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 overweight; children 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 related diseases 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 unfortunately plays a role even at a young age, as do anxiety and stress. In addition, more and more children are being diagnosed with ADHD and are consequently prescribed medications that can raise blood pressure as a long-term effect. During adolescence, energy drinks, alcohol, smoking (including passive smoking) and experiences with 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 develop from infants into fully grown adults. They undergo major changes: some develop a little faster, others a little more slowly, and boys develop differently from girls. This often occurs in phases, which also vary from person to person. It is therefore not possible to provide a single set of normal blood pressure values that applies to everyone, especially not throughout the entire period of development. Reference value tables based solely on age can provide only a rough classification at best. Tables based on percentiles allow a more accurate assessment of the values because they take height and biological sex into account as well as age.
Here, percentiles indicate how a child's blood pressure compares with that of other children of the same age and height. A blood pressure at the 50th percentile therefore means that 50% of children of the same age and height have this blood pressure. If the blood pressure is in an excessively high range, such as the 97th percentile, this means that only 3% of children of this age and height have this blood pressure value.
Blood pressure percentiles refer to the systolic blood pressure value.

Classification of blood pressure by percentile

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, whichever is lower) and < the 95th percentile.
Stage 1 hypertension: Stage 1 hypertension is defined as blood pressure ≥ the 95th percentile and < the 95th percentile + 12 mmHg, or 130/80 to 139/89, whichever is lower.
Stage 2 hypertension: Stage 2 hypertension is defined as blood pressure ≥ the 95th percentile + 12 mmHg or ≥ 140/90, whichever is lower.

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

(Orange = boys' systolic blood pressure, Red = girls' systolic blood pressure, dashed = diastolic blood pressure)

What's behind this?

Data source: Tables from the American Academy of Pediatrics (2017 AAP Guideline) / Merck Manual, which list blood pressure percentiles separately for each age and height category. (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 3-4 mmHg above or below this curve, respectively.
Ages 1-17 years: Over this range, average normal systolic blood pressure rises from approximately 85 mmHg (toddler) to just over 110 mmHg (late adolescence). Diastolic pressure increases from approximately 40-45 mmHg to the mid-60s.
Sex differences: Up to about age 10, the curves are practically identical. During puberty, girls are slightly ahead of boys (due to earlier growth spurts), before the curves converge.

Using the chart:

Plot the measurement:

Child's 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.
Interpretation:
< 90th percentile = normal
90th–<95th percentile = “elevated”
≥ 95th percentile = hypertension threshold (AAP guideline 2017)
Important: The table/graph is an approximation tool. Exact classifications—especially for borderline or repeatedly elevated readings—should always be made 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 thresholds (≈ upper 5% of the population) for systolic and diastolic blood pressure values in boys and girls, for children/adolescents of average height (50th percentile) in each case.

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 easily determined by adding 12 mmHg).
• Compared with the normal values (50th percentile from the first chart), these curves are about 15–20 mmHg higher systolically and 13–17 mmHg higher diastolically.

(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 is from Tensana – the leading app since 2011, helping hundreds of thousands of people 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 outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.