The global prevalence of childhood hypertension has escalated in recent years, but with considerable variation by diagnostic approach, an updated systematic review and meta-analysis has showed.
With in-office blood pressure measurements taken on at least three separate occasions, the pooled prevalence of hypertension in patients aged 19 and younger was 4.28% (95% CI 3.71-4.90) based on 81 articles, reported Peige Song, PhD, of Zhejiang University School of Medicine in Hangzhou, China, and colleagues in The Lancet Child & Adolescent Health.
This figure was slightly higher than the estimated prevalence of 4% reported in a 2019 meta-analysis and 3.89% reported in a meta-analysis published earlier this year.
Meanwhile, reports Medpage Today, the pooled prevalence of sustained hypertension in the current meta-analysis, uniquely based on a combination of in-office and out-of-office blood pressure measurements, was even higher, at 6.67% (95% CI 1.66-14.53).
“Childhood high blood pressure is more common than previously thought, and relying solely on traditional in-office blood pressure readings probably under-estimates the true prevalence or leads to misdiagnosis of hypertension in children and adolescents,” Song said.
“The findings of the study have clear implications for both clinical practice and public health,” she told MedPage Today. “The substantial variation in prevalence depending on diagnostic approach underscores the importance of aligning measurement strategies with current guidelines.”
“In contrast to previous work, this study provides estimates of hypertension, integrating both repeated in-office blood pressure measurements and combined in-office and out-of-office assessments, providing additional estimates of sustained, white-coat, and masked hypertension,” noted Rahul Chanchlani, MD, of McMaster Children’s Hospital in Hamilton, Ontario, Canada, and colleagues in an accompanying commentary.
“Harmonised diagnostic criteria, expanded out-of-office monitoring, and context-sensitive surveillance are essential next steps,” they wrote.
“Education of healthcare providers, families, and policymakers is also crucial. The integration and implementation of childhood hypertension into broader non-communicable disease prevention strategies is a priority, recognising that cardiovascular risk begins not in middle age, but in childhood.”
Notably, a recent prospective cohort study suggested that elevated blood pressure in childhood was tied to a greater risk of early death from cardiovascular disease in adulthood.
Song and colleagues also pointed to the jump in the prevalence of childhood hypertension over the past two decades.
From 2000 to 2020, the prevalence of childhood hypertension increased from 3.40% to 6.53% in boys and from 3.02% to 5.82% in girls, using the in-office approach.
Also using this approach, the highest prevalence of hypertension was observed in kids and adolescents with obesity, at 18.77%, while the pooled prevalence of prehypertension was 8.15%.
Based on the combination approach, masked hypertension was the most common phenotype, at 9.22%, followed by white-coat hypertension, at 5.17%.
For their study, Song and colleagues searched PubMed, Embase, and Medline for studies published between 1 January 2000, and 19 April 2025 that reported the prevalence of hypertension in the paediatric population.
The approach was supplemented by eligible studies from relevant systematic reviews and manual reference screening.
For the in-office approach, there were 83 studies that comprised a total of 443 914 kids and adolescents from 21 countries. The pooled prevalence of hypertension was based on 81 studies.
For the combined in-office and out-of-office approach, there were 15 studies that comprised 12 597 participants from nine countries. The pooled prevalence of sustained hypertension was based on five studies.
Study limitations included substantial heterogeneity in pooled estimates, and the fact that data for certain subgroups like stage-specific hypertension, phenotypes, and out-of-office measurements were based on a small number of studies.
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