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Health Information for the Public

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

U.S. Department of Health and Human Services
National Institutes of Health
National Heart, Lung, and Blood Institute

Measurement

  • Begin routine blood pressure (BP) measurement at 3 years of age.
  • 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.
  • BP should be measured in the right arm of a relaxed, seated child.
  • BP measurement by auscultation is the Gold Standard.
  • BP by automated device correlates reasonably well with auscultation, with practical advantages of rapid measurement remote from child and elimination of reader error.
  • 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

  • Recheck in 1 year.

Prehypertension: SBP or DBP greater than or equal to90th percentile to <95th percentile or BP >120/80 mmHg to <95th percentile

  • Recheck in 6 months.
  • Begin weight management (as appropriate).

Stage 1 Hypertension (HTN): SBP and/or DBP greater than or equal to95th percentile to less than or equal to99th percentile plus 5 mmHg

  • Recheck in 1 to 2 weeks.
  • If 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

  • Begin 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-pro/guidelines/current/hypertension-pediatric-jnc-4/guidelines-report.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 greater than or equal to value from table (90th percentile) to < Stage 1 HTN value; or SBP >120 mmHg to < Stage 1 HTN value.

    Stage 1 HTN: SBP greater than or equal to value from the table (95th percentile) to less than or equal 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 Classification Systolic BP (mmHg)
3 Height (cm) 91 92 95 98 100 103 105
Prehypertension 100 100 102 103 104 106 106
Stage 1 HTN 104 104 105 107 108 109 110
Stage 2 HTN 116 116 118 119 120 121 122
4 Height (cm) 97 99 101 104 108 110 112
Prehypertension 101 102 103 104 106 107 108
Stage 1 HTN 105 106 107 108 110 111 112
Stage 2 HTN 117 118 119 120 122 123 124
5 Height (cm) 104 105 108 111 115 118 120
Prehypertension 103 103 105 106 107 109 109
Stage 1 HTN 107 107 108 110 111 112 113
Stage 2 HTN 119 119 121 122 123 125 125
6 Height (cm) 110 112 115 118 122 126 128
Prehypertension 104 105 106 108 109 110 111
Stage 1 HTN 108 109 110 111 113 114 115
Stage 2 HTN 120 121 122 124 125 126 127
7 Height (cm) 116 118 121 125 129 132 135
Prehypertension 106 107 108 109 111 112 113
Stage 1 HTN 110 111 112 113 115 116 116
Stage 2 HTN 122 123 124 125 127 128 129
8 Height (cm) 121 123 127 131 135 139 141
Prehypertension 108 109 110 111 113 114 114
Stage 1 HTN 112 112 114 115 116 118 118
Stage 2 HTN 124 125 126 127 128 130 130
9 Height (cm) 125 128 131 136 140 144 147
Prehypertension 110 110 112 113 114 116 116
Stage 1 HTN 114 114 115 117 118 119 120
Stage 2 HTN 126 126 128 129 130 132 132
10 Height (cm) 130 132 136 141 146 150 153
Prehypertension 112 112 114 115 116 118 118
Stage 1 HTN 116 116 117 119 120 121 122
Stage 2 HTN 128 128 130 131 132 134 134
11 Height (cm) 136 138 143 148 153 157 160
Prehypertension 114 114 116 117 118 119 120
Stage 1 HTN 118 118 119 121 122 123 124
Stage 2 HTN 130 130 131 133 134 135 136
12 Height (cm) 143 146 150 155 160 164 166
Prehypertension 116 116 117 119 120 120 120
Stage 1 HTN 119 120 121 123 124 125 126
Stage 2 HTN 132 132 133 135 136 137 138
13 Height (cm) 148 151 155 159 164 168 170
Prehypertension 117 118 119 120 120 120 120
Stage 1 HTN 121 122 123 124 126 127 128
Stage 2 HTN 133 134 135 137 138 139 140
14 Height (cm) 151 153 157 161 166 170 172
Prehypertension 119 120 120 120 120 120 120
Stage 1 HTN 123 123 125 126 127 129 129
Stage 2 HTN 135 136 137 138 140 141 141
15 Height (cm) 152 154 158 162 167 171 173
Prehypertension 120 120 120 120 120 120 120
Stage 1 HTN 124 125 126 127 129 130 131
Stage 2 HTN 136 137 138 139 141 142 143
16 Height (cm) 152 154 158 163 167 171 173
Prehypertension 120 120 120 120 120 120 120
Stage 1 HTN 125 126 127 128 130 131 132
Stage 2 HTN 137 138 139 140 142 143 144
17 Height (cm) 152 155 159 163 167 171 174
Prehypertension 120 120 120 120 120 120 120
Stage 1 HTN 125 126 127 129 130 131 132
Stage 2 HTN 138 138 139 141 142 143 144

