Pediatric BP Calculator

AAP Algorithm 2017

Patient Data

Age (years)

Sex

Size (cm)

Systolic BP

mmHg

Diastolic BP

mmHg

Enter height and pressures to calculate percentiles and management (AAP 2017).

Systolic BP

Normal Elevated Stage 1 Stage 2

Diastolic BP

Normal Elevated Stage 1 Stage 2

TAS thresholds (AAP 2017)

TAD thresholds (AAP 2017)

Family and Lifestyle

Medical/Pharmacological Management

⚠️ Urgency/Emergency (AAP Table 17 / KAS 27)

Evaluate symptoms: headache, vomiting, encephalopathy or heart failure.

Emergency Criteria: BP >30 mmHg above p95 (or >180/120 in adolescents) WITH symptoms.
Immediate IV Pharmacological Management: Labetalol, nicardipine, sodium nitroprusside, esmolol or hydralazine.
Goal: Reduce BP no more than 25% of the total planned reduction in the first 8 hours.

Data extracted from Tables 11, 15, 16 and 17 of Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents (AAP, 2017).

DASH Diet (AAP 2017)

The diet DASH (Dietary Approaches to Stop Hypertension) It is the nutritional pillar recommended by the AAP for the management of blood pressure.

Rich in: Fruits, vegetables, low-fat or fat-free dairy products, and whole grains.
Get off at: Sodium, added sugars (sugary drinks) and red meat.

Table 11: Interventions

Summary of interventions for BP reduction in pediatrics according to the AAP 2017:

Weight: Optimize BMI. Avoid excessive weight gain; promote weight loss in overweight or obese children.
Diet: Implement DASH diet. Reduce sodium consumption.
Physical Activity: Moderate to vigorous physical activity at least 3 to 5 days per week (30-60 minutes per session). Limit sedentary activities to <2 hours daily.
Habits: Avoid exposure to tobacco and limit alcohol or excess caffeine consumption.

Table 16: Initial Pharmacological Management

Recommended first-line agents for pediatric HTN (AAP 2017). Start a single agent at the lowest dose:

ACEIs

Enalapril: Start: 0.08 mg/kg/day (Initial Max: 5 mg/day) in 1-2 doses. Max: 40 mg/day.
Lisinopril: Start: 0.07 mg/kg/day (Max start: 5 mg/day) in 1 dose. Max: 40 mg/day.

ARA II

Losartan: Start: 0.7 mg/kg/day (Max start: 50 mg/day) in 1 dose. Max: 100 mg/day.
Valsartan: Start: 1.3 mg/kg/day (Max start: 40 mg/day) in 1 dose. Max: 160 mg/day.

BCC (Long acting)

Amlodipine:
Children 1 to 5 years: 0.1 mg/kg/day in 1 dose.
≥ 6 years: 2.5 mg/day in 1 dose. Max: 10 mg/day.

Thiazide Diuretics

Hydrochlorothiazide: Start: 1 mg/kg/day (Max initial: 12.5 - 25 mg/day) in 1 dose. Max: 50 mg/day.

Absolute contraindication: ACEIs and ARBs are strictly contraindicated in pregnant patients due to the risk of fetal teratogenicity. Furthermore, an ACEI should never be combined with an ARA II simultaneously.

Table 17: IV Drugs

Pediatric dosages of intravenous medications for severe symptomatic HTN (AAP 2017):

Labetalol

Bolus: 0.2 - 1 mg/kg/dose (Max: 40 mg/dose).
Infusion: 0.25 - 3 mg/kg/h.

Nicardipine

Infusion: 0.5 - 5 mcg/kg/min.

Sodium Nitroprusside

Infusion: 0.53 - 8 mcg/kg/min. (Monitor levels for cyanide toxicity)

Esmolol

Bolus: 100 - 500 mcg/kg/dose.
Infusion: 50 - 1000 mcg/kg/min.

Hydralazine

Bolus: 0.1 - 0.2 mg/kg/dose (Initial Max: 20 mg/dose).

Diagnostic Evaluation

Recommended tests for evaluation of children with confirmed HTN (Table 6):

Basic Tests

Urinalysis.
Blood chemistry: Electrolytes, blood urea nitrogen (BUN) and creatinine.
Lipid profile (fasting or without fasting).
Kidney ultrasound: Mandatory in all children < 6 years old, or in any child with abnormal urinalysis or altered kidney function.

Target Organ Damage

Echocardiogram: To evaluate left ventricular hypertrophy (LVH). Recommended when considering the initiation of pharmacological therapy.

Specific Tests

Children with obesity: Hemoglobin A1c (or fasting glucose), AST and ALT (fatty liver screening).
Suspected secondary causes: TSH, toxicology screening, or sleep study (if history of snoring/apnea).