortic arch obstruction or coarctation.
Hypertension should be diagnosed in children and adolescents who have auscultatory-confirmed blood pressure readings greater than the 95^th percentile, based on sex, age, and height tables, at three different visits.
Children and adolescents being evaluated for high BP should have a perinatal history, appropriate nutritional history, physical activity history, psychosocial history, and family history recorded and a physical examination to identify findings suggestive of secondary causes of hypertension. Electrocardiography should not be used for initial evaluation.
Children and adolescents who have been diagnosed with hypertension should be counseled regarding lifestyle modifications including diet and physical activity.
Children and adolescents who fail lifestyle modifications should be prescribed pharmacologic therapy. Treatment options may include an ACE inhibitor, ARB inhibitor, long-acting calcium channel blocker, or thiazide diuretic.
Treatment goals for children and adolescents who have been diagnosed with hypertension should be a reduction in blood pressure to less than the 90^th percentile and less than 130/80 in adolescents aged 13 years or older.

See the full guideline for more recommendations, blood pressure tables, and treatment algorithms.

The AAFP uses the category of “Affirmation of Value” to support clinical practice guidelines that provide valuable guidance, but do not meet our criteria for full endorsement. The primary reasons for not endorsing this guideline included:

There was a lack of transparency in the methodology used for study evaluation.
While recommendations based on expert opinion were identified, it was unclear how those recommendations were developed.
The management of conflicts of interest was not well described.
There was inadequate discussion of the potential harms of medications for long-term use in children.

More About Practice Guidelines

These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.