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Tests and diagnosis
By Mayo Clinic staffThe test for high blood pressure is painless. Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. Your child may feel a tight squeeze around the arm when the cuff is inflated. You can find out what your child's blood pressure is immediately after the test is over.
A blood pressure reading has two numbers. The first, or upper, number measures the pressure in your child's arteries when his or her heart beats (systolic pressure). The second, or lower, number measures the pressure in your child's arteries between beats (diastolic pressure).
Normal blood pressure readings in children vary based on sex, age and height, so what may be a high blood pressure reading for a 4-year-old boy may be normal for a 10-year-old girl. The readings are classified by percentile, similar to the way height and weight are charted for children's growth. For example, if your child's blood pressure is in the 75th percentile, that means 75 percent of children have the same or lower blood pressure than does your child.
Your child's doctor should tell you your child's blood pressure percentile and category. If you know your child's blood pressure measurement, you can also look up his or her percentile using tables from the National Heart, Lung, and Blood Institute.
| Category | Percentile* | What it means |
|---|---|---|
| Normal | 89th percentile or lower | Your child's blood pressure is normal. |
| Prehypertension | 90th percentile to 94th percentile | Your child's blood pressure is slightly elevated. Your child may benefit from lifestyle changes that can lower blood pressure, but the risk of additional health problems is small. |
| Stage 1 hypertension | 95th percentile up to 5 millimeters of mercury (mm Hg) above the blood pressure measurement at the 99th percentile | Your child has high blood pressure. Treatment with lifestyle changes is recommended. If lifestyle changes do not lower blood pressure after four to six months, medication may be recommended. |
| Stage 2 hypertension | 5 mm Hg or more above the 99th percentile | Your child has severe high blood pressure. Medications will likely be recommended immediately, along with lifestyle changes. |
*Percentiles are based on your child's sex, age and height.
Your child won't be diagnosed with high blood pressure after only one blood pressure measurement. To diagnose high blood pressure, it takes three measurements that show your child's blood pressure is higher than normal over the course of at least three visits to the doctor.
If your child's blood pressure is higher than normal, it should be checked every four to six months after high blood pressure is first diagnosed.
If your child is diagnosed with prehypertension or hypertension, your child's doctor may also perform these tests to see if another condition is causing your child's high blood pressure:
- Blood test to check your child's blood sugar, kidney function and blood cell counts
- Urine sample test (urinalysis)
- Echocardiogram, a test to check the blood flow through your child's heart, if your child's doctor suspects a heart problem may be causing high blood pressure
- Ultrasound of your child's kidneys
If your child's doctor is having difficulty diagnosing high blood pressure, or wants to monitor your child's treatment, he or she may recommend ambulatory monitoring. In ambulatory monitoring, your child wears a device that measures his or her blood pressure throughout the day. This is not yet common practice, and more research is necessary to see if ambulatory monitoring helps in the treatment and diagnosis of high blood pressure in children.
