Hypertension and its associated risks among children and adolescents are emerging as a significant paediatric health issue, driven by lifestyle changes, rising obesity and urban living. A recent Lancet systematic review and meta-analysis on the global prevalence of hypertension among children and adolescents aged 19 years or younger found that prevalence has nearly doubled between 2000 and 2020, reflecting a consistent upward trend across regions. Experts warn that this rise carries long-term implications for cardiovascular, metabolic and kidney health.
Adults vs. children
Hypertension in children differs fundamentally in its underlying profile. “Unlike in adults, where most cases are primary and without an identifiable cause, children with high blood pressure often have an underlying condition,” said Suresh Kumar K., cardiologist, Kauvery Hospitals, Chennai. Disorders of the kidneys, adrenal glands and blood vessels are commonly implicated, making evaluation for secondary causes a critical step when elevated readings are detected in children.
This distinction, clinicians say, underscores the need for careful clinical assessment rather than treating elevated blood pressure in children as a lifestyle issue alone.
Key drivers and risk factors
Paediatricians point to rapid urbanisation as a major contributor to changing blood pressure patterns. According to S. Satyamanasa Gayatri Vinay, senior consultant in paediatrics, SRM Global Hospitals, Chennai, increased consumption of processed foods, higher salt intake, reduced physical activity and longer screen time have become defining features of childhood in urban settings. Environmental stressors including noise, air pollution and academic pressure further compound the risk. Limited access to safe play spaces and healthy food options adds to the burden, particularly in cities.
P. Manokar, senior interventional cardiologist at Kauvery Hospital, Vadapalani, described this phenomenon as part of what experts term ‘environmental hypertensionology’, where neighbourhood design, green spaces, walkability and pollution levels influence blood pressure. “Being urban itself has become a non-modifiable risk factor,” he said. Body weight remains the most significant modifiable risk factor. Higher body mass index and central adiposity or abdominal fat are strongly associated with elevated blood pressure in children. Excess fat alters hormonal balance and vascular function, increasing cardiac workload and vascular resistance.
“Obesity can raise the risk of hypertension several-fold, with prevalence rising sharply among children living with severe obesity,” Dr. Manokar noted. Rapid weight gain, rather than gradual increase, poses a particularly high risk, though weight reduction in children can substantially reverse elevated blood pressure.
Long-term risks include coronary heart disease, stroke, type-2 diabetes and chronic kidney disease. Prolonged untreated hypertension may also cause lasting vascular damage, often described as irreversible arterial changes.
Measuring blood pressure in children
Accurate diagnosis requires age-appropriate assessment. “Blood pressure interpretation in children must be guided by percentile charts based on age and body size,” said Neville Solomon, consultant paediatric and adult congenital cardiac surgeon, Apollo Children’s Hospitals, Chennai. Adolescents may be assessed using adult thresholds, but younger children and infants require specialised reference standards.
Improper measurement including the use of adult cuffs can lead to misdiagnosis, experts caution.
School health programmes are increasingly viewed as a key platform for early detection. Regular screening can help identify children at risk and initiate timely dietary, lifestyle or medical interventions.
For effectiveness, screening programmes must use paediatric-appropriate equipment, trained personnel and multiple readings across occasions. Parental engagement and clear referral pathways are essential to ensure follow-up care without stigma.
International guidelines recommend routine blood pressure measurement from early childhood, though experts note that adapting such protocols to Indian school systems will require policy support.
Preventive care
Experts emphasise that prevention and management must begin early. Dietary measures include reducing salt, sugar and processed foods while encouraging fruit- and vegetable-rich meals. Avoiding frequent consumption of packaged snacks, sauces and fried foods is emphasised.
Daily physical activity, at least 30 to 60 minutes remains central, along with limiting screen time. Stress management through adequate sleep, yoga and meditation is also recommended. Parental involvement and community-level programmes can reinforce these changes.
In select cases, medication may be required, but clinicians stress that lifestyle modification remains the cornerstone of long-term control.
Hypertension in children is often asymptomatic, silently affecting vital organs. With evidence pointing to rising prevalence and clear links to modifiable factors, experts underline the need for early detection, structured screening and sustained lifestyle interventions to prevent long-term disease burden.
