American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric Nephrology

View all recommendations from this society

July 16, 2018

Do not initiate an outpatient hypertension (HTN) work-up in asymptomatic pediatric patients prior to repeating the blood pressure measurement.

Blood pressures in children need to be taken in accordance with standard methodology prior to the diagnosis of HTN in order to decrease the number of false positive readings that are often seen in pediatric patients. Methodology should include assessment of blood pressure in the upper extremity, by manual auscultation, with an appropriate-sized cuff.


NHLBI and AAP guidelines recommend repeating blood pressures (BP) x 3 at the same visit and at 2 additional visits to document persistent BP elevation prior to initiating a work up for pediatric hypertension (HTN) due to the possibility of falsely elevated BP readings in children as the prevalence of elevated blood pressures decreases significantly on repeated measures.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatric Section on Nephrology Executive Committee (AAP SONp) and the American Society of Pediatric Nephrology Clinical Affairs Committee (ASPN CAC) utilized a four-stage process to develop its list. First, the two groups independently developed lists based on various common assessments, evaluations, and treatments in the practice of pediatric nephrology. During the second stage, the committee chairs consolidated the lists and then re-convened the individual committees to narrow the topics on the list. During the third stage, a final list of five practices was developed and consensus achieved by both committees that were found to be supported by evidence. The final stage occurred when the list was reviewed and approved by the AAP’s Executive Committee and the ASPN CAC.


Sun J, Steffen LM, Ma C, Liang Y, Xi B. Hypertens Res. 2017 Jan 12. doi: 10.1038/hr.2016.179.

NHLBI guidelines 2012

The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents, National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Pediatrics 14, 555-576, 2004.