High Blood Pressure in Kids can be dangerous

We tend to think of high blood pressure as an adult disease, even call it the “silent killer”.  However studies estimate that between 3-5% of children have high blood pressure.  Of these children, 25% will be diagnosed and only 50% of the diagnosed children will be treated.

Dr. A. H. Zaidi and his colleagues conducted detailed phone interviews with parents of newly diagnosed children with hypertension and their pediatric providers to see if they could find why children are under diagnosed.  They found that the parents were quite knowable about the seriousness of hypertension and the damage it could do.  However there was a mutual skepticism from both the parents and the clinicians about high blood pressure being attributed to measurement errors or “white-coat hypertension”.  This shared doubt created a significant barrier to addressing the urgency this diagnosis requires.

It is important to get an accurate blood pressure reading in the primary care setting.  There are guidelines easily available from the American Academy of Pediatrics which includes have the correct sized blood pressure cuffs and calm surroundings.  It is important that the norms for children’s blood pressure are known to be different from adults’.  Adult blood pressure cuffs cannot give an accurate reading on a child.

If high blood pressure is noted in the primary care clinic, there should be another reading done at the end of the visit.  If still elevated repeat measurements, done correctly, should be done at home and/or at school. 

Secondary causes of hypertension could be diseases of the kidney, heart or endocrine disorders.  In about 70% of these cases, the cause of the hypertension is kidney disease.  Screening blood work includes a chemistry panel, lipid profile and a urinalysis.  There could be abnormalities of blood vessels of the aorta or arteries that carry blood to the kidneys.

If no other cause can be found for the hypertension it is called primary hypertension.   In general primary hypertension occurs in children older than 6 years who are overweight or obese and have a family history of hypertension.  Every child whose blood pressure is above the 90 percentile should have instruction and treatment with diet and exercise.  High blood pressure in children can be prevented, in many cases, with a healthy lifestyle.  This includes maintaining a healthy weight, eating healthy food and making it a priority to get enough physical activity.

Medication should not be deferred for children and long term management of hypertension is important.  If a healthy life style doesn’t lower their blood pressure, medical management is essential.

High blood pressure can cause serious health problems such as damage to the heart, kidney, brain and eyes.  While this damage can be seen in children and adolescents these damaging effects are seen more long term.

The child’s primary care provider should measure the child’s blood pressure on all routine checkups.  3-5% of children means at least one in every classroom. 

Published 05/05/2025

by Sally Robinson MD