High blood pressure, long considered an adult-only problem, is quietly becoming a global childhood health crisis. A major new analysis published in The Lancet has found that childhood hypertension now affects a significant and growing proportion of children and adolescents worldwide, with prevalence nearly doubling over the past two decades.
The systematic review and meta-analysis, the most comprehensive of its kind so far, pooled data from nearly half a million children across 21 countries and found that childhood hypertension is no longer rare, underdiagnosed, or limited to high-risk populations. It is widespread, rising, and deeply linked to how children live today.
Dr Swati Garekar, Senior Consultant - Paediatric Cardiology, Fortis Hospital Mulund, says, lifestyle changes are primarily linked to an increase in hypertension in children around the world. "With more calories consumed and ultra-processed foods eaten, alongside less physical activity and more screen time, children are becoming obese. Childhood hypertension is often accompanied by high blood sugar, high and low cholesterol, and hormonal changes, as well as the clinical sign of Acanthosis Nigricans, a condition wherein there’s darkening of skin around the neck and armpits."
In girls, these changes may also include an irregular menstrual cycle, she adds. "Health issues that were diagnosable only in adults are now being realised to also occur in children. To avoid future issues with the heart and metabolism, identifying and focusing on the child or adolescent’s right nutrition, enough physical activity, and monitored limited screen time is necessary."
The researchers analysed 96 population-based studies published between 2000 and April 2025, focusing on children and adolescents aged 19 years or younger. Using repeated in-clinic blood pressure measurements, which is the gold standard for diagnosis, the pooled global prevalence of childhood hypertension stood at 4.28 per cent.
That number climbed even higher to 6.67 per cent when diagnosis included ambulatory blood pressure measurements, which are better at identifying sustained hypertension.
Age mattered. Blood pressure levels increased steadily through childhood, peaking around the age of 14 before dipping slightly in late adolescence, the report found. Sex differences were also evident in that boys consistently showed a higher prevalence than girls.
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Most concerning was the time trend. Between 2000 and 2020, childhood hypertension nearly doubled in both sexes, rising from just over 3 per cent to more than 6 per cent globally.
Hypertension in childhood is not a benign finding because studies have shown that elevated blood pressure in children tracks into adulthood, increasing the lifetime risk of heart disease, stroke, kidney damage and metabolic disorders.
Yet, childhood hypertension often goes unnoticed. Unlike adults, children are rarely screened routinely, and symptoms, if present at all, are subtle. Headaches, fatigue or poor concentration are often dismissed or attributed to stress or screen time.
"Unlike adults, there is no culture of routine blood pressure screening in children. Add to that the lack of awareness among parents and even some clinicians about age-specific BP cut-offs, and a large number of hypertensive children simply slip through the cracks,” says family physician Dr Ramesh Shah, based in Mumbai.
The Lancet authors stress that inconsistent diagnostic practices are part of the problem. Some studies relied solely on clinic readings, while others used ambulatory monitoring, leading to wide variations in reported prevalence. Without standardised criteria, many children with sustained hypertension remain invisible to health systems.
Although the analysis did not focus on causes, its subgroup findings point clearly towards modern lifestyle shifts. Higher prevalence was seen among children with elevated body mass index, and rates were generally higher in urban settings than rural ones.
Experts link this rise to reduced physical activity, high salt and ultra-processed food consumption, excessive screen time, poor sleep and rising childhood obesity, patterns increasingly seen across low-, middle- and high-income countries alike.
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India, with its rapidly urbanising population and growing burden of childhood obesity, is particularly vulnerable, paediatricians warn.
Experts say that the way forward is to screen early and act early.
Routine blood pressure screening in schools, nutrition reforms in mid-day meal schemes, safer spaces for physical activity, and parental awareness about salt and sugar intake are all critical to reversing the trend.
Most importantly, the findings challenge a long-held assumption that children are too young to worry about chronic lifestyle diseases. As this global analysis makes clear, the seeds of adult heart disease are being sown much earlier than previously believed.
