High Blood Pressure in Teens

Causes, diagnosis, and treatment can differ from adults

Portrait smiling teenage girl with friends taking selfie on outdoor basketball court
Hero Images / Getty Images

While hypertension is commonly thought of as an "adult disease," an increasing number of teenagers and younger children are falling prey to high blood pressure.

Teens in the U.S. now weigh more and exercise less than in past generations. As a result, rates of high blood pressure among this group have a grown at a rapidly increasing rate.

According to research published in the April 2016 issue of Journal of Clinical Hypertension, just over one percent of children in the U.S. between the ages of eight and 17 have high blood pressure, while over six percent (or roughly one of every 15 children) have high-normal blood pressure indicative of prehypertension.

This is no less than five times the rate seen in the late-1980s and early-1990s.

Causes of Teenage Hypertension

It was once believed that high blood pressure in teens was largely related to an underlying problem with the heart or kidneys. Research has shown that this is not the case and that teens today are developing hypertension in approximately the same proportions as adults.

Most cases are classified as primary hypertension, meaning that it is not the consequence of some other health condition. While the underlying cause of primary hypertension is still not fully understood, it is strongly linked to modifiable lifestyle factors such as obesity and decreased cardiovascular fitness.

While most people like to think of teenagers as smaller versions of adults, the physiological changes that teens undergo place them at uniquely vulnerable risk. Hormone changes and rapid growth spurts can cause transient increases in cholesterol and blood pressure levels, conditions of which can be complicated by a high-fat diet, lack of exercise, and smoking.

As a result, even if a child doesn't have the physical manifestations of obesity, their blood pressure and cholesterol readings may fall well within in the range typically seen with obese teens.

Diagnosis

Diagnosing high blood pressure in teens is far more complicated than in adults. With adults, there is a clear set of numeric values to direct the diagnosis.

This is not the case with teens and adolescents, mainly because high blood pressure in persons under 20 do not carry the same health risks as those over 40 (such as heart attack or stroke).

As such, the diagnosis in teens is based on five key factors:

  • Age
  • Gender
  • Height
  • The systolic blood pressure reading (the upper blood pressure value which represents the pressure the heart exerts as it contracts)
  • The diastolic blood pressure reading (the lower blood pressure value which represents the pressure when the heart relaxes)

These values are then compared to other boys or girls to determine where the teen falls with a certain percentile.

A percentile is a comparison between a particular value and the value of the rest of the group. As such, if a teen's blood pressure is in the 90th percentile, it means that his or her blood pressure is higher than 90 percent of everyone else the group.

Blood Pressure Percentiles

The blood pressure percentiles for children, issued by the American Heart Association, can be broadly defined as follows:

  • Normal blood pressure is a blood pressure that falls beneath the 90th percentile.
  • Prehypertension is a blood pressure that falls between the 90th and 95th percentiles OR a blood pressure which is greater 120/80 even if that value is below the 90th percentile for his or her age.
  • Stage 1 hypertension is a blood pressure the falls between the 95th percentile and 5.0 mmHg above the 99th percentile.
  • Stage 2 hypertension is a blood pressure that is greater than 95th percentile plus 5.0 mmHg.

The system is a complicated one but takes into account factors that better characterize a teen's blood pressure.

While some blood pressure readings may seem high when looked at in isolation, they may end up being perfectly normal when adjusted for the child's height, age, and gender.

Prevention and Treatment

Because teenagers with hypertension tend to suffer more cardiovascular events later in life, early intervention is key to lowering the blood pressure and sustaining long-term control.

These include such lifestyle changes as:

  • Eating a healthy diet
  • Maintaining an ideal body mass index (BMI)
  • Exercising regularly
  • Quitting cigarettes
  • Limiting drug and alcohol use

Treatment options can vary but typically focus on lifestyle interventions before medications are considered. As with adults, any teen with stage 2 hypertension or symptomatic disease should be provided antihypertensive medications.

View Article Sources
  • Chuanwei, M.; Zhang, T.; and Xi, B. "Prevalence of Elevated Blood Pressure Among US Children, 2013–2014." J Clin Hyperten. 2016; 18 (10):1071. DOI: 10.1111/jch.12824.
  • Riley, M. and Bluhm, B. "High Blood Pressure in Children and Adolescents." Amer Fam Physician. 2012; 85(7):693-700. PMID: 22534345.