What to Know About New Guidelines for High Blood Pressure in Children

Dr. Joseph Flynn served as the co-chair of the national committee responsible for developing the American Academy of Pediatrics’ new guidelines on high blood pressure.

Parents may notice a renewed focus on screening for hypertension at their child’s next well-child checkup thanks to new guidelines published by the American Academy of Pediatrics (AAP).

While hypertension, or high blood pressure, is common in adults, many people are unaware that approximately 3.5% of all children and adolescents also have the condition. If left untreated, over time hypertension can damage many organs of the body, including the heart, brain, kidneys and eyes.

“The goal is to ensure every child receives annual screening for high blood pressure starting at age 3,” said Dr. Joseph Flynn, an expert in treating children with hypertension at Seattle Children’s and co-chair of the national committee responsible for developing the new guidelines. “Evidence shows pediatricians aren’t routinely measuring blood pressure in younger children, or may not recognize when a child’s blood pressure is high, causing high blood pressure to go undetected and untreated.”

The guidelines update recommendations last issued by the National Heart, Blood and Lung Institute in 2004, and are the first from the AAP addressing the identification and treatment of high blood pressure in children. Here Flynn summarizes the updates made from the committee’s review of over 15,000 studies published on pediatric hypertension since 2004, including his key takeaways for parents.

Simplified blood pressure tables

The normal range for blood pressure depends on a child’s sex, age and height. According to Flynn, the guidelines provide several improvements to aid pediatricians in recognizing abnormal blood pressure.

For example, the new guidelines simplify the reference tables pediatricians use to tell if a child’s blood pressure falls within a normal range.

Flynn High Blood Pressure
Flynn treats children with high blood pressure through the Pediatric Hypertension program.

“Previous tables were unwieldy and could be difficult to apply in a check up visit where the pediatrician needs to cover a lot of ground,” said Flynn. “Updates to the tables make it easier for pediatricians to identify high blood pressure values needing further evaluation.”

He also notes the new reference tables are adjusted to only include blood pressure values based on normal-weight children. With strong evidence showing that children who are overweight or obese are more likely to have elevated blood pressure, the committee recognized that previous tables favored higher blood pressure values by including this population.

By excluding this population in the new tables, the guidelines deliver a more accurate classification of blood pressure according to body size. In practice, it means the values in the new guidelines are lower than those used in prior guidelines.

Know what increases hypertension risk

Family history of high blood pressure can increase a child’s risk of having hypertension. Flynn recommends parents make their child’s pediatrician aware of any family member with hypertension during the preventative visit.

Obesity and other underlying medical conditions, such as kidney disease, certain heart conditions and endocrine disorders can also cause hypertension.

“By knowing whether their child is at greater risk for hypertension, parents can also play an important role in help spotting this dangerous condition early,” said Flynn.

Lifestyle changes remain first-line treatment

The AAP guidelines recommend that pediatricians start blood pressure-lowering medications only after lifestyle changes fail to reduce blood pressure, or if the child has another condition like diabetes or kidney disease.

“Not all children need medicine to manage high blood pressure, so we start with lifestyle changes,” said Flynn. “In most cases, we turn to medication or a combination of treatments because lifestyle changes are not sufficiently adopted.”

Flynn recognizes it can be hard for a child to eat healthy foods or exercise regularly if it is left to them alone to make the necessary changes. Instead, he encourages families to make these changes together.

“Our program is unique in that we provide a range of resources to support families in managing high blood pressure,” said Flynn as he describes the team of doctors, nurses, dietitians, physical therapists and social workers that make up Seattle Children’s Pediatric Hypertension program.

“Above all, we want to set children up for a healthy future free of significant health issues like heart disease and stroke that high blood pressure can lead to if it persists in adulthood,” he said.