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Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis

Peige Song¹, Yan Zhang², Jinyue Yu³

¹Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.

JAMA Pediatrics

|October 8, 2019

Insights

Childhood hypertension affects 4% of children globally, with higher rates in overweight/obese youth. Prevalence has increased significantly over the past two decades, highlighting an urgent need for intervention.

Area of Science:

Pediatric Cardiology
Public Health
Epidemiology

Background:

Reliable estimates of childhood hypertension prevalence are crucial for effective prevention and treatment strategies.
Global synthesis of childhood hypertension prevalence data has been limited.

Purpose of the Study:

To systematically review and meta-analyze the global prevalence of hypertension in the general pediatric population.
To identify variations in prevalence across different subgroups and assess secular trends.

Main Methods:

Systematic review and meta-analysis of studies from PubMed, MEDLINE, Embase, Global Health, and Global Health Library.
Inclusion of studies with blood pressure measurements from at least 3 separate occasions in children aged 19 years and younger.
Random-effects meta-analysis and meta-regression to determine pooled prevalence, subgroup variations, and age-specific trends.

Main Results:

The pooled prevalence of childhood hypertension was 4.00%. Prehypertension prevalence was 9.67%, stage 1 hypertension 4.00%, and stage 2 hypertension 0.95%.
Higher prevalence was observed with aneroid sphygmomanometers (7.23%) and among overweight (15.27%) and obese (4.99%) children.
A significant increasing trend in childhood hypertension prevalence was noted from 2000 to 2015 (75%-79% relative increase).

Conclusions:

This meta-analysis provides a global estimate of childhood hypertension prevalence.
The rising prevalence and subgroup variations underscore the need for targeted public health interventions and further high-quality epidemiologic research.

Read full analysis

Abstract

Importance:

Reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment. However, the prevalence of childhood hypertension has rarely been synthesized at the global level.

Objective:

To conduct a systematic review and meta-analysis to assess the prevalence of hypertension in the general pediatric population.

Data Sources:

PubMed, MEDLINE, Embase, Global Health, and Global Health Library were searched from inception until June 2018, using search terms related to hypertension (hypertension OR high blood pressure OR elevated blood pressure), children (children OR adolescents), and prevalence (prevalence OR epidemiology).

Study Selection:

Studies that were conducted in the general pediatric population and quantified the prevalence of childhood hypertension were eligible. Included studies had blood pressure measurements from at least 3 separate occasions.

Data Extraction And Synthesis:

Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence. Variations in the prevalence estimates in different subgroups, including age group, sex, setting, device, investigation period, BMI group, World Health Organization region and World Bank region, were examined by subgroup meta-analysis. Meta-regression was used to establish the age-specific prevalence of childhood hypertension and to assess its secular trend.

Main Outcomes And Measures:

Prevalence of childhood hypertension overall and by subgroup.

Results:

A total of 47 articles were included in the meta-analysis. The pooled prevalence was 4.00% (95% CI, 3.29%-4.78%) for hypertension, 9.67% (95% CI, 7.26%-12.38%) for prehypertension, 4.00% (95% CI, 2.10%-6.48%) for stage 1 hypertension, and 0.95% (95% CI, 0.48%-1.57%) for stage 2 hypertension in children 19 years and younger. In subgroup meta-analyses, the prevalence of childhood hypertension was higher when measured by aneroid sphygmomanometer (7.23% vs 4.59% by mercury sphygmomanometer vs 2.94% by oscillometric sphygmomanometer) and among overweight and obese children (15.27% and 4.99% vs 1.90% among normal-weight children). A trend of increasing prevalence of childhood hypertension was observed during the past 2 decades, with a relative increasing rate of 75% to 79% from 2000 to 2015. In 2015, the prevalence of hypertension ranged from 4.32% (95% CI, 2.79%-6.63%) among children aged 6 years to 3.28% (95% CI, 2.25%-4.77%) among those aged 19 years and peaked at 7.89% (95% CI, 5.75%-10.75%) among those aged 14 years.

Conclusions And Relevance:

This study provides a global estimation of childhood hypertension prevalence based on blood pressure measurements in at least 3 separate visits. More high-quality epidemiologic investigations on childhood hypertension are still needed.

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