Global Prevalence of Hypertension in Children and Adolescents Younger Than 19 Years

By Editor, Concierge Medicine Today on July 31, 2025

By JAMA Pediatrics

July 2025

Citation

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

Pediatric hypertension, increasingly characterized by obesity-associated primary hypertension, is an emerging public health concern.¹ Hypertension in childhood is associated not only with subclinical target organ damage, such as left ventricular hypertrophy and increased carotid intima-media thickness,² but also with long-term health consequences. Several longitudinal studies demonstrate that blood pressure (BP) percentiles track from childhood into adulthood, as children and adolescents with hypertension have a higher risk of adult-onset hypertension.³ This persistent trajectory significantly elevates lifetime risks of cardiovascular diseases, including stroke and myocardial infarction, as well as related morbidity.⁴^–7 To inform health resource allocation and prevention strategies and ultimately reduce the burden of pediatric hypertension, global data on the prevalence of pediatric hypertension are essential. However, the worldwide prevalence of pediatric hypertension remains unclear due to the lack of monitoring systems in many countries.

Although many estimates for the prevalence of pediatric hypertension are available, most derive from local or single-institution reports and involve only small study populations, which means that these findings lack comprehensiveness and fail to represent the worldwide level of pediatric hypertension. Additionally, significant differences for the prevalence of pediatric hypertension were observed across previous studies, which may be related to inconsistent diagnostic principles.⁸ In particular, most children and adolescents with hypertension present with subclinical symptoms, and BP among children varies with age, sex, and height, which further complicates the diagnosis of pediatric hypertension.⁹ Presently, pediatric hypertension is typically defined as systolic and/or diastolic BP greater than or equal to the 95th percentile by age, sex, and height, and elevated BP (EBP) is defined as BP between the 90th and 95th percentiles.⁹^–11 According to the current international standards proposed by the American Academy of Pediatrics (AAP) in 2017,⁹ a confirmed diagnosis should be based on BP measurements taken on at least 3 separate occasions, which emphasizes that BP must be measured on multiple occasions to calculate the true prevalence of pediatric hypertension (ie, sustained hypertension). However, in many previous studies, the diagnosis of pediatric hypertension was often determined on a single screening visit (in this study, defined as occasional hypertension).¹²^,13 The existing studies indicate that the prevalence of pediatric hypertension based on a single-scenario diagnosis (ie, occasional hypertension) is higher than that based on AAP diagnostic principles (ie, sustained hypertension).¹⁴ To reveal the reality of the huge difference in the prevalence of pediatric hypertension under different diagnostic principles and emphasize the importance of standardized diagnosis, it is necessary to summarize the worldwide prevalence of pediatric hypertension based on these different diagnostic principles. In the context of the lack of monitoring systems in many countries, the meta-analysis is the best way to solve this issue.