Pediatric Nephrology

, Volume 28, Issue 7, pp 1059–1066 | Cite as

The changing face of pediatric hypertension in the era of the childhood obesity epidemic

Educational Review


Historically, hypertension in childhood was thought to be an uncommon diagnosis, usually related to an underlying condition, most often parenchymal renal disease. Primary hypertension in childhood was felt to be quite rare. However, the worldwide childhood obesity epidemic has had a profound impact on the frequency of hypertension and other obesity-related conditions with the result that primary hypertension should now be viewed as one of the most common health conditions in the young. This review will present updated data on the prevalence of hypertension in children and adolescents, the impact of the childhood obesity epidemic on hypertension prevalence and blood pressure levels, shifts in how often primary hypertension is being diagnosed in childhood, and an overview of the pathophysiology of obesity-related hypertension. It is hoped that improved understanding of the significance of these issues will lead to improved recognition and treatment, which will be the key to averting an epidemic of cardiovascular disease in adulthood.


Obesity Hypertension Children Adolescents Epidemiology 


  1. 1.
    Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of obesity in the United States, 2009–2010. NCHS data brief, no 82. Hyattsville, MD: National Center for Health Statistics. Available at Accessed 5 September 2012
  2. 2.
    Lazzeri G, Rossi S, Pammolli A, Pilato V, Pozzi T, Giacchi MV (2008) Underweight and overweight among children and adolescents in Tuscany (Italy). Prevalence and short-term trends. Prev Med Hyg 49:13–21Google Scholar
  3. 3.
    Valdés Pizarro J, Royo-Bordonada MA (2012) Prevalence of childhood obesity in Spain: National Health Survey 2006–2007. Nutr Hosp 27:154–160PubMedGoogle Scholar
  4. 4.
    Kollias A, Skliros E, Stergiou GS, Leotsakos N, Saridi M, Garifallos D (2011) Obesity and associated cardiovascular risk factors among schoolchildren in Greece: a cross-sectional study and review of the literature. J Pediatr Endocrinol Metab 24:929–938PubMedCrossRefGoogle Scholar
  5. 5.
    Midha T, Nath B, Kumari R, Rao YK, Pandey U (2012) Childhood obesity in India: a meta-analysis. Indian J Pediatr 79:945–948PubMedCrossRefGoogle Scholar
  6. 6.
    Marwaha RK, Tandon N, Singh Y, Aggarwal R, Grewal K, Mani K (2006) A study of growth parameters and prevalence of overweight and obesity in school children from Delhi. Indian Pediatr 43:943–952PubMedGoogle Scholar
  7. 7.
    Okafor CI (2012) The metabolic syndrome in Africa: current trends. Indian J Endocrinol Metab 16:56–66PubMedCrossRefGoogle Scholar
  8. 8.
    Wang Y, Lobstein T (2006) Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1:11–25PubMedCrossRefGoogle Scholar
  9. 9.
    Rerksuppaphol S, Rerksuppaphol L (2011) Prevalence of dyslipidemia in Thai schoolchildren. J Med Assoc Thai 94:710–715PubMedGoogle Scholar
  10. 10.
    Raj M (2011) Obesity and cardiovascular risk in children and adolescents. Indian J Endocrinol Metab 16:13–19CrossRefGoogle Scholar
  11. 11.
    Bhardwaj S, Misra A, Khurana L, Gulati S, Shah P, Vikram NK (2008) Childhood obesity in Asian Indians: a burgeoning cause of insulin resistance, diabetes and subclinical inflammation. Asia Pac J Clin Nutr 17 [Suppl 1]:172–175PubMedGoogle Scholar
  12. 12.
    May AL, Kuklina EV, Yoon PW (2012) Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics 129:1035–1041PubMedCrossRefGoogle Scholar
  13. 13.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576CrossRefGoogle Scholar
  14. 14.
    Silverberg DS, Nostrand CV, Juchli B, Smith ES, Dorsser EV (1975) Screening for hypertension in a high school population. Can Med Assoc J 113:103–108PubMedGoogle Scholar
  15. 15.
    Kilcoyne MM, Richter RW, Alsup PA (1974) Adolescent hypertension. I. Detection and prevalence. Circulation 50:758–764PubMedCrossRefGoogle Scholar