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

Age BP Classification Systolic BP (mmHg)
3 Height (cm) 92 94 96 99 102 104 106
Prehypertension 100 101 103 105 107 108 109
Stage 1 HTN 104 105 107 109 110 112 113
Stage 2 HTN 116 117 119 121 123 124 125
4 Height (cm) 99 100 103 106 109 112 113
Prehypertension 102 103 105 107 109 110 111
Stage 1 HTN 106 107 109 111 112 114 115
Stage 2 HTN 118 119 121 123 125 126 127
5 Height (cm) 104 106 109 112 116 119 120
Prehypertension 104 105 106 108 110 111 112
Stage 1 HTN 108 109 110 112 114 115 116
Stage 2 HTN 120 121 123 125 126 128 128
6 Height (cm) 110 112 115 119 122 126 127
Prehypertension 105 106 108 110 111 113 113
Stage 1 HTN 109 110 112 114 115 117 117
Stage 2 HTN 121 122 124 126 128 129 130
7 Height (cm) 116 118 121 125 129 132 134
Prehypertension 106 107 109 111 113 114 115
Stage 1 HTN 110 111 113 115 117 118 119
Stage 2 HTN 122 123 125 127 129 130 131
8 Height (cm) 121 123 127 131 135 139 141
Prehypertension 107 109 110 112 114 115 116
Stage 1 HTN 111 112 114 116 118 119 120
Stage 2 HTN 124 125 127 128 130 132 132
9 Height (cm) 126 128 132 136 141 145 147
Prehypertension 109 110 112 114 115 117 118
Stage 1 HTN 113 114 116 118 119 121 121
Stage 2 HTN 125 126 128 130 132 133 134
10 Height (cm) 130 133 137 141 146 150 153
Prehypertension 111 112 114 115 117 119 119
Stage 1 HTN 115 116 117 119 121 122 123
Stage 2 HTN 127 128 130 132 133 135 135
11 Height (cm) 135 137 142 146 151 156 159
Prehypertension 113 114 115 117 119 120 120
Stage 1 HTN 117 118 119 121 123 124 125
Stage 2 HTN 129 130 132 134 135 137 137
12 Height (cm) 140 143 148 153 158 163 166
Prehypertension 115 116 118 120 120 120 120
Stage 1 HTN 119 120 122 123 125 127 127
Stage 2 HTN 131 132 134 136 138 139 140
13 Height (cm) 147 150 155 160 166 171 173
Prehypertension 117 118 120 120 120 120 120
Stage 1 HTN 121 122 124 126 128 129 130
Stage 2 HTN 133 135 136 138 140 141 142
14 Height (cm) 154 157 162 167 173 177 180
Prehypertension 120 120 120 120 120 120 120
Stage 1 HTN 124 125 127 128 130 132 132
Stage 2 HTN 136 137 139 141 143 144 145
15 Height (cm) 159 162 167 172 177 182 184
Prehypertension 120 120 120 120 120 120 120
Stage 1 HTN 126 127 129 131 133 134 135
Stage 2 HTN 139 140 141 143 145 147 147
16 Height (cm) 162 165 170 175 180 184 186
Prehypertension 120 120 120 120 120 120 120
Stage 1 HTN 129 130 132 134 135 137 137
Stage 2 HTN 141 142 144 146 148 149 150
17 Height (cm) 164 166 171 176 181 185 187
Prehypertension 120 120 120 120 120 120 120
Stage 1 HTN 131 132 134 136 138 139 140
Stage 2 HTN 144 145 146 148 150 151 152
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