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ish-htn-children

Diagnose and manage hypertension in children and adolescents per the 2026 ISH Global Hypertension Practice Guidelines — percentile-based definitions under 16 years and adult thresholds from 16, measurement with child-validated devices and correct cuff, ABPM for confirmation, when to investigate for secondary causes (age <6, age 6–12 without obesity or family history, grade 2 without obesity, organ damage), lifestyle first for grade 1, when to start drugs, paediatric BP targets (<90th percentile; <130/80 from 16; CKD <75th or <50th with proteinuria), and when to refer. Use when a clinician asks "child BP high what next", "paediatric hypertension definition", "BP percentile in a 10-year-old", "when to start BP medicine in a child", "teenager with high BP", "secondary hypertension in children", or "BP target in a child with CKD". Source: Stergiou GS et al, 2026 ISH Global Hypertension Practice Guidelines, J Hypertens 2026 (DOI 10.1097/HJH.0000000000004451).

日本語の概要は準備中です。原文の説明を表示しています。

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Hypertension in Children & Adolescents (ISH 2026)

Global prevalence ~4% and rising, driven by childhood obesity. Childhood high BP tracks into adult CV and kidney disease.

Step 1 — Measure correctly (ESSENTIAL)

  • sOBP at 2–3 visits (adult protocol — see ish-htn-diagnosis-bp-measurement)
  • Calibrated manual auscultatory device, or automated upper-arm device validated specifically in children (stridebp.org)
  • Cuff must fit the child's arm

Step 2 — Classify

AgeGrade 1 hypertensionGrade 2 hypertension
<16 yearssOBP ≥95th percentile to <95th + 12 mmHg for age, sex and heightsOBP ≥95th percentile + 12 mmHg
≥16 yearsAdult thresholds (≥140/90 grade 1; ≥160/100 grade 2)

Use population-based normative data.

Step 3 — Confirm out of office (OPTIMAL)

  • Out-of-office BP is usually needed to confirm the diagnosis
  • ABPM is preferred for diagnosis in children (better studied)
  • Home BP is better for long-term monitoring of treated children
  • Normative tables exist for ABPM and home BP but vary by region, body size and obesity prevalence

Step 4 — Decide whether to look for a secondary cause (ESSENTIAL)

Secondary causes are much more common in children than adults; primary hypertension dominates in adolescents. Investigate selected cases:

  • Age <6 years
  • Age 6–12 without obesity and without family history of hypertension
  • Grade 2 hypertension without obesity
  • Hypertension-mediated organ damage
  • Severe acute hypertension
  • Syndrome or family history of secondary hypertension

Step 5 — Treat

Lifestyle (everyone): especially weight loss in overweight/obese children.

SituationAction
Grade 1Lifestyle alone for 3–6 months; start drugs if hypertension persists
Grade 2, hypertensive emergency, symptomatic hypertension, diabetes, CKD, organ damageStart antihypertensives immediately

Drug rules: same principles as adults, but prefer drugs studied in children.

Targets:

  • <90th percentile in children
  • <130/80 mmHg in adolescents ≥16 years
  • CKD (OPTIMAL): office and 24-h ambulatory BP <75th percentile; <50th percentile if proteinuria

Step 6 — Refer (OPTIMAL)

Refer to a paediatric hypertension specialist if:

  • You are uncomfortable prescribing antihypertensives in a child
  • A secondary cause is suspected

Guardrails

  • Use percentiles under 16 — adult cut-offs miss most childhood hypertension
  • Use child-validated devices and the right cuff — oversized/undersized cuffs mislead
  • Young child (<6) with high BP = investigate for a secondary cause
  • Give grade 1 a 3–6-month lifestyle trial before drugs
  • Don't delay drugs in grade 2, CKD, diabetes or organ damage
  • Tighter targets in CKD with proteinuria (<50th percentile)

Related MD2SKILL skills

  • eso-pediatric-obesity-bp-interpretation — BP interpretation in children with obesity
  • pediatric-obesity-* skills — weight management
  • ish-htn-diagnosis-bp-measurement — measurement technique

Source

Stergiou GS, Kario K, Aristizabal D, et al. 2026 International Society of Hypertension Global Hypertension Practice Guidelines. J Hypertens. 2026;44. DOI: 10.1097/HJH.0000000000004451. Section 9.4. A separate ISH 2026 position paper on hypertension in children is cited by the guideline (DOI 10.1097/HJH.0000000000004238).

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