Routine Blood Pressure Measurement for Children: Is it Necessary?

The incidence of pediatric hypertension is on the rise. Although providers may not routinely check the blood pressure of small children, pediatric nephrologist Melissa Muff-Luett, MD, assistant professor at UNMC College of Medicine says it is vital.


“Hypertension in children is different than adult hypertension,” says Dr. Muff-Luett. “Finding the cause and taking action to correct it is important for children because they would have to endure many more years of the adverse effects of high blood pressure on their health, particularly effects on the heart, kidneys and eyes.”


Dr. Muff-Luett says children under 3 should have their blood pressure checked if they have certain risk factors including prematurity, low birth weight, history of a NICU course, congenital heart disease, known kidney disease, urologic malformations or a history of urinary tract diseases.


Pediatric hypertension may be classified as either primary (also known as essential) or secondary. Primary is more common in adolescents, children with a family history or genetic predisposition, and overweight or obese children.


“A diagnosis of primary hypertension has to be a diagnosis of exclusion,” says Dr. Muff-Luett. “We really should look for a secondary cause for hypertension in any child.”


Secondary causes may include renal parenchymal disease, renovascular disease, congenital renal anomalies, bronchopulmonary dysplasia, coarctation of the aorta, renal vein thrombosis, and congenital adrenal hyperplasia. For children and adolescents, additional causes include renal and renovascular diseases, pheochromocytoma, increased intracranial pressure and drug-induced hypertension.


“If it appears to be pre-hypertension, it would be reasonable to check the blood pressure again in six months,” says Dr. Muff-Luett. “If the child appears to have stage one hypertension, we should recheck in one to two weeks, which can be done either at the medical office or at home or by a school nurse prior to initiating a further evaluation for hypertension.”


If stage two hypertension is suspected, Dr. Muff-Luett recommends that an initial hypertension evaluation occur within 1-2 weeks. She advises primary care providers to consider contacting a pediatric nephrologist if guidance is needed or if therapy is indicated, particularly in cases with significant hypertension, symptomatic hypertension or evidence of end organ damage.