Table II.

 Classification of Hypertension in Children and Adolescents, With Measurement Frequency and Therapy Recommendations

	SBP or DBP Percentilea	Frequency of Blood Pressure Measurement	Therapeutic Lifestyle Changes	Pharmacologic Therapy
Normal	<90th	Recheck at next scheduled physical examination	Encourage healthy diet, sleep, and physical activity	–
Prehypertension	90th to <95th or if BP exceeds 120/80 mm Hg even if <90th percentile up to <95th percentileb	Recheck in 6 mo	Weight‐management counseling  if overweight; introduce  physical activity and  diet managementc	None unless compelling indications such as chronic kidney disease, diabetes mellitus, heart failure, or left ventricular hypertrophy exist
Stage 1 hypertension	95th–99th percentile +5 mm Hg	Recheck in 1–2 wk or sooner if the patient is symptomatic; if persistently elevated on 2 additional occasions, evaluate or refer to source of care within 1 mo	Weight‐management counseling if overweight; introduce physical activity and diet managementc	Initiate therapy based on indications such as symptomatic hypertension, secondary hypertension, hypertensive target‐organ damage, diabetes (types 1 and 2), and persistent hypertension despite nonpharmacologic measures, or if compelling indications existe
Stage 2 hypertension	>99th percentile +5 mm Hg	Evaluate or refer to source of care within 1 wk or immediately if the patient is symptomatic	Weight‐management counseling if overweight; introduce physical activity and diet managementb	Initiate therapyd

^aFor sex, age, and height measured on at least 3 separate occasions; if systolic and diastolic categories are different, categorize by the higher value. ^bThis occurs typically at 12 years old for systolic blood pressure (SBP) and at 16 years old for diastolic BP (DBP). ^cParents and children trying to modify the eating plan to the Dietary Approaches to Stop Hypertension Study eating plan could benefit from consultation with a registered or licensed nutritionist to get them started. ^dMore than 1 drug may be required.^eSymptomatic or secondary hypertension, target‐organ damage, or persistent hypertension despite non‐pharmacologic measures. Reproduced with permission from Pediatrics. 114:555–576. Copyright ©2004 by the American Academy of Pediatrics.