TABLE 5. Classification of Hypertension in Children and Adolescents, With Measurement Frequency and Therapy Recommendations
|
SBP or DBP Percentile* |
Frequency of BP Measurement |
Therapeutic Lifestyle Changes |
Pharmacologic Therapy |
|
| Normal |
<90th |
Recheck at next scheduled physical examination |
Encourage healthy diet, sleep, and physical activity |
— |
| Prehypertension |
90th to <95th or if BP exceeds 120/80 even if <90th percentile up to <95th percentile |
Recheck in 6 mo |
Weight-management counseling if overweight; introduce physical activity and diet management |
None unless compelling indications such as chronic kidney disease, diabetes mellitus, heart failure, or LVH exist |
| Stage 1 hypertension |
95th–99th percentile plus 5 mm Hg |
Recheck in 1–2 wk or sooner if the patient is symptomatic; if persistently elevated on 2 additional occasions, evaluate or refer to source of care within 1 mo |
Weight-management counseling if overweight; introduce physical activity and diet management |
Initiate therapy based on indications in Table 6 or if compelling indications (as shown above) exist |
| Stage 2 hypertension |
>99th percentile plus 5 mm Hg |
Evaluate or refer to source of care within 1 wk or immediately if the patient is symptomatic |
Weight-management counseling if overweight; introduce physical activity and diet management |
Initiate therapy |
|
* For gender, age, and height measured on at least 3 separate occasions; if systolic and diastolic categories are different, categorize by the higher value.
This occurs typically at 12 years old for SBP and at 16 years old for DBP.
Parents and children trying to modify the eating plan to the Dietary Approaches to Stop Hypertension Study eating plan could benefit from consultation with a registered or licensed nutritionist to get them started.
More than 1 drug may be required.