  16. 16.
    Fixler DE, Laird WP, Fitzgerald V, Stead S, Adams R (1979) Hypertension screening in schools: results of the Dallas study. Pediatrics 63:32–36PubMedGoogle Scholar
  17. 17.
    Sinaiko AR, Gomez-Marin O, Prineas RJ (1989) Prevalence of “significant” hypertension in junior high school-aged children: the children and adolescent blood pressure program. J Pediatr 114:664–669PubMedCrossRefGoogle Scholar
  18. 18.
    O’Quin M, Sharma BB, Miller KA, Tomsovic JP (1992) Adolescent blood pressure survey: Tulsa, Oklahoma, 1987 to 1989. South Med J 85:487–490PubMedCrossRefGoogle Scholar
  19. 19.
    Adrogue HE, Sinaiko AR (2001) Prevalence of hypertension in junior high school-aged children: effect of new recommendations in the 1996 Updated Task Force Report. Am J Hypertens 14:412–414PubMedCrossRefGoogle Scholar
  20. 20.
    Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ (2004) Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 113:475–482PubMedCrossRefGoogle Scholar
  21. 21.
    McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ (2007) Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 150:640–644PubMedCrossRefGoogle Scholar
  22. 22.
    Steinthorsdottir SD, Eliasdottir SB, Indridason OS, Agustsdottir IM, Palsson R, Edvardsson VO (2011) Prevalence of hypertension in 9- to 10-year-old Icelandic school children. J Clin Hypertens (Greenwich) 13:774–779CrossRefGoogle Scholar
  23. 23.
    Cao Z-Q, Zhu L, Zhang T, Wu L, Wang Y (2012) Blood pressure and obesity among adolescents: a school-based population study in China. Am J Hypertens 25:576–582PubMedCrossRefGoogle Scholar
  24. 24.
    Task Force on Blood Pressure Control in Children (1987) Report of the second task force on blood pressure control in children—1987. National heart, lung, and blood institute, Bethesda, Maryland. Pediatrics 79:1–25Google Scholar
  25. 25.
    National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (1996) Update on the 1987 task force report on high blood pressure in children and adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 98:649–658Google Scholar
  26. 26.
    Din-Dzietham R, Liu Y, Bielo MV, Shamsa F (2007) High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 116:1488–1496PubMedCrossRefGoogle Scholar
  27. 27.
    Chiolero A, Bovet P, Paradis G, Paccaud F (2007) Has blood pressure increased in children in response to the obesity epidemic? Pediatrics 119:544–553PubMedCrossRefGoogle Scholar
  28. 28.
    Falkner B (2007) What exactly do the trends mean? Circulation 116:1437–1439PubMedCrossRefGoogle Scholar
  29. 29.
    de Rezende FD, Scarpelli RAB, de Souza GF, da Costa JO, Scarpelli AMB, Scarpelli PA, de Carvalho GB, D’Agostini HM, Pedrosa JC (2003) Prevalence of systemic hypertension in students aged 7 to 14 years in the municipality of Barbacena, in the state of Minas Gerais in 1999. Arq Bras Cardiol 81:381–386PubMedCrossRefGoogle Scholar
  30. 30.
    Sharma A, Grover N, Kaushik S, Bhardwaj R, Sankhyan N (2010) Prevalence of hypertension among school children in Shimla. Indian Pediatr 47:873–876PubMedCrossRefGoogle Scholar
  31. 31.
    Moore WE, Stephens A, Wilson T, Wilson W, Eichner JE (2006) Body mass index and blood pressure screening in a rural public school system: the Healthy Kids Project. Prev Chronic Dis Available at: Accessed 5 September 2012
  32. 32.
    Tu W, Eckert GJ, DiMeglio LA, Yu Z, Jung J, Pratt JH (2011) Intensified effect of adiposity on blood pressure in overweight and obese children. Hypertension 58:818–824PubMedCrossRefGoogle Scholar
  33. 33.
    Luepker RV, Jacobs DR, Prineas RJ, Sinaiko AR (1999) Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996. J Pediatr 134:668–674PubMedCrossRefGoogle Scholar
  34. 34.
    Simonetti GD, Schwertz R, Klett M, Hoffmann GF, Schaefer F, Wühl E (2011) Determinants of blood pressure in preschool children: the role of parental smoking. Circulation 123:292–298PubMedCrossRefGoogle Scholar
  35. 35.
