TABLE 5.

Classification of Hypertension in Children and Adolescents, With Measurement Frequency and Therapy Recommendations

SBP or DBP Percentile*Frequency of BP MeasurementTherapeutic Lifestyle ChangesPharmacologic Therapy
Normal<90thRecheck at next scheduled physical examinationEncourage healthy diet, sleep, and physical activity
Prehypertension90th to <95th or if BP exceeds 120/80 even if <90th percentile up to <95th percentileRecheck in 6 moWeight-management counseling if overweight; introduce physical activity and diet managementNone unless compelling indications such as chronic kidney disease, diabetes mellitus, heart failure, or LVH exist
Stage 1 hypertension95th–99th percentile plus 5 mm HgRecheck 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 moWeight-management counseling if overweight; introduce physical activity and diet managementInitiate therapy based on indications in Table 6 or if compelling indications (as shown above) exist
Stage 2 hypertension>99th percentile plus 5 mm HgEvaluate or refer to source of care within 1 wk or immediately if the patient is symptomaticWeight-management counseling if overweight; introduce physical activity and diet managementInitiate 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.