The rate of children and teenagers living with high blood pressure globally has nearly doubled because of a toxic combination of unhealthy diets, mass inactivity and soaring levels of obesity, according to the largest review of its kind.
Experts said 114 million children who have developed hypertension even before reaching adulthood were facing potentially deadly and lifelong harm, including cardiovascular disease, kidney disease and a myriad of serious health complications.
The prevalence of high blood pressure in children and teenagers under 19 has increased to 6.2%, rising from 3.2% in the space of just 20 years. The findings, based on a meta analysis of data from 96 studies involving more than 400,000 children across 21 countries, were published in The Lancet Child and Adolescent Health journal.
The review suggests obesity was a “substantial driver” of the sharp uptick in childhood hypertension, with nearly 19% of those living with obesity affected by the condition, compared with fewer than 3% in children and teenagers considered a healthy weight.
“The nearly twofold increase in childhood high blood pressure over 20 years should raise alarm bells for healthcare providers and caregivers,” said study author Prof Igor Rudan, the director of the Centre for Global Health Research at Edinburgh University’s Usher Institute.
The study also suggests a further 8.2% of children and teenagers have prehypertension, meaning blood pressure levels are higher than normal but do not yet meet the criteria for hypertension.
Prehypertension is especially prevalent during adolescence, with rates reaching 11.8% among teenagers, compared with about 7% in younger children.
Doctors said blood pressure levels rose sharply in early adolescence, peaking about the age of 14, especially among boys. This underlined the critical importance of regular screening during these critical years, they said.
Children and teenagers with prehypertension are more likely to progress to full hypertension.
Prof Steve Turner, the president of the Royal College of Paediatrics and Child Health, who was not involved with the review, said: “This sharp rise in high blood pressure among children is deeply concerning and largely driven by increasing childhood obesity – an entirely preventable condition.
“These findings mirror what paediatricians are seeing on the frontline. Children are presenting not only with hypertension, but also other serious conditions linked to obesity such as type 2 diabetes – once unheard of in children – asthma and mental health problems.
“We know that persistent hypertension is a risk factor for an early death due to damage to the cardiovascular system and other organs. Healthy children grow into healthy adults, but with trends like these, I fear that without urgent action we are hurtling towards a public health emergency.”
The rate of children and teenagers experiencing high blood pressure globally nearly doubled between 2000 and 2020, according to the meta analysis.
In 2000, about 3.2% of children had hypertension, but by 2020, the prevalence had increased to more than 6.2% of children and teenagers under 19, affecting 114 million young people across the world.
Study author Dr Peige Song, of Zhejiang University School of Medicine, said the uptick in cases was “driven largely by lifestyle factors such as unhealthy diets, decreased physical activity, and the increasing prevalence of childhood obesity”.
“Hypertension in children and adolescents has emerged as a substantial public health concern,” she said, adding that parents had a pivotal role in preventing and managing high blood pressure in children.
“Promoting healthy habits, such as a balanced diet rich in fruits, vegetables and whole grains while minimising salt and sugar intake, can substantially reduce the risk of hypertension. Encouraging regular physical activity and limiting sedentary behaviours, such as excessive screen time, are equally crucial,” she said.
“For families with a history of hypertension, regular blood pressure monitoring for children is strongly recommended. Early detection of elevated blood pressure, particularly through home monitoring, can help mitigate the risk of long-term complications.”
Prof Bryan Williams, the chief scientific and medical officer of the British Heart Foundation, who was not involved with the review, said he was very concerned about the rise: “Elevated blood pressure in childhood often persists into adulthood, increasing the risk of heart disease and stroke later in life.”
The good news was that obesity-related high blood pressure could be reversed, he said. But bold action was also needed from governments to prevent so many children from having obesity in the first place. “This includes expanding restrictions on the marketing of unhealthy products and exploring further measures to drive the food industry to make our everyday foods healthier.”
