TABLE 5. Classification of Hypertension in Children and Adolescents, With Measurement Frequency and Therapy Recommendations

SBP or DBP Percentile* Frequency of BP Measurement Therapeutic Lifestyle Changes Pharmacologic Therapy

Normal <90th Recheck at next scheduled physical examination Encourage healthy diet, sleep, and physical activity
Prehypertension 90th to <95th or if BP exceeds 120/80 even if <90th percentile up to <95th percentile1 Recheck in 6 mo Weight-management counseling if overweight; introduce physical activity and diet management2 None unless compelling indications such as chronic kidney disease, diabetes mellitus, heart failure, or LVH exist
Stage 1 hypertension 95th–99th percentile plus 5 mm Hg Recheck in 1–2 wk or sooner if the patient is symptomatic; if persistently elevated on 2 additional occasions, evaluate or refer to source of care within 1 mo Weight-management counseling if overweight; introduce physical activity and diet management2 Initiate therapy based on indications in Table 6 or if compelling indications (as shown above) exist
Stage 2 hypertension >99th percentile plus 5 mm Hg Evaluate or refer to source of care within 1 wk or immediately if the patient is symptomatic Weight-management counseling if overweight; introduce physical activity and diet management2 Initiate therapy

* For gender, age, and height measured on at least 3 separate occasions; if systolic and diastolic categories are different, categorize by the higher value.

1 This occurs typically at 12 years old for SBP and at 16 years old for DBP.

2 Parents and children trying to modify the eating plan to the Dietary Approaches to Stop Hypertension Study eating plan could benefit from consultation with a registered or licensed nutritionist to get them started.

More than 1 drug may be required.