Children and Adolescents

Recommendations

Screening

13.28 Blood pressure should be measured at each routine visit. Children found to have high-normal blood pressure (systolic blood pressure or diastolic blood pressure ≥90th percentile for age, sex, and height) or hypertension (systolic blood pressure or diastolic blood pressure ≥95th percentile for age, sex, and height) should have elevated blood pressure confirmed on 3 separate days. B

Treatment

13.29 Initial treatment of high-‍normal blood pressure (systolic blood pressure or diastolic blood pressure consistently ≥90th percentile for age, sex, and height) includes dietary modiﬁcation and increased exercise, if appropriate, aimed at weight control. If target blood pressure is not reached within 3–6 months of initiating lifestyle intervention, pharmacologic treatment should be considered. E

13.30 In addition to lifestyle modiﬁcation, pharmacologic treatment of hypertension (systolic blood pressure or diastolic blood pressure consistently ≥95th percentile for age, sex, and height) should be considered as soon as hypertension is conﬁrmed. E

13.31 ACE inhibitors or angiotensin receptor blockers should be considered for the initial pharmacologic treatment of hypertension E in children and adolescents, following reproductive counseling due to the potential teratogenic effects of both drug classes. E

13.32 The goal of treatment is blood pressure consistently <90th percentile for age, sex, and height. E

Blood pressure measurements should be performed using the appropriate size cuff with the child seated and relaxed. Hypertension should be conﬁrmed on at least 3 separate days. Evaluation should proceed as clinically indicated (90). Treatment is generally initiated with an ACE inhibitor, but an angiotensin receptor blocker can be used if the ACE inhibitor is not tolerated (e.g., due to cough) (91).