Pediatric Hypertension Increasing Among Children, Adolescents Worldwide

Significant global variation exists in the prevalence of sustained and occasional hypertension among children and adolescents, according to a study published today in JAMA Pediatrics, underscoring the importance of repeated blood pressure measurements to ensure accurate diagnosis.1

Pediatric hypertension is an emerging public health concern due to its association with subclinical target organ damage and long-term cardiovascular risk.2 Prior research found that pediatric hypertension predicts adult hypertension and increases lifetime risk for cardiovascular diseases, such as stroke and myocardial infarction.1

The researchers emphasized the need for global pediatric hypertension prevalence data to guide health resource allocation and prevention efforts. However, they noted that many countries lack monitoring systems, making it difficult to assess the true burden of the condition.

This global study found rising rates of pediatric hypertension, highlighting obesity's impact and the need for improved monitoring and prevention strategies. | Image Credit: Halfpoint - stock.adobe.com

To fill this gap, the researchers conducted a systematic review and meta-analysis to estimate the global prevalence of hypertension in children and adolescents. They categorized cases as either sustained or occasional hypertension. Sustained hypertension was defined as elevated blood pressure confirmed on 3 or more separate occasions, while occasional hypertension was based on an initial diagnosis determined by blood pressure measurements during a single screening visit.

They searched several databases, including PubMed, Embase, and Web of Science, from inception through July 7, 2024, for relevant studies. These included original investigations in children and adolescents aged younger than 19 that reported hypertension prevalence among the general population.

Of the 40,143 records searched, the researchers found 271 eligible studies. Among the 3,609,65 children and adolescents included for analysis, 16,328 had sustained hypertension and 538,735 had occasional hypertension.

The global prevalence was 3.89% (95% CI, 3.27%-4.62%) for sustained hypertension and 11.85% (95% CI, 10.98%-12.75%) for occasional hypertension. Rates were significantly higher among children and adolescents with obesity or overweight (16.35% and 6.79%, respectively) than those of normal weight (2.57%).

Additionally, the researchers observed increasing trends over time. Sustained hypertension rose at an annual rate of 7.20% (95% CI, 4.16%-10.32%; P < .001) from 2006 to 2021, while occasional hypertension had an estimated annual percentage change of 0.33% (95% CI, 0.10%-0.56%) between 1987 and 2022.

Lastly, prevalence varied by World Health Organization region and sociodemographic index (SDI) level. Sustained hypertension was most common in the Western Pacific (5.33%; 95% CI, 3.90%-7.25%) and least common in the Americas (2.53%; 95% CI, 1.94%-3.30%), with a statistically significant difference (P = .003). Also, rates were highest in high-middle SDI countries (4.87%; 95% CI, 3.75%-6.29%) and lowest in high SDI countries (2.95%; 95% CI, 2.13%-4.06%), but this difference was not statistically significant (P = .11).

Occasional hypertension was most prevalent in the Western Pacific (13.16%; 95% CI, 11.89%-14.49%) and African (12.35%; 95% CI, 8.80%-16.39%) regions and lowest in the Eastern Mediterranean (9.32%; 95% CI, 7.10%-11.80%), but these regional differences were not significant (P = .08). In contrast, prevalence did vary significantly by SDI level (P = .03), with high-middle SDI countries reporting the highest rates (13.08%; 95% CI, 11.93%-14.29%) and low SDI countries reporting the lowest (9.77%; 95% CI, 7.68%-12.09%).

The researchers acknowledged their study’s limitations, including variability in hypertension diagnostic definitions across studies, which made it challenging to synthesize and compare their findings. Nonetheless, they expressed confidence in their findings and urged continued research and action.

“Future efforts to reduce the burden of hypertension in children and adolescents should focus primarily on primary prevention by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity,” the authors concluded. “More population-based studies with robust methodologies and rigorous measurement protocols are warranted to determine the exact prevalence of hypertension among children and adolescents.”

References

1. Ruan X, Zhu A, Wang T, et al. Global prevalence of hypertension in children and adolescents younger than 19 years: a systematic review and meta-analysis. JAMA Pediatr. Published online July 28, 2025. doi:10.1001/jamapediatrics.2025.2206
2. Falkner B, Gidding SS, Baker-Smith CM, et al. Pediatric primary hypertension: an underrecognized condition: a scientific statement from the American Heart Association. Hypertension. 2023;80(6):e101-e111. doi:10.1161/HYP.0000000000000228