Trends and risk factors of hypertension in US Children and Adolescents, 1999-2023

We aimed to assess trends in elevated blood pressure (EBP) and hypertension among US children and adolescents before and after the COVID-19 pandemic using data from 25,916 participants aged 8-19 years in NHANES 1999-2023. Survey-weighted multinomial logistic regression was used to examine associations of sociodemographic, nutritional and other factors with EBP and hypertension overall and across subgroups during the pre-pandemic cycles (2015-2020) and post-pandemic cycles (2021-2023). Among children (n = 10,616), EBP prevalence decreased from 4.3% in 1999-2002 to 3.5% in 2021-2023 (P = 0.36), and hypertension declined from 3.3% to 2.3% (P = 0.025). Among adolescents (n = 15,300), EBP declined from 10.0% to 9.4% (P = 0.46), and hypertension prevalence fell from 8.3% to 5.1% (P < 0.001). From 2015-2023, obesity was strongly associated with both EBP and hypertension in children (odds ratio [OR] 1.78, 95% CI 1.02-3.10) and adolescents (OR 1.89, 95% CI 1.30-2.74). In children, higher dietary fat intake was associated with greater odds of EBP, and higher sodium intake with greater odds of hypertension. In adolescents, older age, male sex and non-Hispanic Black race were additional risk factors. Comparing pre-pandemic (2015-2020) with post-pandemic (2021-2023) cycles, EBP prevalence in adolescents decreased (11.6% vs 9.42%, P = 0.46) and hypertension prevalence in children changed modestly (2.53% vs 2.26%, P = 0.025). Despite concerns about pandemic-related increases in obesity, pediatric EBP and hypertension prevalence remained stable or declined from 2015 to 2023, with adiposity remaining the dominant modifiable correlate.