The following simple table to identify children and adolescents needing further evaluation of blood pressure

Any reading equal to or above the readings in the simplified table indicates potentially abnormal blood pressures in one of three ranges: pre-hypertension; stage 1 hypertension; or stage 2 hypertension and identifies blood pressures that requires additional evaluation.

BP Centile Charts

Boys Chart

Girls Chart

The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents

Note: BP measurements repeated on several different occasions are required to diagnose hypertension. The cuff bladder should cover at least 3/4 of the child’s arm length, and the child should be quiet and calm.


Essential hypertension

Obesity may complicate the accurate measurement of blood pressure and be a contributing factor.

Secondary causes

Renal (75%) – post-infectious glomerulonephritis, chronic glomerulonephritis, obstructive uropathy, reflux nephropathy, reno-vascular, haemolytic uraemic syndrome, polycystic kidney disease

Cardiovascular (15%) – coarctation of the aorta

Endocrine (5%) – phaeochromocytoma, hyperthyroidism, congenital adrenal hyperplasia, primary hyperaldosteronism, Cushing syndrome

Other (5%) – neuroblastoma, neurofibromatosis, steroid therapy, raised intracranial pressure.



Appearance – Cushingoid, obese

Height and weight

Upper and lower limb BP measurement

Skin: Cafe-au-lait spots, neurofibromas, hirsutism, vasculitis

Fundoscopy: hypertensive retinopathy

CVS examination: left ventricular hypertrophy, murmurs (particularly interscapular)

Abdomen: renal / adrenal masses, renal bruits

Full neurological examination


Initially: urine analysis, urine microscopy, urea and electrolytes, creatinine,

Further investigations may include: 24 hours urinary catecholamines, chest X-ray, ECG, renal ultrasound, plasma renin activity, plasma aldosterone, thyroid function tests, Cortisol, 17-hydroxy progesterone, renal Doppler scan, renal angiography.



Asymptomatic hypertension

No treatment required acutely. Investigate and manage as out-patient.

Acute severe hypertension

These patients require admission to ICU for urgent treatment.

Hypertensive encephalopathy presents as severe headache, visual disturbance and vomiting, progressing to focal neurological deficits, seizures and impaired conscious state, with grossly elevated BP, papilloedema and retinal haemorrhages. These patients almost always have chronic renal disease and are on dialysis. The differential diagnosis includes uraemic encephalopathy and metabolic disturbance. BP should be lowered in a controlled fashion, with anticonvulsants given for  seizures.


Choice includes (list not exhaustive):

Sublingual / oral nifedipine:

tabs – 0.5 – 1.0 mg/kg/dose (max. 40 mg) 12-hourly

Side effects include tachycardia, flushing and fluid retention.

Intravenous labetalol:

0.2 mg/kg initially; later 0.4 mg/kg by slow push every 10 min up to 3 – 4 mg/kg (max. 100 mg) total dose. Avoid if there is heart failure, asthma or bradycardia.

Intravenous hydralazine:

0.1 – 0.2 mg/kg (max. 10 mg) stat, then 4 – 6 micrograms/kg/min (max 300micrograms/min). Hydralazine may cause tachycardia, nausea and fluid retention.

Oral captopril:

  • mg/kg initially, increasing to a maximum of 1 mg/kg (max. 50 mg).Thereafter 0.1-1.0 mg/kg/dose 8-hourly. Captopril is usually effective within 30 – 60 min