Diagnosis

The doctor will perform a physical exam and ask questions about your child's medical history, family history of high blood pressure, and nutrition and activity level.

Your child's blood pressure will be measured. The correct cuff size is important for measuring accurately. During a single visit, your child's blood pressure might be measured two or more times for accuracy.

For a diagnosis of high blood pressure, your child's blood pressure must be higher than normal when measured during at least three visits to the doctor.

If your child is diagnosed with high blood pressure, it's important to determine whether it's primary or secondary. These tests might be used to look for another condition that could be causing your child's high blood pressure:

  • Blood test to check your child's blood sugar, kidney function and blood cell counts
  • Urine sample test (urinalysis)
  • Echocardiogram, a test to check the blood flow through your child's heart, if your child's doctor suspects a structural heart problem may be causing high blood pressure
  • Ultrasound of your child's kidneys

Ambulatory monitoring

To confirm a diagnosis of high blood pressure, your child's doctor might recommend ambulatory monitoring. This involves your child temporarily wearing a device that measures blood pressure throughout the day, including during sleep and various activities.

Ambulatory monitoring can help rule out blood pressure that's temporarily raised because your child is nervous at the doctor's office (white-coat hypertension).

Treatment

If your child is diagnosed with slightly or moderately high blood pressure (stage 1 hypertension), your child's doctor will likely suggest trying lifestyle changes, such as a heart-healthy diet and more exercise, before prescribing medications.

If lifestyle changes don't help, your child's doctor might recommend blood pressure medication.

If your child is diagnosed with severely high blood pressure (stage 2 hypertension), your child's doctor will likely recommend blood pressure medications.

Medications might include:

  • Diuretics. Also known as water pills, these act on your child's kidneys to help your child remove sodium and water, reducing blood pressure.
  • Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax your child's blood vessels by blocking the formation of a natural chemical that narrows blood vessels. This makes it easier for your child's blood to flow, reducing blood pressure.
  • Angiotensin II receptor blockers. These medications help relax blood vessels by blocking a natural chemical that narrows your child's blood vessels.
  • Calcium channel blockers. These medications help relax the muscles of your child's blood vessels and may slow his or her heart rate.
  • Beta blockers. These medications reduce the workload on your child's heart, causing it to beat slower and with less force. These aren't generally recommended as an initial treatment for a child.

Your child may need blood pressure medications temporarily or indefinitely. If your child's high blood pressure is caused by obesity, losing weight might make medication unnecessary. In other cases, treating other medical conditions your child has might control his or her blood pressure.

Although little is known about the long-term effects of blood pressure medication on a child's growth and development, many of these medications are generally considered safe to take during childhood.

Lifestyle and home remedies

High blood pressure is treated similarly in children and adults, usually starting with lifestyle changes. Even if your child takes medication for high blood pressure, lifestyle changes can make the medication work better.

  • Control your child's weight. If your child is overweight, losing excess pounds or maintaining the same weight while getting taller can lower blood pressure.
  • Give your child a healthy diet. Encourage your child to eat a heart-healthy diet, emphasizing fruits, vegetables, whole grains, low-fat dairy products and lean sources of protein, such as fish and beans, and limiting fat and sugar.
  • Decrease salt in your child's diet. Cutting the amount of salt (sodium) in your child's diet will help lower his or her blood pressure. Children ages 4 to 8 shouldn't have more than 1,200 milligrams (mg) a day, and older children shouldn't have more than 1,500 mg a day.

    Limit processed foods, which are often high in sodium, and eating at fast-food restaurants, whose menu items are full of salt, fat and calories.

  • Encourage physical activity. All children should get 60 minutes of physical activity a day.
  • Limit screen time. To encourage your child to be more active, limit time in front of the television, computer or other devices — no television before age 2, and no more than two hours of screen time a day after age 2.
  • Get the family involved. It can be hard for your child to make healthy lifestyle changes if other family members don't eat well or exercise. Set a good example. Your whole family will benefit from eating better. Create family fun by playing together — ride bikes, play catch or take a walk.

Preparing for your appointment

Your child's blood pressure will be checked as part of a routine complete physical exam or during any pediatric doctor appointment when indicated. Before a blood pressure check, make sure your child hasn't had caffeine or another simulant.

What you can do

Make a list of:

  • Symptoms your child has, and when they began. High blood pressure rarely causes symptoms, but it is a risk factor for heart disease and other childhood illnesses.
  • Key personal information, including a family history of high blood pressure, high cholesterol, heart disease, stroke or diabetes.
  • All medications, vitamins or supplements your child takes, including doses.
  • Your child's diet and exercise habits, including salt intake.
  • Questions to ask your doctor.

For high blood pressure, questions to ask your doctor include:

  • What tests will my child need?
  • Will my child need medications?
  • What foods should he or she eat or avoid?
  • What's an appropriate level of physical activity?
  • How often do I need to schedule appointments to check my child's blood pressure?
  • Should I monitor my child's blood pressure at home?
  • Should my child see a specialist?
  • Can you give me brochures or other printed material? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your child's doctor is likely to ask you questions, such as:

  • When was your child's blood pressure last checked? What was the blood pressure measurement then?
  • Was your child premature or underweight at birth?
  • Does your child or anyone in your family smoke?
Dec. 05, 2018
References
  1. Bakris GL, et al. Hypertension in children and adolescents. Hypertension: A Companion to Braunwald's Heart Disease. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2018. https://www.clinicalkey.com. Accessed Nov. 16, 2018.
  2. Mattoo TK. Definition and diagnosis of hypertension in children and adolescents. https://www.uptodate.com/contents/search. Accessed Nov. 16, 2018.
  3. Rao G. Diagnosis, epidemiology and management of hypertension in children. Pediatrics. 2016;138:e20153616.
  4. Mattoo TK. Evaluation of hypertension in children and adolescents. https://www.uptodate.com/contents/search. Accessed Nov. 16, 2018.
  5. Flynn JT, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904.
  6. AskMayoExpert. Diet and activity guidelines (child). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
  7. Reducing sodium in children's diets. Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/children-sodium/index.html. Accessed Nov. 17, 2018.