At 17, his BP shot up to 200/120 mmHg: Lancet study flags why child and teen hypertension doubled between 2000 and 2020

The teen boy’s case reflects a trend captured by researchers in a latest study, published in The Lancet Child and Adolescent Health. It says that high blood pressure in children and adolescents nearly doubled between 2000 to 2020, affecting 114 million young people around the world. As per the report, approximately 3.2% of children had hypertension in 2000, but the prevalence had increased to more than 6.2% of children and adolescents under age 19 by 2020.

Why is the study concerning?

Although there is no India-specific data, study author Dr Peige Song, from the Zhejiang University School of Medicine (China), told The Indian Express that as a lower-middle-income country, India shares many characteristics captured in the broader analysis of LMICs. “India is part of the WHO South-East Asia Region (SEAR), which reported the highest prevalence of isolated diastolic hypertension at 2.77% compared to other regions. This phenomenon may reflect regional cardiovascular risk factors, such as high dietary sodium intake, rising obesity rates, low levels of physical activity, and systemic health disparities,” she said.

Funded by the National Natural Science Foundation of China, the study was based on a meta-analysis of data from 96 large studies involving more than 443,000 children across 21 countries. “This is the first study to comprehensively assess the global prevalence, stages and phenotypes of hypertension in children and adolescents under 19 years of age using diagnostic approaches, namely in-office blood pressure alone and combined in-office and out-of-office blood pressure measurements,” Dr Song said.

Obesity a key driver

The study suggests that obesity is a substantial driver of the increase in childhood hypertension as nearly 19% of children and adolescents with obesity have hypertension, eight times higher than the prevalence of hypertension in those considered to be of a healthy weight.

Approximately 8% of children and adolescents now have pre-hypertension, a warning sign of potential progression to hypertension, which could lead to serious health issues, including cardiovascular and kidney disease, if not addressed.

Explaining the findings, Dr Natarajan says, “Obesity, poor dietary choices, sedentary lifestyles, stress at a young age from career goals, irregular sleeping hours and an incapability to handle emotional situations are among the many triggers for hypertension in adolescents.”

According to Dr Natarajan, the increase in affordability standards and easy access to unhealthy foods are major contributors to the childhood obesity graph. “It’s a lifestyle healthcare epidemic of unknown proportions because of the lack of monitoring data. However regular health screening at schools and colleges can detect such conditions early and start definitive treatment immediately. This can reduce the early onset of potentially dangerous complications of the heart, brain and kidneys at a later stage,” he said.

Researchers flagged the need for diagnostics, saying how blood pressure is measured in children and adolescents can affect prevalence estimates. When hypertension is confirmed by a healthcare provider over at least three in-office visits, the prevalence was estimated to be approximately 4.3%. However, when the researchers also included out-of-office assessments, such as ambulatory or home blood pressure monitoring, the prevalence of sustained hypertension climbed to about 6.7%.

The research highlighted that conditions like masked hypertension — where hypertension is not detected during routine checkups — affect nearly 9.2% of children and adolescents globally, indicating underdiagnosis.

“Data gaps persist, particularly for out-of-office BP monitoring, such as ambulatory or home BP assessments, which remain underutilized in the SEAR region. This under-representation underscores the need for enhanced data collection efforts to better capture the true burden of childhood hypertension in India. White-coat hypertension (a condition where a person’s blood pressure is elevated only when they are in a medical setting, such as a doctor’s office, but is normal at home or when measured with a home blood pressure monitor) was found to be more prevalent in LMICs (8.13%) compared to high-income countries (HICs, 3.70%), which suggests that a notable proportion of children in LMICs might be misclassified,” Dr Song added.

She called for standardized BP measurement protocols in India to improve diagnostic consistency and comparability across healthcare settings.

Improve screening, prevention efforts

The report should raise alarm bells for healthcare providers and caregivers, according to study author Prof Igor Rudan, Director of the Centre for Global Health Research at The Usher Institute, University of Edinburgh (UK). “But the good news is that we can take steps now, such as improving screening and prevention efforts, to help control high blood pressure in children and reduce the risks of additional health complications in the future,” he said.