Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Dec 1;173(12):1154-1163.
doi: 10.1001/jamapediatrics.2019.3310.

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

Peige Song  1 , Yan Zhang  2 , Jinyue Yu  3 , Mingming Zha  4 , Yajie Zhu  5 , Kazem Rahimi  5 , Igor Rudan  1
Affiliations
Meta-Analysis

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

Peige Song et al. JAMA Pediatr. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Rahimi reported receiving grants from National Institute for Health Research Oxford Biomedical Research Centre, British Heart Foundation, Economic and Social Research Council, Research Councils UK, and Oxford Martin School, University of Oxford, during the conduct of the study, and personal fees from PLOS Medicine and BMJ Heart outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Diagram of Literature Search and Study Selection
WHO indicates World Health Organization.
Figure 2.
Figure 2.. Age-Specific Prevalence of Childhood Hypertension in 2000, 2010, and 2015
Childhood hypertension was based on blood pressure measured by mercury sphygmomanometer. Shaded areas indicate 95% CIs.
See this image and copyright information in PMC

Comment in

References

    1. Danaei G, Lu Y, Singh G, et al. ; Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration . Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment. Lancet Diabetes Endocrinol. 2014;2(8):634-647. doi:10.1016/S2213-8587(14)70102-0 - DOI - PMC - PubMed
    1. Zhou B, Bentham J, Di Cesare M, et al. ; NCD Risk Factor Collaboration (NCD-RisC) . Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017;389(10064):37-55. doi:10.1016/S0140-6736(16)31919-5 - DOI - PMC - PubMed
    1. World Health Organization A GLOBAL BRIEF on Hypertension: Silent Killer, Global Public Health Crisis: World Health Day 2013. Geneva, Switzerland: World Health Organization; 2013.
    1. Mills KT, Bundy JD, Kelly TN, et al. . Global disparities of hypertension prevalence and control clinical perspective: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134(6):441-450. doi:10.1161/CIRCULATIONAHA.115.018912 - DOI - PMC - PubMed
    1. Bao W, Threefoot SA, Srinivasan SR, Berenson GS. Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa Heart Study. Am J Hypertens. 1995;8(7):657-665. doi:10.1016/0895-7061(95)00116-7 - DOI - PubMed