Australia’s first clinical guidelines to identify and manage high blood pressure in children aims to curb growing rates of heart disease, kidney failure and organ damage in adulthood.

The guidelines, created by a national collaboration, led by Murdoch Children’s Research Institute (MCRI) and Edith Cowan University, addresses a longstanding gap in paediatric care.

MCRI Associate Professor Jonathan Mynard said there was a great need to identify at-risk children earlier with hypertension a major contributor to chronic disease and premature death worldwide.

Cases of childhood hypertension are increasing alongside rising rates of obesity, disproportionately affecting Aboriginal and Torres Strait Islander children. Globally, high blood pressure affects about one in seven children and adolescents.

How will the guidelines help tackle high pressure in children?

“There is strong evidence that blood pressure in childhood is linked to serious health conditions such as heart attack and stroke later in life,” Associate Professor Mynard said. “Early identification of risk factors provides an opportunity to alter adverse health trajectories and improve long-term outcomes.”

Image: Associate Professor Jonathan Mynard

Published in the Journal of Paediatrics and Child Health, the guidelines developed by the BPOzKids Network and Hypertension Australia, and endorsed by the Heart Foundation, have been adapted from American Academy of Paediatrics recommendations.

“Identifying and managing high blood pressure in children has rarely been on the radar of health professionals,” Associate Professor Mynard said.

“Previous guidelines haven’t covered children because the evidence linking high blood pressure in childhood and later health conditions was unclear. But we now have multiple large longitudinal studies demonstrating strong links to health outcomes.”

Importance of tailoring clinical guidance to the Australian context

Associate Professor Jonathan Mynard said while international guidelines provided an important foundation, they don’t always reflect the realities of the Australian healthcare system.

“It was essential to develop guidance that considers the needs of Australian children, including those living in rural and remote communities where access to healthcare can be more limited,” he said.

“In rural settings, school-based programs and home blood pressure monitoring may play a greater role in managing high blood pressure in children.”

Whole-of-family approach required for lasting impact

Edith Cowan University and Perth Children’s Hospital Dr Nicholas Larkins said the guidelines recommended routine blood pressure checks for Australian children, along with lifestyle interventions, recognising that meaningful and lasting improvements in blood pressure required a whole-of-family approach that considered a child’s social, cultural and economic circumstances.

“Our recommendations focus on targeted screening at key ages, rather than trying to measure blood pressure at every opportunity, which isn’t always feasible in real-world practice,” he said.

“The most important interventions are often the simplest such as improving diet, increasing physical activity and supporting families to make sustainable lifestyle changes.

“A big part of these guidelines is also about making care more accessible by supporting GPs, improving access to monitoring tools and embedding blood pressure checks into routine care.”

The guideline recommendations include:

• Blood pressure checks at seven to nine years old, and again at 13 to 15 years
• Screening during all healthcare visits for children over three who have risk factors
• Obtaining perinatal, nutritional, physical, and family history for children being evaluated for high blood pressure, alongside a physical exam to identify possible underlying causes
• Treatment pathways and monitoring for children with hypertension
• Interventions such as nutrition, physical activity and, where necessary, pharmacological management

Researchers from University of Western Australia, Deakin University, Sydney Children's Hospital, University of Melbourne, Flinders University, Southern Adelaide Local Health Network, Central Adelaide Local Health Network, Telethon Kids Institute, National Heart Foundation Australia, The Royal Children's Hospital, Monash Children's Hospital, The Children's Hospital at Westmead, Children's Health Queensland, University of Cambridge School of Clinical Medicine, Royal North Shore Hospital, Kolling Institute, University of Tasmania, also contributed to the guidelines.

Publication

Larkins NG, Medley T, Black A, Bolton KA, Chaturvedi S, Clark M, Gabb GM, Glenning JG, Grimes CHuang RC, Hyland A, Jeffries-Stokes C, Kalman L, Kaul S, Kim S, McTaggart S, Kowalski R, Li SX, McNab S, Metz D,Mihailidou AS, Monin J, Nelson M, Pathak M, Roebuck D, Schlaich MP, Sleaby R, Quinlan C and Mynard JP. ‘Australian Guideline for the Identification and Management of Hypertension in Children and Adolescents, The Journal of Paediatrics and Child Health. DOI: 10.1111/jpc.70491

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Associate Professor Jonathan Mynard, MCRI Group Leader, Clinical Sciences

Dr Nicholas Larkins, Edith Cowan University

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About Murdoch Children’s Research Institute

Murdoch Children’s Research Institute (MCRI) is one of the world’s top three child health research institutes, dedicated to improving the health of children and adolescents in Australia and around the world. In 2026 MCRI celebrates its 40th anniversary, marking four decades of transforming child health through research, discovery and innovation. Its breakthroughs have improved diagnosis, informed global vaccine strategies, advanced precision medicine, and continue to redefine what’s possible for sick children. MCRI is one of the only research institutes in Australia to offer genetic testing to help families find answers for children with previously undiagnosed conditions.