Table 2.

Hypertension classification by casual blood pressure measurement, frequency of measurement, and therapy recommendations^*

	Prehypertension	Stage I hypertension	Stage II hypertension
Systolic BP or diastolic BP percentile	90–94th percentile or if BP exceeds 120/80 mmHg even if <90th percentile	Systolic BP or diastolic BP 95–99th percentile plus 5 mmHg	Systolic BP or diastolic BP percentile >99th percentile plus 5 mmHg
Frequency of BP measurement	Recheck in six months	Recheck in 1–2 weeks or sooner; if child is symptomatic; if hypertension is persistent, evaluate on 2 additional occasions or refer to a specialist within one month	Evaluate or refer to source of care within one week, or, immediately if the child is symptomatic
Therapeutic lifestyle changes	Weight management counseling if overweight; introduce physical activity and diet management	Weight management counseling if overweight; introduce physical activity and diet management	Weight management counseling if overweight; introduce physical activity and diet management
Pharmacologic therapy	None, unless there are compelling indications such as chronic kidney disease, diabetes mellitus, heart failure, or left ventricular hypertrophy	Initiate therapy if the child has: symptoms secondary hypertension, hypertensive target organ injury, diabetes (type 1 or 2), or persistent hypertension despite nonpharmacological measures	Initiate therapy

Note:

^*All reference limits are based on gender, age and height for casual BP measurement11

Abbreviation: BP, blood pressure.