Pediatric BP Calculator (Ages 1–12)

Pediatric Blood Pressure Percentiles (Ages 1–12 years)

Notes: BP percentiles for children are based on the child’s sex, age, and height percentile. This calculator compares the entered blood pressure with reference thresholds (50th, 90th, 95th, and 99th percentiles) and reports the approximate percentile range.

Reference: NHLBI BP Chart

Pediatric Hypertension: Definitions, Etiologies, and Treatment

Date Published: March 13, 2025
Hypertension in Children and Adolescents is defined using age-, sex-, and height-specific blood pressure (BP) percentiles. The 2017 American Academy of Pediatrics (AAP) guidelines are most commonly used in the United States. Under these guidelines:
  • Normal BP: Falls below the 90th percentile for a given age, sex, and height.
  • Elevated BP: Readings are between the 90th and 95th percentiles, or just above the normal range.
  • Hypertension (HTN): Defined as BP at or above the 95th percentile on repeated measurements. In older children and adolescents, thresholds similar to those in adults may also be applied.
Hypertension in children is further categorized into:
  1. Primary (Essential) Hypertension: This is diagnosed when no specific underlying condition is identified. It is more common in older children and adolescents, especially in those with a family history of hypertension and in those who are overweight or obese.
  2. Secondary Hypertension: This type occurs when an underlying, identifiable cause is present. In younger children, secondary causes are more common, and they may include renal (kidney) disorders, endocrine abnormalities, or vascular issues.
Additionally, other BP phenotypes include:
  • White Coat Hypertension: Elevated BP in a clinical setting (often due to anxiety) but normal readings in other settings. It may indicate a prehypertensive state.
  • Masked Hypertension: Normal BP readings in the office with elevated measurements outside the clinical environment. This condition can be associated with obesity and increased left ventricular mass, contributing to long-term cardiovascular risk.
Etiologies: Pediatric hypertension can result from different underlying causes, broadly classified into primary and secondary etiologies.
  1. Primary Hypertension: Primary hypertension is a diagnosis of exclusion where no specific secondary cause is found. It is most frequently seen in adolescents and older children. In these cases, a combination of genetic predisposition and environmental influences (such as high dietary sodium intake, sedentary lifestyle, and obesity) are believed to contribute. Common causes of primary HTN include:
    • Family History: A significant proportion of children with primary HTN have a family history of high blood pressure, indicating a genetic contribution.
    • Obesity: Excess body weight is strongly linked to higher BP levels, with the risk increasing even in early childhood.
    • Lifestyle Factors: Diet (particularly high sodium intake), lack of physical activity, and other modifiable risk factors can exacerbate or precipitate primary hypertension.
  2. Secondary Hypertension: Secondary hypertension is due to an identifiable underlying condition, and the causes vary with age and clinical presentation. In many cases, treating the underlying condition can resolve the high blood pressure. Common causes of secondary HTN include:
    • Glomerulonephritis: Infections (e.g., poststreptococcal) or immune-mediated diseases (e.g., IgA nephropathy) cause inflammation in the kidneys leading to fluid retention and BP elevation.
    • Kidney Scarring: Past infections or congenital anomalies like vesicoureteral reflux can lead to scarring and impaired kidney functions.
    • Chronic Kidney Disease: Ongoing kidney damage—whether due to congenital issues or acquired insults—often presents with hypertension.
    • Liddle Syndrome: Gain-of-function mutation leading to increased sodium retention.
    • Pseudohypoaldosteronism Type 2 (Gordon Syndrome): Characterized by increased chloride reabsorption and subsequent BP elevation.
    • Familial Hyperaldosteronism: Excess aldosterone production resulting in salt and water retention.
    • Fibromuscular Dysplasia: A non-inflammatory condition that causes arterial stenosis, including in the renal arteries.
    • Umbilical Artery Catheterization: In neonates, injury from catheter use may lead to renal artery stenosis.
    • Other Causes: Such as neurofibromatosis and arteritis, can compromise renal blood flow, triggering secondary hypertension.
    • Catecholamine Excess: Conditions like pheochromocytoma or neuroblastoma cause intermittent or sustained hormone surges that raise blood pressure.
