The cardiovascular health of children and adolescents around the world is deteriorating. A scientific review published on Wednesday revealed that childhood hypertension, an important risk factor in the development of cardiovascular and kidney disease, has almost doubled in the past 20 years. At the beginning of this century, 3.4% of boys and 3% of girls suffered from this disease, but in 2020 this number has already increased to 6.5% and 5.8%, respectively. “It’s very worrying,” admitted Paige Song, a researcher at Zhejiang University in China and author of the study published in the journal. The Lancet Child and Youth Health. According to their calculations, 114 million children under the age of 19 are currently living with high blood pressure worldwide.
Scientists believe this increase is due to poor lifestyle habits, particularly the rise in obesity. The study, which looked at up to 83 studies involving nearly 444,000 children and adolescents in 21 countries, found that obese children were, in fact, eight times more likely to have high blood pressure. 19% of children with excess body fat had high blood pressure, compared to 2.4% of children with a healthy weight. “The fact that these patterns are being identified in an increasingly younger population highlights the urgent need for early detection, prevention, and intervention strategies,” warns Song.
Hypertension occurs when blood pressure, the force exerted by blood on artery walls as the heart pumps, remains too high. When this happens, the heart becomes overworked, which can lead to heart complications over time, and the arteries can also become stiff and narrow, causing insufficient blood flow or bursting, causing bleeding.
In fact, this is a risk factor traditionally associated with adulthood, but its appearance at such an early age is becoming more and more frequent, which has alarmed the scientific community. “Numerous studies have shown that untreated childhood hypertension can persist into adulthood and significantly increase the risk of cardiovascular complications later in life,” warns Dr. Song. High blood pressure in adults can lead to heart and cerebrovascular problems, such as heart attack and stroke, and even kidney failure if it’s not controlled with medications and lifestyle changes.
In fact, scientists argue that the upward trend in childhood hypertension numbers is reflected in “worsening cardiovascular health among young people.” And he attributes this phenomenon in large part to “modern lifestyle factors, such as high-salt diets and ultra-processed foods, increased sedentary habits, and above all, a marked increase in childhood obesity.” Researchers say these behaviors not only raise blood pressure, but also “accelerate metabolic and vascular changes that may lead to severe cardiovascular disease in adulthood.”
footprint of obesity
This is not the first time the scientific community has called attention to the impact of unhealthy lifestyle habits, particularly childhood obesity, on children’s health in the short, medium and long term. An example of this is the onset of adult diseases such as hypertension at increasingly younger ages. But experts also warn that excess body fat, in particular, can leave behind mechanical, metabolic and psychological imprints that can perpetuate lifelong health problems.
Ignacio Fernández Lozano, president of the Spanish Society of Cardiology, who did not take part in it, assures that such studies help explain the trends and show with data what experts have known for some time in their medical examinations: “It is worrying because we know that the cardiovascular health of children and adolescents is deteriorating. Hypertension is an adult disease, and it is alarming that it starts to appear at such a young age,” he laments.
This early cardiovascular risk is already beginning to translate into “signs of organ damage,” explains Pedro Arango, a pediatric nephrologist at Barcelona’s Sant Joan de Deu Hospital. “In pediatrics, we are increasingly seeing retinal damage and cardiac ventricular hypertrophy associated with high blood pressure,” he exemplifies.
The “good news” in this area, Song points out, is that hypertension in children can be corrected. “Early detection, better nutrition, increased physical activity and policies that encourage healthier environments create real opportunities for prevention,” he agrees. There is also a need for improved and more flexible diagnostic strategies for childhood hypertension to facilitate early detection.
Masked hypertension and white coat hypertension
This call to improve diagnostic methods is not straightforward. Meta-analyses have shown that the estimated prevalence of hypertension in children and adolescents is highly dependent on the method of blood pressure measurement. That is, the numbers will differ depending on whether the data are collected from repeated measurements in the office or outside the office (for example, with a home blood pressure monitor).
In fact, depending on where and how it is measured, phenomena such as masked hypertension (which can only be diagnosed if non-office measurements are included) and white-coat hypertension (which occurs when measurements at a health center identify high blood pressure, but it is not confirmed outside this health care setting) can be revealed. A meta-analysis found that the former affects 9.2% of children and adolescents worldwide, and the latter 5.2%. “Both symptoms indicate the complexity of measuring blood pressure in children,” Song surmises.
Masked hypertension, in which a child’s blood pressure appears normal in the office but is elevated outside the office, “can lead to underdiagnosis because these children are told that they are okay when in fact they are not,” the researchers explained. But on the other hand, he acknowledged that white-coat hypertension, which occurs only during office hours and not outside office hours, “could cause unnecessary worry and even overtreatment.” “These findings highlight the limitations of isolated in-office measurements and the importance of out-of-office monitoring, especially for children whose blood pressure is on the borderline between normal and pathological.”
Another phenomenon studied in the meta-analysis is prehypertension. This is defined as a condition in which blood pressure is higher than normal but not in the hypertensive range. “This is an important warning sign,” Song summarizes. The study found that around 8.2% of people under the age of 19 fell into this category, but this was more common among adolescents, rising to 12% in these age groups, compared to 7% in younger children. “[Adolescence]is a critical time for intervention and an opportunity to prevent long-term complications,” Song says.
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