A significant global health concern is that growing numbers of children and adolescents worldwide are developing high blood pressure. Newly published research highlights childhood hypertension, once considered rare in young people, as a rapidly growing health problem and a powerful predictor of cardiovascular and kidney disease later in life.
The new position paper, released by the International Society of Hypertension (ISH) and published on 12 February in the Journal of Hypertension, gives updated, evidence-based guidance on the evaluation, diagnosis and management of paediatric hypertension.
“This latest ISH position paper on paediatric hypertension arrives at a critical moment for global child health. Rising rates of obesity, earlier exposure to cardiometabolic risk and widening health-system inequities mean that elevated blood pressure in children and adolescents can no longer be overlooked or deferred. What sets this position paper apart is its practical, globally adaptable approach. Rather than assuming ideal conditions, it offers clear, evidence-based guidance that can be implemented across diverse health systems, including low- and middle-income settings. By prioritising simplified screening, feasible treatment pathways and continuity of care, the ISH provides a realistic framework for early action where it is needed most,” says Prof. Ruan Kruger, research professor in the Hypertension in Africa Research Team (HART) at the North-West University (NWU), president of the Childhood Hypertension Consortium of Africa (CHCAfrica) and acting chief executive officer of SA Heart®.
Prof. Kruger was part of an international panel of paediatric hypertension clinicians and researchers from 12 countries who co-authored the paper. The panel was led by him and Prof. Joseph Flynn of the University of Washington and the Seattle Children’s Hospital in the United States of America.
Paediatric blood pressure management is an investment in lifelong health
“Elevated blood pressure in childhood tracks strongly into adulthood, driving premature cardiovascular disease. Paediatric blood pressure management is an investment in lifelong health that demands early detection, sustained follow-up and integration across the life course. Acting earlier and acting smarter are essential if we are serious about protecting cardiovascular health across generations,” says Prof. Kruger.
He explains that a central focus of the paper is the importance of accurate blood pressure measurement. “Blood pressure in children is often measured incorrectly, contributing to under-recognition and missed diagnoses. One of the key recommendations of the research paper is the use of automated devices that have been validated for use in children to improve diagnostic accuracy and consistency.”
Beyond diagnostic challenges, the paper examines the drivers behind the global rise in paediatric hypertension. While obesity stays a major contributing factor, the authors also point to diets high in salt and ultra-processed foods, excessive screen time, insufficient physical activity, short sleep duration and chronic stress. Exposure to adverse childhood experiences, including abuse, neglect and household dysfunction, is also associated with higher blood pressure trajectories that persist into adulthood.
Practical recommendations for hypertension management
The position paper sets out practical recommendations for health systems worldwide. These include targeted screening of young people, early lifestyle interventions for those with elevated blood pressure and the use of evidence-based medication where necessary.
Prof. Kruger says most children with early-stage hypertension can initially be managed through lifestyle modification, such as healthier eating patterns, reduced salt and sugary drink consumption, regular physical activity, improved sleep and stress management. Medication is reserved for more severe cases, for children with co-existing conditions such as diabetes, or where blood pressure remains elevated despite lifestyle changes.
The authors emphasise that the burden of childhood hypertension is particularly high in low- and middle-income countries, where access to healthy food, safe environments for physical activity and healthcare services may be limited. The position paper is therefore designed as a practical, globally adaptable reference that can be implemented across diverse healthcare settings.
“By reframing paediatric blood pressure management as a long-term investment in cardiovascular health, the ISH position paper underscores the urgency of early detection and sustained care. Protecting the heart health of future generations requires coordinated action across health systems, communities and families. Addressing high blood pressure in childhood is a critical step in that effort,” concludes Prof. Kruger.
To read the position paper visit: https://journals.lww.com/jhypertension/abstract/9900/practical_approach…
Prof. Joseph Flynn of the University of Washington and the Seattle Children’s Hospital in the United States of America.
Prof. Ruan Kruger, research professor in the Hypertension in Africa Research Team (HART) at the NWU, and president of the Childhood Hypertension Consortium of Africa (CHCAfrica) is currently the acting chief executive officer of SA Heart®.
