Pediatric Blood Pressure

Categories and stages (AAP 2017, Table 3, verbatim)

For children aged 1-<13 y
  Normal BP:   <90th percentile
  Elevated BP: ≥90th percentile to <95th percentile or 120/80 mm Hg
               to <95th percentile (whichever is lower)
  Stage 1 HTN: ≥95th percentile to <95th percentile + 12 mmHg,
               or 130/80 to 139/89 mm Hg (whichever is lower)
  Stage 2 HTN: ≥95th percentile + 12 mm Hg, or ≥140/90 mm Hg
               (whichever is lower)
For children aged ≥13 y
  Normal BP:   <120/<80 mm Hg
  Elevated BP: 120/<80 to 129/<80 mm Hg
  Stage 1 HTN: 130/80 to 139/89 mm Hg
  Stage 2 HTN: ≥140/90 mm Hg

How this page applies it, for 1 to <13 years: each threshold is the lower of the percentile value and the absolute value, separately for systolic and diastolic.

SBP: elevated = min(P90, 120); stage 1 = min(P95, 130); stage 2 = min(P95 + 12, 140)
DBP: elevated = min(P90, 80);  stage 1 = min(P95, 80);  stage 2 = min(P95 + 12, 90)
Category = the higher of the systolic and diastolic categories (the guideline defines HTN by "SBP and/or DBP").
Each threshold is inclusive (≥). ≥13 y: DBP 80-89 is stage 1; DBP ≥90 is stage 2; elevated needs SBP 120-129 with DBP <80.

• Table 3's header for the younger column reads "1–13 y" in a February 2018 copy of the article and "1–<13 y" in a September 2018 copy (after the 2018 erratum); this page uses 1 to <13 years.
• The "higher of SBP and DBP" rule is how this page combines the two components; Table 3 itself lists combined values (e.g. 120/80). [Interpretation]
• Tables 4 and 5 (BP by age, sex and height percentile) are not reproduced here. Read the 90th and 95th percentile values there. They were derived by quantile regression in normal-weight children (BMI <85th percentile) and differ from the 2004 Fourth Report tables.
• One reading gives a category for that reading. KAS 3: diagnose HTN when auscultatory-confirmed BP is ≥95th percentile at 3 different visits. Table 11 lists the follow-up interval for each category.
• Table 11 footnote d: if the patient is symptomatic or BP is >30 mm Hg above the 95th percentile (or >180/120 mm Hg in an adolescent), send to an emergency department. This page flags that condition.

Screening values requiring further evaluation (Table 6)

Based on the 90th percentile for age and sex at the 5th height percentile; a screening tool only, not for classification. Values are mm Hg (systolic/diastolic).

Four-limb gradient

• Section 5.3: coarctation "is usually associated with HTN and right arm BP that is 20 mm Hg (or more) greater than the lower extremity BP". This page flags a right arm minus leg systolic difference ≥20 mm Hg.
• Table 7, item 5: "The SBP in the legs is usually 10%–20% higher than the brachial artery pressure." A leg pressure below the arm pressure is therefore unusual even when the gradient is under 20 mm Hg.
• Table 7, item 2: measure in the right arm partly "to avoid a falsely low reading from the left arm in the case of coarctation of the aorta". The right-to-left arm difference is shown without a threshold; no cut-off was taken from a source for it.
• A gradient under 20 mm Hg does not exclude coarctation; the guideline gives no negative-predictive statement. Neonatal four-limb screening is not addressed by this source.

Not implemented

• Percentile lookup from Tables 4 and 5 and height-percentile calculation from CDC data: not implemented. The tables are copyrighted (AAP); the R package pedbp that encodes them is GPL-2 and was not used.
• Neonatal BP: see Neonatal Blood Pressure (NNNI 1999 systolic centiles, birth to 1 year). The Dionne 2012 table by postmenstrual age is not implemented.

Verification

Checked in October 2026 against MDCalc’s AAP 2017 interpretation table and the Baylor College of Medicine BP reference tables: the category agreed in 129 of 129 readings (102 children, 27 adolescents) at and around every threshold, including MDCalc’s worked example (14 years, 135/90 = stage 2); Table 6 screening values 26 of 26. This page does not compute percentiles (you enter the 90th and 95th values from the AAP tables), so MDCalc’s computed percentiles were not compared.

References

• Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017;140(3):e20171904. doi:10.1542/peds.2017-1904 (Tables 3, 6, 7, 11; KAS 3 and 5; section 5.3)
• Erratum, Pediatrics 2017;140(6):e20173035 (dosing in Table 19 only). doi:10.1542/peds.2017-3035
• Erratum, Pediatrics 2018;142(3):e20181739. doi:10.1542/peds.2018-1739. The erratum notice itself could not be retrieved [unverified]; Tables 3 and 6 were checked in a copy of the article downloaded 11 September 2018.