High blood pressure in children and adolescents

High blood pressure in children and adolescents is getting more attention. Prevention is especially important given increasing physical inactivity, unhealthy diets with lots of fast food, high salt intake, sugary drinks and sweets, and the growing number of overweight and obese children and teens. Medical societies recommend integrating blood pressure measurements into routine check-ups starting as early as age three. Currently, blood pressure measurement is only included in the U10 check-up, which is scheduled for ages 78.

Biggest risk factor: excess weight

About 400,000 children and adolescents currently have high blood pressure, which is roughly three percent. Not all are overweightchildren of normal weight can also be affected. However, they make up only 1.4% of pediatric hypertension patients, while one in four (25%) overweight children already shows high blood pressure at a young age.

High blood pressure and long-term consequences in adulthood

If high blood pressure is present in childhood or adolescence, the risk of having high blood pressure as an adult is high. High blood pressure only "goes away" on its own in very rare cases.
Complications usually appear in adulthood, but some young hypertensive patients already show changes in the back of the eye or in the heart.

Other risk factors

In addition to the risk factors already mentioned, increasing pressure, worries and stress can play a role even at a young age. More children are being diagnosed with ADHD and are prescribed medications that can raise blood pressure as a long-term effect. During adolescence, energy drinks, alcohol, smoking (including passive smoking) and exposure to drugs often come into play, all of which can affect the development of high blood pressure.

What blood pressure values are normal for children and adolescents?

Children grow from infancy to adulthood. They go through big changessome faster, some slower, boys differently than girls. These changes often happen in phases that are individual. Therefore, giving a single value that is normal for all children and all ages is not possible. Age-only reference tables can at best provide a rough estimate. More accurate assessment comes from tables based on percentiles that take age, height and biological sex into account.
Percentiles here describe how a childs blood pressure compares with other children of the same age and height. A blood pressure at the 50th percentile means that 50% of children of the same age and height have that blood pressure. If blood pressure is high, for example at the 97th percentile, it means only 3% of children of that age and height have such a value.
Percentiles for blood pressure refer to the systolic blood pressure value.

Classifying blood pressure using percentiles

Normal: Blood pressure is considered normal in children when it is < the 90th percentile.
Elevated: Values are considered elevated when they are the 90th percentile (or 120/80 mmHg, whichever is lower) up to < the 95th percentile.
Stage 1 hypertension: Stage 1 hypertension is defined as blood pressure the 95th percentile and < (95th percentile + 12 mmHg), or between 130/80 and 139/89 mmHg, whichever threshold is lower.
Stage 2 hypertension: Stage 2 hypertension is defined as blood pressure (95th percentile + 12 mmHg) or 140/90 mmHg, whichever threshold is lower.

Classification of blood pressure values by percentiles:
The example chart below shows normal ( 50th percentile) blood pressure values for children separated by boys and girls and adjusted to the median (50th) height percentile.

(Orange = systolic boys, Red = systolic girls, dashed = diastolic)

What's behind this?

Data source: Tables from the American Academy of Pediatrics (AAP Guideline 2017) / Merck Manual, which list blood pressure percentiles separately for each age and height class. (merckmanuals.com, merckmanuals.com)

Selection: Display of the 50th percentile (median height). For very short (5th) or very tall (95th) children, normal values are typically about ±34 mmHg above or below this curve.
Ages 117 years: Over this range, average normal systolic blood pressure rises from 85 mmHg (toddler) to about 110 mmHg (late adolescence). Diastolic pressure increases from 4045 mmHg to around the mid-60s mmHg.
Sex differences: Up to about age 10 the curves are nearly identical. During puberty girls are slightly ahead of boys (due to earlier growth spurts), before the curves converge.

Using the chart:

Plot the measurement:

Childs age straight up to the systolic or diastolic curve.

Height correction:
Child < 15th height percentile subtract 3 mmHg from the curve value.
Child > 85th height percentile add 3 mmHg to the curve value.
Interpretation:
< 90th percentile= normal
90th<95th percentile= elevated
95th percentile= hypertension threshold (AAP guideline 2017)
Important: The table/graph is an approximate tool. Exact classificationespecially for borderline or repeatedly elevated readingsshould always be done using the full AAP tables or a validated BP calculator and verified in clinical practice.

The second chart is the hypertension chart:
It shows the 95th percentile limits ( the top 5% of the population) for systolic and diastolic blood pressure values in boys and girls, each for children/teens of average height (50th percentile).

Solid lines: systolic hypertension threshold

Dashed lines: diastolic hypertension threshold

Boys/ girls: separate curves because the thresholds especially during puberty differ slightly

• Hypertension threshold (stage 1): 95th percentile or (from age 13) 130/80 mmHg.
• Hypertension stage 2: 95th percentile + 12 mmHg (not shown, but can be determined by adding 12 mmHg).
• Compared with the normal values (50th percentile from the first chart), these curves are about 1520 mmHg higher systolic and 1317 mmHg higher diastolic.

(Sources: All numbers come directly from the official tables of the AAP Guideline 2017 (Table 4 = boys, Table 5 = girls). (blk-pediatric-practice.com, blk-pediatric-practice.com, blk-pediatric-practice.com))

Note: For exact clinical classification always take into account age, sex and height percentile or use a validated BP calculator. The chart is meant for quick orientation.

Sources:

This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands monitor their blood pressure every day. Our content is based on carefully researched, evidence-based data and is continuously updated (as of 08/2025).

Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has led BloodPressureDB's specialist editorial team since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder and in various therapy and emergency areas, she provides solid, practical and reliably reviewed information.