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 ■ ■ ■ ■ ■ ■ 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 > 90th 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 > 95th percentile to < 99th 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/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. SBP > value from the table (95th Stage 1 HTN < percentile) to Stage 2 HTN. SBP >value from table (99th percentile Stage 2 HTN 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) Prehypertension Stage 1 HTN Stage 2 HTN 91 100 104 116 92 100 104 116 95 102 105 118 98 103 107 119 100 104 108 120 103 106 109 121 105 106 110 122 4 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 97 101 105 117 99 102 106 118 101 103 107 119 104 104 108 120 108 106 110 122 110 107 111 123 112 108 112 124 5 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 104 103 107 119 105 103 107 119 108 105 108 121 111 106 110 122 115 107 111 123 118 109 112 125 120 109 113 125 6 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 110 104 108 120 112 105 109 121 115 106 110 122 118 108 111 124 122 109 113 125 126 110 114 126 128 111 115 127 7 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 116 106 110 122 118 107 111 123 121 108 112 124 125 109 113 125 129 111 115 127 132 112 116 128 135 113 116 129 8 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 121 108 112 124 123 109 112 125 127 110 114 126 131 111 115 127 135 113 116 128 139 114 118 130 141 114 118 130 9 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 125 110 114 126 128 110 114 126 131 112 115 128 136 113 117 129 140 114 118 130 144 116 119 132 147 116 120 132 10 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 130 112 116 128 132 112 116 128 136 114 117 130 141 115 119 131 146 116 120 132 150 118 121 134 153 118 122 134 11 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 136 114 118 130 138 114 118 130 143 116 119 131 148 117 121 133 153 118 122 134 157 119 123 135 160 120 124 136 12 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 143 116 119 132 146 116 120 132 150 117 121 133 155 119 123 135 160 120 124 136 164 120 125 137 166 120 126 138 13 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 148 117 121 133 151 118 122 134 155 119 123 135 159 120 124 137 164 120 126 138 168 120 127 139 170 120 128 140 14 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN-- 151 119 123 135 153 120 123 136 157 120 125 137 161 120 126 138 166 120 127 140 170 120 129 141 172 120 129 141 15 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 152 120 124 136 154 120 125 137 158 120 126 138 162 120 127 139 167 120 129 141 171 120 130 142 173 120 131 143 16 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 152 120 125 137 154 120 126 138 158 120 127 139 163 120 128 140 167 120 130 142 171 120 131 143 173 120 132 144 17 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 152 120 125 138 155 120 126 138 159 120 127 139 163 120 129 141 167 120 130 142 171 120 131 143 174 120 132 144 Boys SBP by Age and Height (Normal SBP is less than the prehypertensive result.) Age ➟ BP Classification Systolic BP (mmHg) 3 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 92 100 104 116 94 101 105 117 96 103 107 119 99 105 109 121 102 107 110 123 104 108 112 124 106 109 113 125 4 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 99 102 106 118 100 103 107 119 103 105 109 121 106 107 111 123 109 109 112 125 112 110 114 126 113 111 115 127 5 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 104 104 108 120 106 105 109 121 109 106 110 123 112 108 112 125 116 110 114 126 119 111 115 128 120 112 116 128 6 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 110 105 109 121 112 106 110 122 115 108 112 124 119 110 114 126 122 111 115 128 126 113 117 129 127 113 117 130 7 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 116 106 110 122 118 107 111 123 121 109 113 125 125 111 115 127 129 113 117 129 132 114 118 130 134 115 119 131 8 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 121 107 111 124 123 109 112 125 127 110 114 127 131 112 116 128 135 114 118 130 139 115 119 132 141 116 120 132 9 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 126 109 113 125 128 110 114 126 132 112 116 128 136 114 118 130 141 115 119 132 145 117 121 133 147 118 121 134 10 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 130 111 115 127 133 112 116 128 137 114 117 130 141 115 119 132 146 117 121 133 150 119 122 135 153 119 123 135 11 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 135 113 117 129 137 114 118 130 142 115 119 132 146 117 121 134 151 119 123 135 156 120 124 137 159 120 125 137 12 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 140 115 119 131 143 116 120 132 148 118 122 134 153 120 123 136 158 120 125 138 163 120 127 139 166 120 127 140 13 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 147 117 121 133 150 118 122 135 155 120 124 136 160 120 126 138 166 120 128 140 171 120 129 141 173 120 130 142 14 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 154 120 124 136 157 120 125 137 162 120 127 139 167 120 128 141 173 120 130 143 177 120 132 144 180 120 132 145 15 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 159 120 126 139 162 120 127 140 167 120 129 141 172 120 131 143 177 120 133 145 182 120 134 147 184 120 135 147 16 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 162 120 129 141 165 120 130 142 170 120 132 144 175 120 134 146 180 120 135 148 184 120 137 149 186 120 137 150 17 Height (cm) Prehypertension Stage 1 HTN Stage 2 HTN 164 120 131 144 166 120 132 145 171 120 134 146 176 120 136 148 181 120 138 150 185 120 139 151 187 120 140 152 NIH Publication 07-5268 May 2007
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