Pediatric Hypertension On the Rise Globally

High blood pressure in children and adolescents is a growing problem in all corners of the world, an updated look at global data shows.

Overall, the pooled prevalence of pediatric hypertension based on in-office measurements among studies published between 2000 and 2025 was 4.28%, with much higher rates seen in those with obesity, according to Jiali Zhou, PhD (Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China), and colleagues.

Studies that took into account both in- and out-of-office measurements showed that the pooled prevalence of sustained hypertension was 6.67%, they report in a paper published online recently in the Lancet Child & Adolescent Health.

Over time, prevalence increased substantially in both boys (from 3.40% to 6.53%) and girls (from 3.02% to 5.82%).

“This is, for the most part, consistent across the world,” study author Kazem Rahimi, MD (University of Oxford, England), told TCTMD. Though this analysis was not designed to explore drivers of the trend, it’s likely related at least partially to increasing rates of obesity, greater consumption of salt, and sedentary lifestyles in the pediatric population, he said.

Also contributing may be improvements in detection of high BP, Rahimi said, noting that the current analysis differs from prior ones by including out-of-office readings. “This is likely to be one of the other drivers of why essentially the hidden aspect of hypertension in children is better revealed in this study than before.”

High Rates With Obesity

The investigators reviewed 96 articles published between January 1, 2000, and April 19, 2025, that included BP readings from children and adolescents younger than 20 years old. Most studies (84%) relied on in-office measurements, 14% used a combination of in-office and out-of-office readings, and 2% applied both the in-office and combination approaches. Overall, the analyses included in-office measurements from 443,914 children and adolescents across 21 countries and a combination of in-office and out-of-office readings from 12,597 youths across nine countries.

Based on in-office BP, roughly one out of every 23 children and adolescents had hypertension. Prevalence significantly varied by BMI, with the highest rate seen in those with obesity (18.77%), followed by those with overweight (7.70%), normal weight (2.44%), and underweight (1.90%).

Another 8.15% of individuals had prehypertension. The pooled prevalences of stage 1 and stage 2 hypertension were 4.02% and 0.83%. By phenotype, systolic hypertension was seen in 2.94%, diastolic hypertension in 1.88%, isolated systolic hypertension in 1.78%, isolated diastolic hypertension in 0.88%, and systolic-diastolic hypertension in 1.39%.

Out-of-office readings revealed that 5.17% of children and adolescents had white-coat hypertension and 9.22% had masked hypertension.

“This study underscores the substantial and growing burden of childhood hypertension and the importance of early identification, particularly among adolescents and children with overweight or obesity,” Zhou et al write. “Prevalence estimates vary considerably by diagnostic approaches, emphasizing the need for harmonized, feasible, and context-appropriate strategies. Strengthening detection efforts and updating clinical guidelines to reflect real-world constraints are essential to reducing long-term cardiovascular risk in pediatric populations.”

Tackling Awareness First

Rahul Chanchlani, MD (McMaster Children’s Hospital, Hamilton, Canada), lead author of an accompanying editorial, told TCTMD that “pediatric hypertension is a very under-recognized and underappreciated problem.”

There is increasing evidence that high BP in children and adolescents, once thought to be benign, is associated with long-term health consequences, Chanchlani noted. He pointed, for example, to studies his group has published showing links between pediatric hypertension and subsequent major adverse cardiac events and major adverse kidney events.

“Now, the narrative is changing, and so this study [by Zhou et al] is really important because it is showing that pediatric hypertension is getting worse as we speak,” Chanchlani said.

The first step in responding to the problem is to raise awareness of the issue among both primary care physicians, who are often the first point of contact with the healthcare system, and patients and their families, he said. Next, the appropriate resources—like BP machines with cuffs sized for pediatric measurement and training to use them—need to be provided to physicians. In addition, measurement of BP must be prioritized along with other issues during visits with children and teens, he said.

Raising awareness of pediatric hypertension will require collaborations between hypertension organizations, policymakers at all levels of government, social media influencers, and other stakeholders, Chanchlani said. “We have to talk about hypertension in these children. I think that all levels of care need to be involved. Otherwise, things will not change.”

In their editorial, Chanchlani and colleagues say that “the task ahead is straightforward: to ensure that no child’s elevated blood pressure goes undetected, unrecognized, or untreated.”

Rahimi agreed with the need for greater awareness of the problem, saying it’s critical “for everyone to be more vigilant and take childhood obesity and the common lifestyle factors that contribute to those phenomena that we’ve observed more seriously in trying to counteract them.”

“Don’t take it lightly,” he emphasized. “Be mindful that childhood hypertension means much higher chances of its translation to adult hypertension and higher risk of cardiovascular disease down the line.”