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home : columns : ask the doctors February 24, 2018

1/20/2018 9:07:00 AM
New guidelines help track hypertension in children

DEAR DOCTOR: How important is it to keep track of a child's blood pressure? I read that the American Academy of Pediatrics just updated its guidelines for screening and managing high blood pressure in kids. Is this really a problem that I need to worry about? 

DEAR READER: We're so glad you brought up this very important topic. Blood pressure is a diagnostic tool that's as important in children as it is in adults. However, because blood pressure readings in children are evaluated by a different set of metrics than those of adults, the subject has often been confusing.

By now, the significance of high blood pressure, or hypertension, is well known to most of us. It's not a condition that you can readily feel, but when left untreated it can cause significant damage to your body. By the time symptoms appear, you can be dealing with a host of problems, including damage to your heart, kidneys, eyes, bones and cognitive function.  

High blood pressure in children can be a predictor of the condition later in life. It can cause certain types of damage to the structures and blood vessels of a child's heart. And it can be a symptom of other serious underlying conditions, including heart or kidney problems. Between 2.2 to 3.5 percent of children have high blood pressure, according to the new guidelines. The number jumps up to 24 percent among children who are obese or overweight. Children who were born prematurely and those with sleep-disordered breathing are also at risk of high blood pressure.

That's why establishing a baseline blood pressure reading beginning as early as the age of 3 is important. After that, a child's blood pressure should be measured during annual physical exams, and the trajectory of those readings over time should be noted and used as a diagnostic tool.

Thanks to the new blood pressure guidelines, released in August 2017 by the American Academy of Pediatrics, this should be much more easily accomplished. Unlike in adults, whose blood pressure readings fall into uniform parameters, readings in children must be interpreted based on gender, age and height. It's no surprise that, with so many variables to deal with, repeated studies show that up to 75 percent of children with high blood pressure have gone undiagnosed.  

Before, health care professionals had to delve into multiple pages of charts to assemble the numbers and come up with a reading. The updated guidelines have simplified this pile of data into a single table. It's easy to use and easy for everyone, including parents, to understand.  

For a child to be diagnosed with high blood pressure requires three separate readings that fall above the established guidelines. A single high reading, while not a diagnosis, does indicate the need for subsequent evaluations to rule out hypertension.  

If your pediatrician or family physician doesn't routinely check your children's blood pressure, don't be afraid to ask. With one-third of adults in the United States now diagnosed with hypertension, it's clear that it's never too soon to get ahead of this serious condition.

(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)

(Send your questions to, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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