High blood pressure isn’t just a problem for adults. Rates in children have nearly doubled in 20 years

Many children have "masked" hypertension, which did not show up at the doctor's office, a new study finds. (Maskot/Digital Vision/Getty Images via CNN Newsource)

Global rates of hypertension, or high blood pressure, in childhood and adolescence have nearly doubled since 2000, putting more kids at risk for poor health later in life.

“In 2000, about 3.4 per cent of boys and three per cent of girls had hypertension. By 2020, those numbers had risen to 6.5 per cent and 5.8 per cent respectively,” said Dr. Peige Song, a researcher from the School of Public Health at Zhejiang University School of Medicine in China. Song is one of the authors of a study describing the findings that published Wednesday in the journal The Lancet Child and Adolescent Health.

Children who have hypertension could be at greater risk later on of developing heart disease –– the No. 1 cause of death in the United States, said Dr. Mingyu Zhang, assistant professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. He was not involved in the research.

“The good news is that this is a modifiable risk,” Song said in an email. “With better screening, earlier detection, and a stronger focus on prevention, especially around healthy weight and nutrition, we can intervene before complications arise.”

High blood pressure in kids can be addressed

The rise in hypertension in children is likely due to many factors.

Childhood obesity is a significant risk factor, because it is associated with factors like insulin resistance, inflammation and vascular function, Song said.

Dietary factors such as consuming high levels of sodium and ultraprocessed food can also contribute to hypertension risk, as well as poor sleep quality, stress and genetic predisposition, she said.

Many children also get less movement than past generations and spend more time on sedentary activities, like screen use, which may be affecting risk, she said.

“We are also starting to know that other factors, including environmental pollutants, can contribute,” Zhang added.

Zhang served as senior author on a previous study that showed a connection between prebirth exposure to chemicals called PFAS — a class of about 15,000 human-made compounds linked to cancers, endocrine-related conditions and developmental issues in children — and childhood hypertension. Short for perfluoroalkyl and polyfluoroalkyl substances, PFAS are sometimes called “forever chemicals” because they don’t fully break down in the environment.

The biggest takeaway of this research for families is not to assume high blood pressure is only a problem for adults, Song said.

If you are worried about your child’s risk for obesity or hypertension, pressure, shame and restriction are not the best approaches.

Instead, focus on increasing healthy behaviors in a happy way, said Jill Castle, a pediatric dietitian in Massachusetts, in a previous CNN article.

“The goal of the food pillar is really to embrace flexibility with food and to emphasize foods that are highly nutritious and … to allow foods also that might be minimally nutritious within the diet in ways that can be fully enjoyed and flexible,” Castle said.

Try to prioritize sitting down as a family for meals and avoid labeling foods as “good” or “bad,” said Castle, author of “Kids Thrive at Every Size.”

“The clean plate club or rewarding with sweets — they might work in the moment, but they don’t do a good job of establishing the self-trust and an intuitive, good relationship with food as kids grow up,” Castle said.

Masked hypertension in children

The study didn’t just track rates in the United States. Instead, researchers analyzed data from 96 studies across 21 countries.

Another important consideration the study team made is how blood pressure differs in and outside the doctor’s office. Some children might have normal blood pressure at home, but a higher reading in the office, while others might have a lower blood pressure in the office than they normally would.

By including data from both office visits and at-home blood pressure readings, the researchers were able to include hypertension rates that are “masked,” or wouldn’t be caught in a doctor’s visit, Zhang said. Masked hypertension was found to be the most common kind, according to the data.

“This is important because it means that many children with true hypertension could go undetected if we rely only on office blood pressure readings,” he said.

The result show that one reading may not be enough, and there may be a need for more scalable solutions for better monitoring and care of hypertension around the world, Song added.

By Madeline Holcombe, CNN