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Drug Treatment of High Blood Pressure in Children


Bruce A. Kaiser

, MD, Nemours/Alfred I. DuPont Hospital for Children

Reviewed/Revised Dec 2021 | Modified Sep 2022
Topic Resources

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

In children under 13 years of age, the values that are considered high vary based on sex, age, and height. Thus, there is no clear-cut blood pressure that indicates high blood pressure for all children. Rather, if blood pressure is the same as or higher than 90% of the blood pressure of children who are the same sex, age, and height, elevated blood pressure is diagnosed.

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

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

  • Stage 1 hypertension causes organ dysfunction or damage.

  • 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 drug treatment.

Drugs 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 drug treatment program, including possible side effects. Any antihypertensive drug 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 drug.

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

There are many types of antihypertensive drugs. Categories include

The different types of antihypertensive drugs 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 drugs.


Adrenergic blockers

Adrenergic blockers include alpha-blockers, beta-blockers (atenolol), alpha-beta blockers (labetalol), alpha-agonists (clonidine), and peripherally acting adrenergic blockers. These drugs block the effects of the sympathetic division, the part of the autonomic nervous system that can rapidly respond to stress by increasing blood pressure.

Beta-blockers are the most commonly used adrenergic blockers.

Alpha-blockers are no longer used as the main treatment of high blood pressure.

Alpha-agonists are more likely than other antihypertensive drugs to cause drowsiness, fatigue, and depression, so they are rarely used now. 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 drugs 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 Regulating Blood Pressure: The Renin-Angiotensin-Aldosterone System Regulating Blood Pressure: The Renin-Angiotensin-Aldosterone System ).

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 drugs may be short-acting or long-acting. Short-acting calcium channel blockers are not used to treat high blood pressure.

Thiazide diuretics

A thiazide diuretic (such as chlorthalidone) may be the first drug 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 dilate blood vessels by another mechanism. A drug of this type is almost never used alone. Rather, a vasodilator is added as a second or third drug when another drug alone does not lower blood pressure sufficiently.

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