High Blood Pressure in Teens

Causes and Diagnosis Can Differ From Adults

Hypertension is commonly thought of as an "adult disease," but an increasing number of teenagers and younger children are falling prey to the condition.﻿﻿ Also known as high blood pressure, hypertension occurs when your heart and arteries are consistently working harder than normal to move blood around your body—specifically when the heart pumps blood through the circulatory system and/or when the arteries resist the blood flow.

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 grown at a rapidly increasing rate over the last two decades.

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


It was once believed that high blood pressure in teens was largely related to an underlying problem with the heart or kidneys. But research shows this isn't 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's not the consequence of some other health condition. While the underlying cause of primary hypertension is still not fully understood, it's 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. Hormonal changes and rapid growth spurts can cause transient increases in cholesterol and blood pressure levels, conditions that 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, his or her blood pressure and cholesterol readings may fall well within the range typically seen in obese teens.


Diagnosing high blood pressure in teens is far more complicated than in adults, with whom 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 people under 20 doesn't carry the same health risks as those over 40 (such as heart attack or stroke).

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 within a certain percentile, a comparison between a particular value and the value of the rest of the group.﻿﻿

If your 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 in the group.

Classifying Blood Pressure

The 2017 American Heart Association guidelines now recommend using adult definitions of hypertension for people 13 or above:

  • Normal = <120 systolic and <80 diastolic
  • Elevated = 120-129 systolic and diastolic < 80
  • Stage 1 hypertension = 130-139 systolic OR 80-89 diastolic
  • Stage 2 hypertension = 140 or higher systolic OR 90 or higher diastolic

A teen's blood pressure should always be taken in context. While some readings may seem high in isolation, they may end up being perfectly normal when adjusted for the teen's height, age, and gender. International definitions of hypertension for children and adolescents are quite variable, and are often based on local demographics. 

Treatment and Prevention

Because teenagers with hypertension tend to suffer more cardiovascular events later in life, early intervention is key to lowering their 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
  • Eliminating 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 should receive antihypertensive medications if the blood pressure remains elevated over two readings taken a week apart.

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Article Sources
  1. Riley, M and Bluhm, B. High blood pressure in children and adolescents. American Family Physician. 2012;85(7):693-700.

  2. Anyaegbu EI, Dharnidharka VR. Hypertension in the teenager. Pediatr Clin North Am. 2014;61(1):131-51. doi:10.1016/j.pcl.2013.09.011. 

  3. Widén E, Silventoinen K, Sovio U, et al. Pubertal timing and growth influences cardiometabolic risk factors in adult males and females. Diabetes Care. 2012;35(4):850-6. doi:10.2337/dc11-1365.

  4. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115. doi:10.1161/HYP.0000000000000065.

Additional Reading
  • 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.