    • Corticosteroid Excess: Either from endogenous overproduction (as seen in Cushing syndrome) or from external steroid use can induce hypertension.
    • Other Hormonal Abnormalities: Thyroid dysfunctions and hypercalcemia (e.g., due to hyperparathyroidism) also influence blood pressure.
    • Coarctation of the Aorta: A congenital narrowing of the aorta that results in elevated BP in the upper extremities compared to the lower body.
    • Drugs and Toxins: Various medications and toxic exposures—including oral contraceptives, certain immunosuppressants (e.g., cyclosporine, tacrolimus), and environmental toxins—can lead to increased blood pressure.
Treatment Strategies: Managing pediatric hypertension requires a tailored approach based on the type (primary or secondary), severity, and the presence of comorbid conditions. Treatment strategies generally include:
  1. Lifestyle Modifications
    • Reduced Sodium Intake: Lowering salt consumption can help lower BP.
    • Healthy Eating Patterns: Emphasis on fruits, vegetables, whole grains, and lean proteins. Dietary approaches similar to the DASH (Dietary Approaches to Stop Hypertension) diet are recommended.
    • Weight Management: Addressing overweight and obesity through a balanced diet and regular physical activity is essential. Even modest weight loss can have a positive impact on BP.
    • Increased Physical Activity: Regular aerobic exercise (e.g., brisk walking, cycling, swimming) is recommended to help control blood pressure and improve overall cardiovascular health.
    • Behavioral and Psychosocial Support: Counseling may be needed for children and families to adopt and maintain healthy lifestyle habits, especially when adverse childhood experiences contribute to stress-related BP elevation.
  2. Medical Management
    1. Pharmacologic Therapy: When lifestyle modifications do not adequately control blood pressure or when there is evidence of target organ damage, medications may be introduced. The choice of antihypertensive agents is influenced by the patient’s age, underlying etiology, and comorbidities. Common classes include:
    2. Angiotensin-Converting Enzyme (ACE) Inhibitors: Often used as first-line agents in children, especially with kidney involvement.
    3. Angiotensin Receptor Blockers (ARBs): An alternative to ACE inhibitors with similar benefits.
    4. Calcium Channel Blockers and Diuretics: May be considered depending on the specific clinical scenario.
  3. Treating Underlying Causes (for Secondary HTN): In cases of secondary hypertension, addressing the primary disease is key:
    • Renal Disorders: Specific treatment for glomerulonephritis, management of vesicoureteral reflux, or interventions for chronic kidney disease.
    • Endocrine or Cardiac Causes: Surgical or medical treatment to correct hormone imbalances or structural abnormalities (e.g., repair of coarctation of the aorta).
  4. Monitoring and Follow-Up: Regular monitoring of BP, growth, and development is critical. Ambulatory blood pressure monitoring (ABPM) may be used to distinguish between white coat, masked, and sustained hypertension, allowing for more precise treatment adjustments.
Summary Pediatric hypertension is a multifactorial condition that begins early in life and can have serious long-term cardiovascular implications. Pediatric HTN is defined by age-, sex-, and height-specific percentiles. It is categorized as primary (with no identifiable cause) or secondary (linked to underlying conditions). Additionally, patterns such as white coat and masked hypertension highlight the variability in blood pressure readings depending on the environment. Primary Hypertension: Generally related to genetic predisposition and lifestyle factors, including obesity and dietary sodium. Secondary Hypertension: Often linked to renal diseases, monogenic disorders, endocrine abnormalities, cardiac defects (such as coarctation of the aorta), and exposure to certain drugs or toxins. Effective management combines lifestyle modifications—such as dietary changes, weight management, and increased physical activity—with medical treatment when necessary. In cases of secondary hypertension, treating the underlying cause is essential. Continuous monitoring ensures that the treatment plan is appropriately adjusted to support the child’s health and development. Early recognition, thorough evaluation, and a comprehensive treatment plan are critical for reducing the risk of future cardiovascular disease. By addressing both modifiable and nonmodifiable factors, healthcare providers can improve outcomes and help set children on a healthier path into adulthood.