Pediatric Blood Pressure Ranges
For children under 13 years, normal blood pressure is defined as less than the 90th percentile for age, sex, and height; for adolescents 13 years and older, normal blood pressure is less than 120/80 mmHg. 1
Blood Pressure Categories by Age Group
Children Under 13 Years
Blood pressure classification in younger children is based on percentiles adjusted for age, sex, and height 1:
- Normal BP: <90th percentile for age, sex, and height 1
- Elevated BP: ≥90th percentile but <95th percentile for age, sex, and height 1
- Stage 1 Hypertension: ≥95th percentile to <95th percentile + 12 mmHg 1
- Stage 2 Hypertension: ≥95th percentile + 12 mmHg 1
Adolescents ≥13 Years
The 2017 American Academy of Pediatrics guidelines aligned adolescent thresholds with adult definitions to simplify management 1:
- Normal BP: <120/80 mmHg 1, 2
- Elevated BP: 120-129/<80 mmHg 1, 2
- Stage 1 Hypertension: 130/80 to 139/89 mmHg 1, 2
- Stage 2 Hypertension: ≥140/90 mmHg 1, 2
Representative Normal Values by Age
Young Children (Age 6)
For a 6-year-old girl at the 50th height percentile 3:
- 50th percentile: 105/67 mmHg
- 95th percentile: 111/74 mmHg
School-Age Children (Age 10)
Height significantly affects blood pressure values, with a 10-year-old at the 50th height percentile typically measuring 135-140 cm tall 3
Adolescents (Age 14)
For 14-year-old boys and girls 2:
- 50th percentile: Approximately 118/73 mmHg (boys) and 117/73 mmHg (girls)
- 24-hour ambulatory average: 118/68 mmHg (boys) and 117/67 mmHg (girls)
Older Adolescents (Age 16-17)
For 16-year-old males, 24-hour ambulatory monitoring shows 2:
- 50th percentile: 123.4/68.6 mmHg
- 95th percentile: 138.2/76.2 mmHg
For 17-year-olds at the 50th percentile 1:
- Boys: 114/65 mmHg (systolic range 114-122 mmHg across height percentiles)
- Girls: Similar values adjusted for height percentile
Critical Measurement Considerations
Proper Technique
- Cuff sizing: Bladder width must be 40% of mid-arm circumference and cover 80-100% of arm circumference 3
- Patient positioning: Child seated quietly with right arm resting at heart level on solid surface 3
- Measurement method: Auscultation remains the preferred method for diagnosis 1
Screening Recommendations
Annual blood pressure screening at preventive care visits is recommended for all children starting at age 3 years 1. More frequent screening is indicated for children with obesity, diabetes mellitus, heart disease, or kidney disease 1.
Diagnostic Confirmation
Hypertension diagnosis requires elevated readings on three separate occasions unless the patient is symptomatic 1, 4. Ambulatory blood pressure monitoring (ABPM) should be performed to confirm the diagnosis and rule out white coat hypertension 1, 4.
Common Pitfalls to Avoid
Incorrect cuff size is the most common source of error—too small a cuff falsely elevates readings 5. Always verify proper cuff dimensions before interpreting values 3.
Single elevated reading should never be used to diagnose hypertension except in symptomatic patients 1. The requirement for three separate elevated measurements prevents overdiagnosis 4.
Ignoring height percentile in children under 13 years leads to misclassification, as blood pressure normally increases with height 3. Always use age-, sex-, and height-specific percentiles for accurate interpretation 1.
White coat hypertension is common in pediatric patients and can only be ruled out with ambulatory monitoring 2. Office readings alone may lead to unnecessary treatment 1.