Describe special considerations.
Most childhood and adolescent hypertension in the US is due to primary hypertension.
Diagnosis and treatment of hypertension in children is important for reducing the risk of:
Hypertension and cardiovascular disease in adulthood
End organ damage (e.g., left ventricular hypertrophy, CKD)
Describe the management approach.
Initiate lifestyle changes for managing hypertension.
Manage the underlying cause of secondary hypertension and treat associated comorbidities (if present).
Aim for target blood pressure of < 90th percentile or < 130/80 mm Hg for children ≥ 13 years of age.
Assess for indications for pharmacotherapy and start if present.
List indications for pharmacotherapy.
HTN not improving with lifestyle changes
Symptomatic HTN (e.g., headaches, altered mental status) 
HTN in children with CKD or diabetes
LVH on echocardiography
List drug options.
ACE inhibitors (e.g., benazepril, captopril)
ARBs (e.g., candesartan, losartan)
Thiazide diuretics (e.g., chlorothiazide, hydrochlorothiazide)
Long-acting calcium channel blocker (e.g., amlodipine)
ACE inhibitors or ARBs are generally preferred for hypertensive children with diabetes, CKD, and/or proteinuria.
Bbeta blockers are not recommended for the initial treatment of hypertension in children because of their potential adverse effects (metabolic effects such as impaired glucose tolerance and potential exacerbation of asthma) and lack of improved efficacy compared to other medications.