Cardiovascular health is deteriorating in children and adolescents worldwide. A scientific review published on Wednesday revealed that high blood pressure in children, a major risk factor in the development of cardiovascular and kidney problems, has almost doubled in the past two decades: at the beginning of this century, 3.4% of boys and 3% of girls suffered from this disease, but in 2020 the percentage was already 6.5% and 5.8%, respectively. “It’s very worrying,” admits Big Song, a researcher at Zhejiang University (China) and author of this study published in the journal. Lancet Child and Adolescent Health. According to their calculations, today 114 million children under the age of 19 around the world live with high blood pressure.
Scientists attribute this increase to deteriorating lifestyle habits, especially increased obesity. The research, which reviewed 83 studies of nearly 444,000 children and adolescents from 21 countries, revealed that the prevalence of high blood pressure was eight times higher among children with obesity: 19% of children with excess body fat had high blood pressure, while the prevalence among those at a healthy weight was 2.4%. “The fact that we are identifying these patterns (of high blood pressure) in an increasingly younger population underscores the urgent need for early detection, prevention and intervention strategies,” Song warns.
High blood pressure occurs when blood pressure, which is the force that blood exerts against the wall of the arteries as the heart pumps, is constantly too high. When this happens, the heart overworks itself, which over time can lead to heart complications. Arteries can also become stiffer and narrower, causing insufficient blood flow, or rupture and cause bleeding.
In fact, it is a risk factor traditionally associated with adulthood, but its increasingly frequent appearance at such early ages has put the scientific community on alert: “Numerous studies have shown that childhood hypertension, if untreated, can persist into adulthood and significantly increase the risk of cardiovascular complications in old age,” warns Song. High blood pressure in adults, if not controlled with medications or lifestyle changes, can cause heart and cerebrovascular problems, such as heart attacks and strokes, as well as kidney failure.
In practical terms, what reflects the upward trend in the numbers of high blood pressure in children, as the scientist emphasizes, is “the deterioration of cardiovascular health at younger ages.” He attributes much of this phenomenon to “modern lifestyle factors, such as diets high in salt and ultra-processed foods, increasingly sedentary habits and, above all, the marked increase in childhood obesity.” The researcher points out that these behaviors not only raise blood pressure, but also “accelerate metabolic and vascular changes that can lead to serious cardiovascular problems in adulthood.”
Obesity fingerprint
This is not the first time that the scientific community has drawn attention to the impact that unhealthy lifestyle habits, especially childhood obesity, can have on a child’s health in the short, medium and long term. An example is the onset of adult diseases, such as high blood pressure, at an increasingly younger age. But experts also warn that excess body fat, in particular, also leaves a mechanical, metabolic and psychological imprint that can perpetuate health problems throughout life.
Ignacio Fernandez Lozano, president of the Spanish Society of Cardiology, emphasizes that research like this, in which he was not involved, helps clarify trends and shows with data what specialists have been aware of for some time in consultations: “It is worrying because we see that cardiovascular health in children and adolescents is getting worse. Hypertension is an adult-onset disease, and its onset at such an early age is worrying.”
This early cardiovascular risk has already begun to translate into “signs of organ damage,” explains Pedro Arango, a pediatric nephrologist at Sant Joan de Déu Hospital in Barcelona. “In pediatrics, we are increasingly seeing retinal damage or ventriculomegaly in the heart associated with high blood pressure,” he explains.
Song notes that the “good news” in this area is that high blood pressure in children is modifiable. He agrees: “With early detection, improved nutrition, increased physical activity, and policies that encourage healthier environments, there is a real opportunity for prevention.” It also calls for improving and making strategies for diagnosing high blood pressure in children more flexible to improve early detection.
Masked hypertension and white coat
This call to improve diagnostic methods is not trivial. A meta-analysis showed that estimates of the prevalence of hypertension in children and adolescents depend, to a large extent, on methods of measuring blood pressure. That is, the numbers differ depending on whether the data is collected from repeated measurements in the office or outside it (through blood pressure monitors at home, for example).
In fact, how and where it is measured reveals phenomena such as masked hypertension – which can only be diagnosed when measurements outside a consultation are included – or white-coat hypertension, which occurs when high blood pressure is identified when measured in a health centre, but not outside that healthcare setting. A meta-analysis determined that the former affects 9.2% of children and adolescents worldwide and that the prevalence of the latter is 5.2%. “Both cases illustrate the complexity that can be involved in measuring blood pressure in children,” Song posits.
Masked hypertension, where a child’s blood pressure appears normal in the office, but is high outside, can lead to “underdiagnosis, as these children may be told they are fine when they are not,” the researcher explains. But, on the other hand, with white-coat hypertension, which only occurs on schedule during the consultation and not outside of it, it can also “generate unnecessary anxiety or even over-treatment,” he admits. “These results highlight the limitations of isolated in-office measurements and the importance of out-of-office monitoring, especially for children with borderline blood pressure.”
Another phenomenon studied in the meta-analysis is hypertension, which is defined as blood pressure that is higher than normal, but does not reach the hypertensive range. “It’s an important warning sign,” Song sums up. The research confirms that about 8.2% of those under the age of 19 belonged to this category, although it was more common among teenagers: in these age groups it rose to 12%, 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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