HeartCalc / BP

Pediatric Blood Pressure Experimental

AAP 2017 category and stage for one reading, age 1 to <18 years, plus a four-limb gradient helper

Under 1 year? Use Neonatal Blood Pressure (systolic centiles from birth through the first year, gestation 23 to 41 weeks).

Patient

Age years Sex

Age 1 to <13 years uses the child's own percentile values; 13 to <18 years uses fixed thresholds. Nothing on this page is saved or sent anywhere.

Reading (right arm)

Systolic mm Hg Diastolic mm Hg

Use an auscultatory (or averaged) reading taken as in Table 7 of the guideline: seated, right arm, correct cuff. KAS 5: confirm an elevated oscillometric reading by auscultation.

Percentile values (age 1 to <13 y)

SBP 90th percentile mm Hg SBP 95th percentile mm Hg DBP 90th percentile mm Hg DBP 95th percentile mm Hg

Read these from the guideline. Table 4 (boys) or Table 5 (girls) of the AAP 2017 guideline, row for the child's age, column for the child's height percentile. This page does not contain those tables, so it cannot look the values up for you (guideline).

Four-limb systolic BP (optional)

Right arm mm Hg Left arm mm Hg Leg mm Hg

Systolic values taken close together in time. The gradient is right arm minus leg.

BP category for this reading

—

Normal
Elevated
Stage 1
Stage 2

Systolic category: —
Diastolic category: —
Age group: —

Four-limb gradient

—

Model, equations and sources

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).

Age, y	Boys	Girls

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.

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.

Classifies one reading from the values you enter. It does not look up percentiles, diagnose hypertension (that needs repeated, auscultatory-confirmed readings) or replace the guideline's management table.

Experimental. Check every result against the AAP 2017 guideline.