• Hypertension is present if either SBP or DBP meet criteria
Category SBP (mmHg) DBP (mmHg)
Normal < 120 < 80
Elevated 120 - 129 < 80
Stage 1 hypertension 130 - 139 80 - 89
Stage 2 hypertension ≥ 140 ≥ 90















  • *See table below for upper limits of normal blood pressure readings by age
  • Reference [6]
AAP BLOOD PRESSURE CATEGORIES
Children aged 1 - 13 years
Normal BP
  • < 90th percentile
Elevated BP
  • ≥90th percentile to < 95th percentile OR 120/80 mmHg to < 95th percentile (whichever is lower)
Stage 1 HTN
  • ≥ 95th percentile to < 95th percentile + 12 mmHg, OR 130/80 to 139/89 mmHg (whichever is lower)
Stage 2 HTN
  • ≥ 95th percentile + 12 mmHg, OR ≥ 140/90 mmHg (whichever is lower)
Children aged ≥ 13 years
Normal BP
  • <120/< 80 mmHg
Elevated BP
  • 120/<80 to 129/<80 mmHg
Stage 1 HTN
  • 130/80 to 139/89 mmHg
Stage 2 HTN
  • ≥140/90 mmHg

  • Blood pressure readings above these values are considered high
  • Reference [6]
UPPER LIMITS OF NORMAL BY AGE
AGE
(years)
Boys
(SBP/DBP)
Girls
(SBP/DBP)
1 98 / 52 98 / 54
2 100 / 55 101 / 58
3 101 / 58 102 / 60
4 102 / 60 103 / 62
5 103 / 63 104 / 64
6 105 / 66 105 / 67
7 106 / 68 106 / 68
8 107 / 69 107 / 69
9 107 / 70 108 / 71
10 108 / 72 109 / 72
11 110 / 74 111 / 74
12 113 / 75 114 / 75
≥ 13 120 / 80 120 / 80


  • Reference [6]
SELECT CAUSES OF SECONDARY HYPERTENSION
Condition Comments
Renal disease
  • Most common cause of secondary HTN in children, particularly those < 6 years old
Coarctation of the aorta
  • Right arm SBP that is ≥ 20 mmHg more than the lower extremity SBP
  • HTN is common even after successful repair (up to 77% of patients)
  • Masked hypertension is common and ambulatory blood pressure monitoring should be performed
Obstructive sleep apnea
  • Snoring
  • Adenotonsillar hypertrophy
Medications / Supplements
  • Oral contraceptives
  • Corticosteroids and anabolic steroids
  • Herbal and nutritional supplements
  • Diet products
Congenital adrenal hyperplasia
  • Low potassium
  • Acne, hirsutism, and virilization in girls
  • Pseudoprecocious puberty in boys
Hyperaldosteronism
  • Low potassium
  • May be familial
Cushing syndrome
  • Central obesity and enlarged fat pad on upper back (buffalo hump)
  • Hirsutism and acne
  • Moon facies
  • Absent or irregular menses
Hyperthyroidism
  • Tachycardia, anxiety, sweating, heat intolerance
Environmental exposures
  • Lead, cadmium, mercury, phthalates
Neurofibromatosis
  • Cafe-au-lait macules
  • Neurofibromas
  • Lisch nodules of the iris
  • Axillary freckling