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Matters of the Heart

The lowdown on high blood pressure in kids

Hypertension is a word you expect to hear at your mother or grandmother’s yearly physical— not your fourth-grader’s. But since the late ’80s, there’s been a growing number of pediatric hypertension cases, enough that the American Academy of Pediatrics (AAP) recently released new guidelines for detecting and treating high blood pressure in kids.

According to the report, published in September, an estimated 3.5 percent of all kids and teens have hypertension. That’s two to three times higher than previous studies have indicated.

“Elevated blood pressure in children often goes undetected,” says Dr. Stormee Williams, medical director for school-based telehealth services at Children’s Health. “This is partially why the American Academy of Pediatrics’ clinical guidelines for addressing pediatric hypertension have been updated.”

The scary part? Hypertension, ominously known as the “silent killer,” has serious health ramifications. Undiagnosed cases in childhood can result in progressive health complications, like organ damage and cardiovascular disease.

But because high blood pressure is “silent,” there are no obvious signs or symptoms to set off a parent’s warning alarm, explains Dr. Deborah Schutte, medical director of cardiology at Cook Children’s. Consequently parents have to rely on blood pressure tests at the doctor’s office to catch a number that’s too high.

Even when kids notch several high blood pressure readings, they may not get diagnosed. A 2016 study funded by the National Institutes of Health found that three-quarters of kids with repeated high blood pressure readings went undiagnosed—and therefore untreated.

The old pediatric blood pressure screening tables were difficult for doctors to navigate. The AAP is hoping its new, streamlined guidelines will help kids get the treatment they need. But why is it needed in the first place?


“For most infants and young children, hypertension is most likely secondary to an underlying disease often involving the kidneys or cardiovascular systems,” Williams explains. Studies have shown that sleep disorders and premature birth can also trigger high blood pressure.

For kids who’ve reached puberty (say, mid- to late-elementary years), high blood pressure is usually the primary problem, due to genetics, poor diet, inactivity or environmental factors.

But weight is the biggie.

“Obesity in this country has increased tremendously over the past two decades,” Williams says. According to the latest Beyond ABC report from Children’s Health, more than a fourth of Denton County kids and more than a third of Dallas County kids in grades three to 12 are overweight or obese.

Per the AAP, the prevalence of high blood pressure leaps to as high as 24 percent among kids in this category.

The connection between obesity and high blood pressure is one reason the AAP made some changes to its blood pressure screening tables, which provide normal blood pressure levels based on age, height and sex. The previous tables factored in measurements from kids who are overweight or obese; the new tables are based on normal-weight children.  

As a result, the threshold for what’s considered elevated blood pressure has been lowered, meaning more kids—overweight and normal-weight both—are likely to get flagged for high numbers.

And, should kids register on the high side, the new guidelines recommend ambulatory monitoring—taking blood pressure readings over a 24-hour period while the child goes about her day, instead of relying only on the reading from the clinic. This will help clear the kiddos whose blood pressure spikes because of doctor’s office anxiety.


The updated AAP guidelines make it easier to evaluate, diagnose and treat high blood pressure, but all of it is for naught if your child’s blood pressure isn’t tested regularly.

“Because there are no symptoms of hypertension, the key is screening at well-child checks,” Schutte says. She points out that for kids 3 and older, the AAP report says blood pressure should be checked at least annually. And since conditions like diabetes and high cholesterol can go hand in hand with high blood pressure, those routine health checks are even more important.

At your child’s next physical, make sure your child’s blood pressure has been evaluated by the new standards, and ask to look at the blood pressure tables to see where your child stands. Since genetic risk factors can predispose kids to hypertension, talk about your family history with your pediatrician, Williams says.

If needed, the doctor may prescribe lifestyle changes (see sidebar) or medication to get your child’s numbers back on track—a small price to pay for a healthier heart down the road.