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What Level of Blood Pressure Is Concerning in Childhood?

Joseph T Flynn1

  • 1Department of Pediatrics, University of Washington School of Medicine. Division of Nephrology, Seattle Children's Hospital, WA.

Circulation Research
|March 3, 2022
PubMed

Insights

Current guidelines define high blood pressure (BP) in children at the 95th percentile. Emerging evidence suggests harmful effects, including cardiac and kidney issues, begin at the 90th percentile, prompting a review of lower BP thresholds.

Area of Science:

  • Pediatric Cardiology
  • Public Health
  • Hypertension Research

Background:

  • Current pediatric hypertension guidelines define high blood pressure (BP) at the 95th percentile.
  • Emerging research indicates adverse health effects associated with BP levels below the current hypertensive threshold.

Purpose of the Study:

  • To review evidence supporting a lower BP threshold for concern in children and adolescents.
  • To identify remaining questions before adopting a revised pediatric BP guideline.

Main Methods:

  • Systematic review of cross-sectional and longitudinal studies.
  • Analysis of data on cardiac, vascular, cognitive, and kidney effects.
  • Examination of markers for adult cardiovascular disease in youth.

Main Results:

  • Detrimental effects on cardiac, vascular, cognitive, and kidney function observed starting at the 90th BP percentile.
  • Longitudinal studies show adult cardiovascular disease markers in individuals with youth BP in the normal or modestly elevated ranges.
  • Evidence suggests current 'normal' BP levels may pose risks.

Conclusions:

  • A lower BP threshold for concern in pediatric populations is supported by current data.
  • Further research is needed to establish a new, lower BP threshold for clinical adoption.

Keywords:
atherosclerosisblood pressurechild; adolescenthearthypertension

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