TABLE 8-1

Age-Specific Recommendations for BP Measurement and Diagnosis of Hypertension

Birth to 3 yNo routine BP measurement
Measure BP if history (+) for neonatal complications, congenital heart disease, urinary/renal abnormality, solid-organ transplant, malignancy, drug prescription, or condition known to raise BP or increase intracranial pressure (Table 8-2)
If BP ≥90th percentile by oscillometry, confirm by auscultation → If BP confirmed ≥90th percentile, initiate evaluation for etiology and treatment per algorithm (Figure 8-2)
3 to 11 yAnnual BP measurement in all, interpreted for age/gender/height per Tables 8-3 and 8-4
If BP <90th percentile, repeat in 1 y
If BP ≥90th percentile:
        Repeat BP × 2 by auscultation
        Average replicate measurements and reevaluate BP category (Fig 8-1)
If BP confirmed >90th percentile, <95th percentile = prehypertension (HTN):
        Recommend weight management if indicated
        Repeat BP in 6 mo
If BP ≥95th percentile, <99th percentile + 5 mm Hg:
        Repeat BP in 1–2 wk, average all BP measurements and reevaluate BP category (Fig 8-1)
If BP confirmed >95th percentile, <99th percentile + 5 mm Hg = stage 1 HTN:
        Basic work-up per Fig 8-2
If BP ≥99th percentile + 5 mm Hg
        Repeat BP by auscultation × 3 at that visit, average all BP measurements and reevaluate BP category
If BP confirmed >99th percentile + 5 mm Hg = stage 2 HTN:
        Refer to pediatric HTN expert within 1 wk OR
        Begin BP treatment and initiate basic work-up, per Fig 8-2
12 to 17 yAnnual BP measurement in all, interpreted for age/gender/height per Tables 8-3 and 8-4
If BP <90th percentile, counsel on CHILD-1 diet, activity recommendations, and repeat BP in 1 y
If BP ≥90th percentile or ≥120/80 mm Hg:
        Repeat BP × 2 by auscultation
        Average replicate measurements and reevaluate BP category (Fig 8-1)
If BP confirmed >90th percentile, < 95th percentile or >120/80 = pre-HTN:
        CHILD-1 diet, activity recommendations, weight management if indicated
        Repeat BP in 6 mo
If BP ≥95th percentile, <99th percentile + 5 mm Hg
        Repeat BP in 1–2 wk, average all BP measurements and reevaluate BP category (Fig 8-1)
If BP confirmed ≥95th percentile, <99th percentile + 5 mm Hg = stage 1 HTN:
        Basic workup per Fig 2
If BP ≥99th percentile + 5 mm Hg:
        Repeat BP by auscultation × 3 at that visit, average all BP measurements and reevaluate BP category
If BP confirmed >99th percentile + 5 mm Hg = stage 2 HTN:
        Refer to pediatric HTN expert within 1 wk OR
        Begin BP treatment and initiate work-up per Fig 8-2
18 to 21 yMeasure BP at all health care visits
        BP ≥120/80 to 139/89 = pre-HTN
        BP ≥140/90 to 159/99 = stage 1 HTN
        BP ≥160/100 = stage 2 HTN
  • BP recommendations are based on the NHLBI's “The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents” with the evidence review updated from 2003. Recommendations are all graded as expert opinion (grade D) because they are based on the expert consensus conclusions of the Fourth Report.