    Muntner P, He J, Cutler JA, Wildman RP, Whelton PK (2004) Trends in blood pressure among children and adolescents. JAMA 291:2107–2113PubMedCrossRefGoogle Scholar
  36. 36.
    Feld LG, Springate JE (1988) Hypertension in children. Curr Probl Pediatr 18:317–373PubMedGoogle Scholar
  37. 37.
    Arar MY, Hogg RJ, Arant BS Jr, Seikaly MG (1994) Etiology of sustained hypertension in children in the southwestern United States. Pediatr Nephrol 8:186–189PubMedCrossRefGoogle Scholar
  38. 38.
    Flynn JT, Alderman MH (2005) Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol 20:961–966PubMedCrossRefGoogle Scholar
  39. 39.
    Croix B, Feig DI (2006) Childhood hypertension is not a silent disease. Pediatr Nephrol 21:527–532PubMedCrossRefGoogle Scholar
  40. 40.
    Kapur G, Ahmed M, Pan C, Mitsnefes M, Chiang M, Mattoo TK (2010) Secondary hypertension in overweight and stage 1 hypertensive children: a Midwest Pediatric Nephrology Consortium report. J Clin Hypertens (Greenwich) 12:34–39CrossRefGoogle Scholar
  41. 41.
    Flynn JT, Zhang Y, Solar-Yohay S, Shi V (2012) Clinical and demographic characteristics of children with hypertension. Hypertension 60:1047–1054PubMedCrossRefGoogle Scholar
  42. 42.
    Welch WP, Yang W, Taylor-Zapata P, Flynn JT (2012) Antihypertensive drug use in children: are the drugs labeled and indicated? J Clin Hypertens (Greenwich) 14:388–395CrossRefGoogle Scholar
  43. 43.
    Hall JE (2003) The kidney, hypertension, and obesity. Hypertension 41:625–633PubMedCrossRefGoogle Scholar
  44. 44.
    Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G (2010) Mechanisms of obesity-induced hypertension. Hypertens Res 33:386–393PubMedCrossRefGoogle Scholar
  45. 45.
    Rocchini AP (2011) Childhood obesity and blood pressure regulation. In: Flynn JT, Ingelfinger J, Portman R (eds) Pediatric hypertension, 2nd edn. Humana Press., New York, pp 301–328CrossRefGoogle Scholar
  46. 46.
    Grontved A, Steene-Johannessen J, Kynde I, Franks PW, Helge JW, Froberg K, Anderssen SA, Andersen LB (2011) Association between plasma leptin and blood pressure in two population-based samples of children and adolescents. J Hypertens 29:1093–1100PubMedCrossRefGoogle Scholar
  47. 47.
    Shatat IF, Freeman KD, Vuguin PM, Dimartino-Nardi JR, Flynn JT (2009) Relationship between adiponectin and ambulatory blood pressure in obese adolescents. Pediatr Res 65:691–695PubMedCrossRefGoogle Scholar
  48. 48.
    Mohamed-Ali V, Bulmer K, Clarke D, Goodrick S, Coppack SW, Pinkney JH (2000) Beta-adrenergic regulation of proinflammatory cytokines in humans. Int J Obes Relat Metab Disord 24 [Suppl 2]:S154–S155PubMedCrossRefGoogle Scholar
  49. 49.
    Jung RT, Shetty PS, Barrand M, Callingham BA, James WP (1979) Role of catecholamines in hypotensive response to dieting. Br Med J 6155:12–13CrossRefGoogle Scholar
  50. 50.
    Chrousos GP (1995) The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med 332:1351–1362PubMedCrossRefGoogle Scholar
  51. 51.
    Aghamohammadzadeh R, Heagerty AM (2012) Obesity-related hypertension: epidemiology, pathophysiology, treatments, and the contribution of perivascular adipose tissue. Ann Med 44 [Suppl 1]:S74–S84PubMedCrossRefGoogle Scholar
  52. 52.
    Shatat IF, Flynn JT (2011) Relationships between renin, aldosterone and 24-hour ambulatory blood pressure in obese adolescents. Pediatr Res 69:336–340PubMedCrossRefGoogle Scholar
  53. 53.
    Daniels SR (1999) Is there an epidemic of cardiovascular disease on the horizon? J Pediatr 134:665–666PubMedCrossRefGoogle Scholar
  54. 54.
    Bibbins-Domingo K, Coxson P, Pletcher MJ, Lightwood J, Goldman L (2007) Adolescent overweight and future adult coronary heart disease. N Engl J Med 357:2371–2379PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2012

Authors and Affiliations

  1. 1.Seattle Children’s HospitalUniversity of Washington School of MedicineSeattleUSA
  2. 2.Division of Nephrology, A-7931Seattle Children’s HospitalSeattleUSA

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