Hypertension in childhood is defined as a systolic blood pressure and/or diastolic blood pressure greater than the 95th percentile for age, gender, and height on multiple occasions. In the past decade, the detection and management of pediatric hypertension has evolved, partly because normative data has become available and the long-term consequences have been more clearly elucidated. Additionally, given the increasing incidence of childhood obesity and the association with elevated blood pressure, hypertension is being recognized as a major health issue in the pediatric population. Although lifestyle modification plays an important role in pediatric hypertension, medical management is often required.

Pharmacologic therapy should be initiated when lifestyle modification fails or in the presence of secondary hypertension, symptomatic hypertension, or end organ damage (often left ventricular hypertrophy). To begin, single drug therapy is recommended. When initiated, treatment may be with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium channel blockers, beta blockers, or diuretics. Specific classes of medication are used preferentially in certain disease states; for example, ACE inhibitors have been shown to be efficacious in preventing disease progression in children with proteinuric renal disease.