Summary:
This systematic review and meta-analysis indicates that high blood pressure in children is more widespread than previously understood and is steadily rising. Across 96 eligible studies, data from more than 440,000 children in 21 countries showed that approximately 4% met criteria for hypertension. Prevalence increased gradually with age, reaching its highest point in early adolescence. When studies combined both clinic and out-of-clinic blood pressure assessments, prevalence estimates were even higher. These analyses, which included around 12,600 children across nine countries, suggested that nearly 7% had sustained hypertension. This difference highlights how strongly prevalence is influenced by the diagnostic approach used. The rise in childhood hypertension is likely driven by multiple factors. Increasing rates of childhood overweight and obesity, reduced physical activity, higher intake of processed and salty foods, and greater exposure to chronic stress are all known contributors. Genetic predisposition plays a role as well. High blood pressure is concerning because it often develops silently, without obvious symptoms, yet it is a major contributor to stroke, heart disease, and chronic kidney disease later in life. The World Health Organization reports that hypertension is one of the leading causes of premature death globally, affecting more than a billion people worldwide. These findings show that childhood hypertension is not only common but increasing, and should be treated as a significant warning sign for clinicians, families, and health systems. Early identification and prevention are likely critical to reducing long-term cardiovascular risk.
Abstract:
Background: Childhood hypertension is an important global public health issue, but prevalence estimates remain inconsistent. To date, no meta-analysis has synthesised global prevalence using both in-office blood pressure measurements and combined in-office and out-of-office assessments. We aimed to provide updated global prevalence rstimates of childhood hypertension using both diagnostic approaches. Methods: In this systematic review and analysis, we searched PubMed, Embase, and MEDLINE for population-based studies published between Jan 1, 2000, and April 19, 2025, reporting the prevalence of hypertension in the general paediatric population aged 19 years or younger. This was supplemented by eligible studies identified from relevant systematic reviews and manual reference screening. Two reviewers independently screened records for eligibility, extracted study-level data, and assessed the risk of bias. Random-effects meta-analysis was used to estimate pooled prevalence. Subgroup analyses were performed by age, sex, setting (urban vs rural), device, investigation period, BMI group, and WHO and World Bank regions. Meta-regression was performed to examine age-specific prevalence, sex-specific prevalence, and secular trends. Primary outcomes were the prevalence of childhood hypertension assessed using repeated in-office blood pressure measurements based on at least three separate occasions (in-office approach) and a combination of in-office and out-of-office blood pressure measurements (combination approach). This study was registered with PROSPERO, CRD420251057655. Findings: We identified 11 703 records from database searches, supplemented by 87 articles retrieved from relevant systematic reviews and manual reference screening. Ultimately, 96 articles met the inclusion criteria, all of which were rated with quality scores of at least 5. For the in-office approach, 83 articles included a total of 443 914 children and adolescents across 21 countries. Based on 81 articles, the pooled prevalence of childhood hypertension was 4·28% (95% CI 3·71–4·90). Prevalence increased with age, peaking at 14 years before declining. Between 2000 and 2020, the prevalence of childhood hypertension nearly doubled, increasing from 3·40% (95% CI 2·14–5·34) to 6·53% (4·17–10·07) in boys and from 3·02% (1·90–4·75) to 5·82% (3·71–9·01) in girls. Regarding the combination approach, 15 articles included 12 597 children and adolescents across nine countries. The pooled prevalence was 6·67% (95% CI 1·66–14·53) for sustained hypertension based on five articles. Interpretation: Childhood hypertension affects a substantial and growing proportion of the global paediatric population, with prevalence varying considerably by diagnostic approach. These findings underscore the need for harmonised diagnostic criteria in paediatric hypertension research.
Article Publication Date: 12/11/2025
DOI: 10.1016/S2352-4642(25)00281-0
