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
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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