Why is High Blood Pressure Missed in Kids and Teens?

Posted on Feb 09, 2018

Monesha Gupta, M.D., with John

John loves to sing for his school and church, and has overall been a pretty healthy 17-year-old. But last fall during his annual physical, his blood pressure reading was high. Blood pressure is influenced by emotions, activity and hormones in the body but when it is chronically elevated it is called hypertension.

“At first, I wasn’t too concerned because I didn’t understand the implications,” John explains. “Then I started taking medicine and I noticed how drastic the difference was.”

John used to get terrible migraines, but never knew it was related to his high blood pressure. Now he takes medicine to control his hypertension, and could tell a big difference when he accidentally forgot his dose one evening. He has also made lifestyle and dietary changes to help improve his health.

“I feel like everyone can get cravings for salty foods, and for some reason, I just loved salty foods,” John says. “Then after realizing how dangerous having high blood pressure can be and how much sodium can affect it, I’m noticing that there’s a bunch of different options that I can have–that still allow me to eat good foods, but avoid sodium.”

John is not alone. High blood pressure, or hypertension, may not seem like a common condition in pediatric patients, but it actually affects up to 5 to 12 percent of children and teens from newborn to 18.

“I was surprised to learn that so many children (and adults) have undiagnosed high blood pressure,” says John’s mom, Carolyn. “The changes John is making are good changes for all of us. More vegetables and fruits in our diet, less sodium and more exercise are things we can all benefit from.”

Symptoms of high blood pressure in children and teens:

  • Irritability
  • Headaches
  • Dizziness
  • Concentration issues

High blood pressure can lead to complications such as stroke, heart disease and kidney failure. What’s more, Monesha Gupta, M.D., a cardiologist and high blood pressure expert at Johns Hopkins All Children’s Hospital, says many times it is missed by pediatricians.

“Hypertension in children is a very specialized field. It’s not like an adult where a reading is 140/90 and you have hypertension,” Gupta says.

A child’s arm circumference needs to be measured to identify the correct cuff size for the child to wear when measuring blood pressure. Once the reading is correct, the child is considered to have high blood pressure if the measurement is above the 95th percentile for the height, weight and gender of the child, much like their growth charts.

“That is why I’ve done research in this area and created an easy-to-read blood pressure chart,” Gupta says. “In children, the measurements are very different, and it’s more tedious compared to adults. Each child has his or her own normal blood pressure number based on height, age and gender.”

The most common reason for high blood pressure in children from newborn to age six are secondary causes, such as an abnormal kidney. In older children it can be large tonsils causing disruption in the child’s sleep. Once these secondary issues are resolved, the high blood pressure typically returns to normal. After the age of 6 years, the most common cause is genetic or essential hypertension. According to the American Heart Association, the reasons for high blood pressure in children 8 and older may be due to higher body mass, larger waistlines and eating excess sodium.

The best advice Gupta can give parents in addition to being aware of your child’s sodium intake, is getting your children to the pediatrician regularly so they can monitor blood pressure and ask questions about the process. This is especially important if the child has a parent with high blood pressure.

“The earlier you catch the high blood pressure, the better chances it can be eliminated with just dietary therapy,” Gupta says. “There are some kids that will require medicine for a lifetime, but there are some kids who do really well after a few years.”

That is what John and Carolyn hope for–a future with healthy blood pressure and no medication.

Visit to learn more about the Johns Hopkins All Children's Heart Institute. 

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