Drug treatment of hypertension in children Immediate drug treatment is typically started (along with lifestyle changes) for children with Symptomatic hypertension at any stage or level Stage 1 hypertension with any evidence of end-organ dysfunction or damage Stage 2 hypertension even with an obvious, modifiable risk factor (eg, obesity), which should be addressed while BP is being controlled Any stage of hypertension if they have chronic kidney disease, diabetes, or cardiac disease In children with high normal or borderline hypertension or stage 1 hypertension without symptoms or end-organ dysfunction, lifestyle changes are initiated, and if these do not sufficiently lower BP within about 6 months, drug treatment will be necessary.