A Pocket Guide to Blood Pressure Measurement in Children

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Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 07-5268). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

A Pocket Guide to

Blood Pressure Measurement in Children

From the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents.

Measurement

n Begin routine blood pressure (BP) measurement at 3 years of age. n Correct cuff size depends on arm size. Practically speaking, correct cuff size equals largest cuff that will fit on the upper arm with room below for the stethoscope head. n BP should be measured in the right arm of a relaxed, seated child. n BP measurement by auscultation is the Gold Standard. n BP by automated device correlates reasonably well with auscultation, with practical advantages of rapid measurement remote from child and elimination of reader error. n If BP is high by automated device, repeat by auscultation.

BP Classification/Interpretation

BP is classified by systolic BP (SBP) and diastolic BP (DBP) percentiles for age/sex/height. If SBP or DBP >90th percentile, repeat twice at same office visit before interpreting result.

Normal BP: SBP and DBP <90th percentile ßRecheck in 1 year. Prehypertension: SBP or DBP > 90th percentile to <95th percentile or BP >120/80 mmHg to <95th percentile ßRecheck in 6 months. ßBegin weight management (as appropriate). Stage 1 Hypertension (HTN): SBP and/or DBP >95th percentile to < 99th percentile plus 5 mmHg ßRecheck in 1 to 2 weeks. ßIf BP remains at this level on recheck, begin evaluation and treatment including weight management if appropriate. Stage 2 HTN: SBP and/or DBP >99th percentile plus 5 mmHg ßBegin evaluation and treatment within 1 week, immediately if symptomatic.

Systolic BP Percentile Tables

Since diastolic HTN rarely occurs without systolic HTN in children, the SBP percentile tables on the next page can be used for HTN screening. If a child’s SBP on screening is classified as prehypertension or HTN, then both SBP and DBP percentiles should be determined using the tables in the complete report: The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics 2004 Aug;114(Suppl 2:)555-76; or http://www.nhlbi. nih.gov/health/prof/heart/hbp/hbp_ped.htm.

Directions for Use of Tables

1.Heights in the table are given for age at midyear. Use closest height to interpret BP. 2. Prehypertension SBP > value from table (90th percentile) to < Stage 1 HTN value; or SBP >120 mmHg to < Stage 1 HTN value. Stage 1 HTN SBP > value from the table (95th percentile) to < Stage 2 HTN. Stage 2 HTN SBP >value from table (99th percentile plus 5 mmHg).

For more information go to: www.nhlbi.nih.gov.

Girls SBP by Age and Height (Normal SBP is less than the prehypertensive result.)

Age BP ß Classification

3 Height (cm) 91 92 Prehypertension 100 100 Stage 1 HTN 104 104 Stage 2 HTN 116 116

4 Height (cm) 97 99 Prehypertension 101 102 Stage 1 HTN 105 106 Stage 2 HTN 117 118

5 Height (cm) 104 105 Prehypertension 103 103 Stage 1 HTN 107 107 Stage 2 HTN 119 119

6 Height (cm) 110 112 Prehypertension 104 105 Stage 1 HTN 108 109 Stage 2 HTN 120 121

7 Height (cm) 116 118 Prehypertension 106 107 Stage 1 HTN 110 111 Stage 2 HTN 122 123

8 Height (cm) 121 123 Prehypertension 108 109 Stage 1 HTN 112 112 Stage 2 HTN 124 125

9 Height (cm) 125 128 Prehypertension 110 110 Stage 1 HTN 114 114 Stage 2 HTN 126 126

10 Height (cm) 130 132 Prehypertension 112 112 Stage 1 HTN 116 116 Stage 2 HTN 128 128

11 Height (cm) 136 138 Prehypertension 114 114 Stage 1 HTN 118 118 Stage 2 HTN 130 130

12 Height (cm) 143 146 Prehypertension 116 116 Stage 1 HTN 119 120 Stage 2 HTN 132 132

13 Height (cm) 148 151 Prehypertension 117 118 Stage 1 HTN 121 122 Stage 2 HTN 133 134

14 Height (cm) 151 153 Prehypertension 119 120 Stage 1 HTN 123 123 Stage 2 HTN-- 135 136

15 Height (cm) 152 154 Prehypertension 120 120 Stage 1 HTN 124 125 Stage 2 HTN 136 137

16 Height (cm) 152 154 Prehypertension 120 120 Stage 1 HTN 125 126 Stage 2 HTN 137 138

17 Height (cm) 152 155 Prehypertension 120 120 Stage 1 HTN 125 126 Stage 2 HTN 138 138

Systolic BP (mmHg)

Boys SBP by Age and Height (Normal SBP is less than the prehypertensive result.)

Age BP ß Classification

3 Height (cm) 92 94 Prehypertension 100 101 Stage 1 HTN 104 105 Stage 2 HTN 116 117

4 Height (cm) 99 100 Prehypertension 102 103 Stage 1 HTN 106 107 Stage 2 HTN 118 119

5 Height (cm) 104 106 Prehypertension 104 105 Stage 1 HTN 108 109 Stage 2 HTN 120 121

6 Height (cm) 110 112 Prehypertension 105 106 Stage 1 HTN 109 110 Stage 2 HTN 121 122

7 Height (cm) 116 118 Prehypertension 106 107 Stage 1 HTN 110 111 Stage 2 HTN 122 123

8 Height (cm) 121 123 Prehypertension 107 109 Stage 1 HTN 111 112 Stage 2 HTN 124 125

9 Height (cm) 126 128 Prehypertension 109 110 Stage 1 HTN 113 114 Stage 2 HTN 125 126

10 Height (cm) 130 133 Prehypertension 111 112 Stage 1 HTN 115 116 Stage 2 HTN 127 128

11 Height (cm) 135 137 Prehypertension 113 114 Stage 1 HTN 117 118 Stage 2 HTN 129 130

12 Height (cm) 140 143 Prehypertension 115 116 Stage 1 HTN 119 120 Stage 2 HTN 131 132

13 Height (cm) 147 150 Prehypertension 117 118 Stage 1 HTN 121 122 Stage 2 HTN 133 135

14 Height (cm) 154 157 Prehypertension 120 120 Stage 1 HTN 124 125 Stage 2 HTN 136 137

15 Height (cm) 159 162 Prehypertension 120 120 Stage 1 HTN 126 127 Stage 2 HTN 139 140

16 Height (cm) 162 165 Prehypertension 120 120 Stage 1 HTN 129 130 Stage 2 HTN 141 142

17 Height (cm) 164 166 Prehypertension 120 120 Stage 1 HTN 131 132 Stage 2 HTN 144 145

Systolic BP (mmHg)

NIH Publication 07-5268 May 2007