Consumer edition active

Medication Treatment of High Blood Pressure in Children

ByMichael A. Ferguson, MD, Harvard Medical School
Reviewed/Revised Apr 2025
VIEW PROFESSIONAL VERSION
Recently Added

Topic Resources

High blood pressure (hypertension) is persistently high pressure in the arteries. Some children who have high blood pressure need medications to lower it.

(See also High Blood Pressure in Children.)

In children under 13 years of age, the values that are considered high vary based on sex, age, and height. Thus, there is no single blood pressure reading that indicates high blood pressure for all children. In children under 13, blood pressure is classified as follows:

  • Normal: At or lower than 90% of others of the same age, gender, and height

  • Elevated: Higher than 90% of others of the same age, gender, and size, but not height enough to qualify for stage 1

  • Stage 1: Higher than 95% of others of the same age, gender, and height, but not high enough to qualify for stage 2 hypertension

  • Stage 2: 12 mm Hg higher than stage 1 level

In adolescents (13 years of age or over), blood pressure is classified as it is in adults:

  • Normal: Lower than 120 systolic blood pressure and lower than 80 diastolic blood pressure

  • Elevated: 120 to 129 systolic blood pressure and lower than 80 diastolic blood pressure

  • Stage 1 (mild) high blood pressure: 130/80 to 139/89)

  • Stage 2 high blood pressure: 140/90 or higher

Children under 13 use the adult thresholds for classifying BP if that number is lower than their age, gender, and size-based threshold.

Immediate medication treatment (plus lifestyle changes) is typically started if any of the following apply:

  • High blood pressure, regardless of severity, causes symptoms.

  • Stage 1 hypertension causes organ dysfunction or damage or does not improve with lifestyle changes.

  • Stage 2 hypertension is present.

  • Children have chronic kidney disease, diabetes, or heart disease regardless of the stage of high blood pressure.

Children who have milder forms of high blood pressure that are not controlled after about 6 months of lifestyle changes will need medication treatment.

Medications that are used in the treatment of high blood pressure are called antihypertensive drugs. Treatment is most effective when the parents, child, and doctor communicate well and discuss the medication treatment program, including possible side effects. Any antihypertensive medication can have side effects, so parents should be alert for them. If side effects develop, parents or the child should tell the doctor, who can adjust the dose or substitute another medication.

Doctors typically start antihypertensive medications, given by mouth, at a low dose and increase the dose as needed to lower blood pressure until the maximum dose of the medication is reached or side effects occur. If blood pressure is still too high, doctors may give children a second medication or switch medications.

There are many types of antihypertensive medications. Categories include:

The different types of antihypertensive medications work in different ways, so there are many options for treatment. It is not unusual for someone who has high blood pressure to be prescribed more than one of the medications.

Table
Table

Adrenergic blockers

Adrenergic blockers used for hypertension include beta-blockers (atenolol), alpha-beta blockers (labetalol), alpha-agonists (clonidine). These medications block the effects of the sympathetic division of the Adrenergic blockers used for hypertension include beta-blockers (atenolol), alpha-beta blockers (labetalol), alpha-agonists (clonidine). These medications block the effects of the sympathetic division of theautonomic nervous system, which can rapidly respond to stress by increasing blood pressure.

Beta-blockers are the most commonly used adrenergic blockers. Common side effects include fatigue, dizziness, changes in appetite, and changes in mood.

Alpha-agonists are more likely than other antihypertensive medications to cause drowsiness, fatigue, and depression, so they are rarely used. Clonidine can be applied as a patch.Alpha-agonists are more likely than other antihypertensive medications to cause drowsiness, fatigue, and depression, so they are rarely used. Clonidine can be applied as a patch.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors lower blood pressure in part by dilating arterioles (small blood vessels) in the kidneys and heart. Theses medications dilate arterioles by preventing the formation of angiotensin II, a chemical produced in the body that causes arterioles to constrict. Specifically, these inhibitors block the action of angiotensin-converting enzyme, which converts angiotensin I to angiotensin II (see figure Regulating Blood Pressure). A cough is the most common side effect of ACE inhibitors.

Angiotensin II receptor blockers (ARBs)

ARBs lower blood pressure by a mechanism similar to the one used by ACE inhibitors: They directly block the action of angiotensin II, which causes arterioles to constrict. Because the mechanism is more direct, ARBs may cause fewer side effects.

Calcium channel blockers

Calcium channel blockers cause arterioles to dilate by a completely different mechanism. These medications may be short-acting or long-acting. Short-acting calcium channel blockers are not used to treat high blood pressure. Dizziness and fast heart rate are the most common side effects of calcium channel blockers used for high blood pressure.

Thiazide diuretics

A thiazide diuretic (such as chlorthalidone) may be the first medication given to treat high blood pressure. Diuretics can cause blood vessels to widen (dilate). Diuretics also help the kidneys eliminate sodium and water, decreasing fluid volume throughout the body and thus lowering blood pressure.A thiazide diuretic (such as chlorthalidone) may be the first medication given to treat high blood pressure. Diuretics can cause blood vessels to widen (dilate). Diuretics also help the kidneys eliminate sodium and water, decreasing fluid volume throughout the body and thus lowering blood pressure.

Thiazide diuretics cause potassium to be excreted in the urine, so potassium supplements sometimes must be taken with a thiazide diuretic.

Direct vasodilators

Direct vasodilators dilate blood vessels by another mechanism. A medication of this type is almost never used alone. Rather, a vasodilator is added as a second or third medication when another medication alone does not lower blood pressure sufficiently.

quizzes_lightbulb_red
Test your KnowledgeTake a Quiz!
Download the free MSD Manual App iOS ANDROID
Download the free MSD Manual App iOS ANDROID
Download the free MSD Manual App iOS ANDROID