High Blood Pressure in Kids

Feb 16, 2024, 13:46 PM by Dr. Sally Robinson


The “Silent Killer” sounds like a new series, possibly rated PG 13 or even “R”.  If you do a search for “Silent Killer”, the first item that comes up is high blood pressure.  It is called silent as it has few symptoms and it is called killer because it kills.

High blood pressure (hypertension) is usually thought of as a problem that affects adults.  Unfortunately it can be present at any age.  The American Academy of Pediatrics (AAP) reports that an estimated 3.5% of all children and teens in the United States have hypertension.  However it often goes undetected and untreated.

Blood pressure is the pressure of blood pushing against the walls of your arteries.  It is measured using two numbers.  The first number (systolic) measures the pressure of the heart muscle pushing the blood through the arteries.  The second number (diastolic) is the pressure in your arteries when your heart rest.

Screening children is difficult. While it would be easier if children were not afraid of doctors or afraid of having their vital signs measure, there are many other factors such as height, weight, age, sex, and size of the blood pressure cuff for the tiny arm. 

The AAP and the National Heart, Lung and Blood Institute both recommend that children have yearly screenings for hypertension, starting at age 3 in their annual visit.  If the child’s blood pressure is high they will be asked to come back in a week to see if it is still high.  If it is high in three consecutive visits they should be evaluated as to the cause of the hypertension.  Infants who were preterm or had a long hospital stay may need screening sooner than age 3. 

High blood pressure in children is almost always without symptoms. Hypertension seems to develop with age.  By age 7, more than 50% of hypertension is due to obesity and this rises to 85-95% by the teenage years. Sometimes no specific cause can be found but tests should be done to rule out kidney or heart problems.  If no specific cause can be found it is called ‘essential’ hypertension.

The first line treatment for children with high blood pressure remains life style changes. If obesity is a possible cause, the first step is to have the child lose weight.  This will need to be closely monitored possibly for lifetime.  Second, limit the salt in your child’s diet.  In some patients giving up table salt and restricting salty foods can lower blood pressure.  Common sources of salty foods include snacks, bread, deli meats, pizza and foods prepared outside the home.  Be careful shopping for package foods as canned and processed foods contain a great deal of salt so check labels. Help your child get aerobic exercise (walking, running, climbing, swimming, etc.) for 60 minutes daily.  All of these recommendations are good for the entire family.

If blood pressure remains high, medications might be needed with careful follow-up. Sometimes a referral to a kidney doctor (nephrologist) is needed.

by Sally Robinson, MD Clinical Professor
Keeping Kids Healthy
Published 02/2024

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