Global Prevalence of Hypertension in Children and Adolescents Younger Than 19 Years: A Systematic Review and Meta-Analysis

Abstract

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.