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Global Prevalence of Hypertension in Children and Adolescents Younger Than 19 Years: A Systematic Review and
Xiaorui Ruan1,2, Anji Zhu3, Tingting Wang2
1Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, China.
Insights
Global pediatric hypertension prevalence varies significantly, with sustained hypertension affecting 3.89% and occasional hypertension 11.85%. Overweight and obese children have higher rates, underscoring the need for lifestyle interventions.
Area of Science:
- Pediatric Cardiology
- Public Health Epidemiology
- Global Health
Background:
- Pediatric hypertension is a predictor of adult hypertension and early target organ damage.
- Global prevalence estimates for pediatric hypertension are scarce, particularly across different diagnostic criteria.
Purpose of the Study:
- To estimate the global prevalence of pediatric hypertension using distinct diagnostic principles.
- To analyze temporal trends and regional variations in pediatric hypertension prevalence.
Main Methods:
- Systematic search of multiple databases (PubMed, Web of Science, Embase, CNKI, Wanfang) up to July 2024.
- Inclusion of original studies on children and adolescents (<19 years) representing the general population.
- Random-effects meta-analysis to estimate prevalence, with subgroup and meta-regression analyses to address heterogeneity.
Main Results:
- Analysis included 271 studies with over 3.6 million children and adolescents.
- Global prevalence: 3.89% for sustained hypertension and 11.85% for occasional hypertension.
- Increasing prevalence trends observed over time; significantly higher rates in overweight/obese children (16.35% vs. 2.57% in normal weight).
Conclusions:
- Substantial global variations in pediatric hypertension prevalence exist, emphasizing the need for reliable diagnostic methods (multiple measurements).
- Higher prevalence in overweight/obese youth necessitates targeted interventions promoting healthy lifestyles.
- Findings highlight the critical public health importance of monitoring and managing pediatric hypertension globally.
Importance:
Pediatric hypertension predicts adult hypertension and early target organ damage, yet global prevalence estimates based on different diagnostic principles remain scarce.
Objective:
To estimate global pediatric hypertension prevalence according to different diagnostic principles.
Data Sources:
Several databases, including PubMed, Web of Science, Embase, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database, were systematically searched from inception to July 7, 2024.
Study Selection:
Studies were included if they were original investigations in children and adolescents younger than 19 years, represented the general population, and provided data on hypertension prevalence.
Data Extraction And Synthesis:
Data screening and extraction were performed independently by 2 authors. A random-effects model was used to estimate prevalence. Temporal trends, as well as regional and population differences, were explored. Subgroup analyses and meta-regression analyses were performed to identify sources of heterogeneity. Publication bias was assessed by funnel plots and the Egger test.
Main Outcomes And Measures:
The primary outcome was pediatric hypertension, categorized into sustained hypertension (persistent diagnosis confirmed on ≥3 separate occasions) and occasional hypertension (initial diagnosis determined by blood pressure measurements on a single screening visit).
Results:
A total of 271 studies involving 16 328 individuals with sustained hypertension, 538 735 individuals with occasional hypertension, and 3 609 665 children and adolescents were included for analysis. The global prevalence of pediatric hypertension was 3.89% (95% CI, 3.27%-4.62%) for sustained hypertension and 11.85% (95% CI, 10.98%-12.75%) for occasional hypertension. Increasing trends with time were observed, with an annual increase of 7.20% (95% CI, 4.16%-10.32%; P < .001) from 2006 to 2021 for sustained hypertension and an estimated annual percentage change of 0.33% (95% CI, 0.10%-0.56%) between 1987 and 2022 for occasional hypertension. Additionally, significant differences were observed across geographical regions and population characteristics for the prevalence of pediatric hypertension. Children and adolescents with obesity or overweight (16.35% and 6.79% vs 2.57% [normal weight] for sustained hypertension) had significantly higher prevalence of hypertension.
Conclusions And Relevance:
This systematic review and meta-analysis indicates substantial variations in the global prevalence of sustained and occasional hypertension, highlighting the importance of measurements on multiple occasions to enhance reliability. Notable differences in prevalence across individuals' body mass index values highlight the necessity for targeted interventions to promote healthy lifestyles.
Related Concept Videos
01:28Hypertension I: Introduction
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:18Hypertension and Regulation of Blood Pressure
01:29Hypertension II: Pathophysiology
01:28Factors affecting Blood pressure
Physiological Factors:
01:30Alterations in Blood Pressure
Hypertension (High blood pressure)
Hypertension occurs when blood pressure readings consistently exceed the normal range. It is diagnosed when systolic blood pressure (the top number, indicating pressure while the heart...