Pediatric Hypertension: Early-onset Cardiovascular Risk and the Need for Proactive Screening

Rossi Kaufman^*
*Correspondence: Rossi Kaufman, Department of Cardiac Surgery, Emergency Clinical Hospital for Children, Bucharest, Romania, Email:

Introduction

Historically considered an adult condition, hypertension is now increasingly recognized in the pediatric population, raising concerns about its long-term impact on cardiovascular health. The growing prevalence of hypertension in children and adolescents driven by obesity, sedentary lifestyles, poor dietary habits and increased psychosocial stress signals a critical public health issue. Pediatric hypertension often goes undiagnosed due to its asymptomatic nature and the lack of routine blood pressure screening in children. Left unmanaged, elevated blood pressure in youth can lead to early vascular damage, left ventricular hypertrophy and increased arterial stiffness, setting the stage for cardiovascular disease (CVD) in adulthood. This article underscores the urgent need for early detection, risk stratification and structured screening programs to identify hypertension in children and mitigate lifelong cardiovascular risks [1].

Description

The prevalence of pediatric hypertension is estimated to be 3â??5% globally, though this may be an underestimation due to inconsistent screening practices. Secondary hypertension often resulting from renal, endocrine, or cardiovascular disorders predominates in younger children, whereas primary (essential) hypertension becomes more common during adolescence. The primary risk factors include obesity, family history of hypertension, high sodium intake, physical inactivity and metabolic syndrome. Racial and ethnic disparities are also evident, with higher rates observed among African American and Hispanic youth. Additionally, prenatal factors such as low birth weight and maternal preeclampsia are linked to altered vascular development and increased hypertension risk later in life. Psychosocial stress, screen time and poor sleep hygiene further contribute to rising incidence. Understanding these risk profiles enables targeted preventive strategies and the development of culturally sensitive health education campaigns aimed at families and schools [2].

Diagnosing hypertension in children is more complex than in adults due to age-, sex- and height-specific percentiles used to define elevated blood pressure. According to the American Academy of Pediatrics (AAP), hypertension is defined as average systolic or diastolic BP â?¥ 95th percentile for age, sex and height on three or more occasions. However, many healthcare providers do not routinely measure BP in children, especially in younger age groups, leading to underdiagnosis. Furthermore, elevated readings are often dismissed as white-coat hypertension or attributed to stress. Clinical signs may be absent, although symptoms such as headaches, fatigue, or blurred vision may occasionally occur. Secondary hypertension may present with features of underlying disease, including growth retardation or electrolyte abnormalities. Accurate diagnosis requires appropriately sized BP cuffs, standardized protocols and, in select cases, confirmation with Ambulatory Blood Pressure Monitoring (ABPM). Greater provider awareness, updated clinical guidelines and integration of BP screening into pediatric well-child visits are essential to overcoming diagnostic inertia [3].

Pediatric hypertension is not a benign or transient condition it is associated with target organ damage, even in asymptomatic individuals. Structural and functional cardiovascular changes, including left ventricular hypertrophy, increased carotid intima-media thickness and arterial stiffness, have been documented in hypertensive youth. Studies also show an early onset of renal impairment, endothelial dysfunction and microalbuminuria. Importantly, blood pressure levels in childhood track into adulthood, significantly elevating the risk of ischemic heart disease, stroke and premature mortality. Children with persistent hypertension are more likely to develop metabolic syndrome, type 2 diabetes and dyslipidemia exacerbating cardiovascular risk. These findings reinforce the need for early, aggressive intervention to prevent irreversible organ damage and interrupt the trajectory toward adult cardiovascular disease. Longitudinal research further supports that reducing BP in youth can reverse or mitigate these subclinical changes, highlighting the value of early therapeutic engagement [4-5].

Conclusion

First-line treatment involves lifestyle modification: promoting physical activity, reducing screen time, limiting dietary sodium and sugar, encouraging whole-food nutrition and ensuring adequate sleep. Family-based interventions, school nutrition programs and national policies targeting childhood obesity are critical components of primary prevention. Pharmacologic therapy may be warranted for children with stage 2 hypertension, underlying disease, or evidence of end-organ damage. Public health campaigns must also educate parents, caregivers and school personnel about the importance of monitoring blood pressure in youth.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Healey, J.â?¯ and S.â?¯J. Connolly. 2003. “Atrial fibrillation: Hypertension as a causative agent, risk factor for complications and potential therapeutic target.” Am J Cardiol 91 (10A): 9G–14G

Google Scholar Cross Ref Indexed at

2. Buonacera, Agata, Benedetta Stancanelli and Lorenzo Malatino. 2019. “Stroke and hypertension: An appraisal from pathophysiology to clinical practice.” Curr Vasc Pharmacol 17 (1): 72–84.

Google Scholar Cross Ref Indexed at

3. Canniffe, Carla, Phalla Ou, Kevin Walsh and Damien Bonnet, et al. 2013. “Hypertension after repair of aortic coarctation: A systematic review.” Int J Cardiol 167 (6): 2456–61.

Google Scholar Cross Ref Indexed at

4. Ashraf, M., Mohd Irshad and Nazir A. Parry. 2020. “Pediatric hypertension: An updated review.” Clin Hypertens 26 (1): 22

Google Scholar Cross Ref Indexed at

5. Di Bonito, Procolo and Anna Di Sessa. 2020. “New diagnostic criteria for hypertension in children and adolescents: Lights and shadows.” Children 7 (10): 196.

Google Scholar Cross Ref Indexed at