The Lancet

Global hypertension boom in children: doubling in 20 years

According to a meta-analysis of more than 443,000 under-19s, the prevalence will increase from 3.2 % in 2000 to 6.2 % in 2020. Childhood obesity is the main driver

by Francesca Cerati

13 November 2025

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Medico controlla la pressione sanguigna di una adolescente (Mark Hunt / AGF)

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Key points

Study modalities
Main factors and the role of obesity
Practical applications for screening and prevention
Critical Limits and Reflections
What it means for families and the healthcare system in Italy

3' min read

Translated by AI

Versione italiana

Over the past two decades, there has been an alarming increase in hypertension in children and adolescents worldwide. A recent analysis published in the journal The Lancet Child & Adolescent Health shows that the percentage of under-19s with elevated blood pressure has risen from around 3.2 % in 2000 to over 6.2 % in 2020, i.e. a doubling in prevalence. In absolute terms, this equates to approximately 114 million children and adolescents worldwide suffering from hypertension

The modalities of the study

The authors performed a meta-analysis of 96 studies that together involved more than 443,000 children and adolescents from 21 countries. They observed that the way in which blood pressure is measured can significantly influence the prevalence estimate: for example, when hypertension was confirmed by the physician in at least three visits, the estimated prevalence was approximately 4.3 %; when ambulatory or home measurements were included, the prevalence rose to approximately 6.7 %.

Main factors and the role of obesity

The study identifies childhood obesity as a determining factor: children and adolescents with obesity are almost eight times more likely to develop hypertension than their peers with a normal weight. The figure is stark: around 19 % of overweight young people are affected by hypertension, while in the normal weight group the proportion is less than 3 %. Furthermore, it is shown that the condition of 'pre-hypertension' affects about 8.2 % of young people under 19 years of age, with higher rates in adolescence, up to 11.8 %.

Paediatric hypertension is not an 'adult problem'. If not recognised and treated, it can be the first step towards cardiovascular, renal and other organ damage in adulthood.

Practical applications for screening and prevention

The authors emphasise the need for harmonised diagnostic criteria for hypertension in young people, off-site monitoring (outpatient, home) and contextual surveillance of living conditions.

Primary prevention - especially related to nutrition, physical activity, weight control - is mentioned as a priority. Some sources point out that unhealthy eating habits, sedentariness, and environments that are not conducive to exercise are behind the childhood obesity epidemic.

In Italy (and in Europe), the application of these data requires attention: although the study does not provide country-specific estimates, the implications suggest that paediatricians, schools and families should integrate blood pressure monitoring into children's health pathways.

Critical Limits and Reflections

The authors acknowledge certain limitations: in particular the variability in measurement methods, the concentration of studies in low- and middle-income countries, and the lack of data on certain types of hypertension and in certain regions.

Moreover, as noted by commentator Rahul Chanchlani of McMaster University (Canada), 'integrating childhood hypertension into broader non-communicable disease prevention strategies is a priority, recognising that cardiovascular risk does not begin in middle age, but in childhood'.

What it means for families and the health system in Italy

For Italian families, these data suggest some concrete actions: making sure that overweight or obese children have their blood pressure checked in paediatric settings; promoting healthy lifestyles such as a diet rich in fruit, vegetables and whole grains; limiting sugar and salt; encouraging daily physical activity, but also paying attention to the signs of adolescence: the analysis shows that the increase in blood pressure is particularly marked around the age of 14, especially in boys.

Finally, for the health care system, consideration should be given to including pressure screening in paediatric protocols, educating health professionals and parents, and developing preventive policies at school and community level.

Hypertension in children and adolescents is not a marginal phenomenon, and its rapid increase highlights a global challenge - which also concerns Italy - in terms of prevention, early diagnosis and intervention. The main causes (obesity, sedentariness, poor diet) are largely modifiable, which means that targeted interventions today can make a difference tomorrow.