Epidemiology, risk factors, and etiology of hypertension in children and adolescents
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
It has become clear that hypertension (HTN) begins in childhood and adolescence and that it contributes to the early development of cardiovascular disease (CVD). The supporting data include clinical studies that demonstrate cardiovascular structural and functional changes in children with HTN and autopsy studies that have shown an association of blood pressure (BP) with atherosclerotic changes in the aorta and heart in children and young adults. (See "Definition and diagnosis of hypertension in children and adolescents" and "Risk factors and development of atherosclerosis in childhood", section on 'Hypertension'.)
In hypertensive adults, multiple randomized trials have shown that reduction of BP by antihypertensive therapy reduces cardiovascular morbidity and mortality. The magnitude of the benefit increases with the severity of the HTN. (See "Hypertension: Who should be treated?".)
Based upon these observations, identifying children with HTN and successfully treating their HTN should have an important impact on long-term outcomes of CVD.
The epidemiology, risk factors, and etiology of childhood HTN will be reviewed here. The diagnosis, evaluation, and treatment of HTN in children and adolescents are reviewed separately. (See "Definition and diagnosis of hypertension in children and adolescents" and "Evaluation of hypertension in children and adolescents" and "Nonemergent treatment of hypertension in children and adolescents".)
Neonatal HTN, including etiology, is also discussed separately. (See "Etiology, clinical features, and diagnosis of neonatal hypertension".)
- Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903.
- Kit BK, Kuklina E, Carroll MD, et al. Prevalence of and trends in dyslipidemia and blood pressure among US children and adolescents, 1999-2012. JAMA Pediatr 2015; 169:272.
- Yang Q, Zhong Y, Merritt R, Cogswell ME. Trends in High Blood Pressure among United States Adolescents across Body Weight Category between 1988 and 2012. J Pediatr 2016; 169:166.
- McNiece KL, Poffenbarger TS, Turner JL, et al. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 2007; 150:640.
- Falkner B, Gidding SS, Portman R, Rosner B. Blood pressure variability and classification of prehypertension and hypertension in adolescence. Pediatrics 2008; 122:238.
- Chiolero A, Paccaud F, Bovet P. Pre-hypertension and hypertension among adolescents of Switzerland. J Pediatr 2007; 151:e24.
- Papandreou D, Stamou M, Malindretos P, et al. Prevalence of hypertension and association of dietary mineral intake with blood pressure in healthy schoolchildren from northern Greece aged 7-15 years. Ann Nutr Metab 2007; 51:471.
- Acosta AA, Samuels JA, Portman RJ, Redwine KM. Prevalence of persistent prehypertension in adolescents. J Pediatr 2012; 160:757.
- Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 2007; 116:1488.
- Rosner B, Cook NR, Daniels S, Falkner B. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension 2013; 62:247.
- Jago R, Harrell JS, McMurray RG, et al. Prevalence of abnormal lipid and blood pressure values among an ethnically diverse population of eighth-grade adolescents and screening implications. Pediatrics 2006; 117:2065.
- Parker ED, Sinaiko AR, Kharbanda EO, et al. Change in Weight Status and Development of Hypertension. Pediatrics 2016; 137:e20151662.
- Dasgupta K, O'Loughlin J, Chen S, et al. Emergence of sex differences in prevalence of high systolic blood pressure: analysis of a longitudinal adolescent cohort. Circulation 2006; 114:2663.
- Wirix AJ, Nauta J, Groothoff JW, et al. Is the prevalence of hypertension in overweight children overestimated? Arch Dis Child 2016; 101:998.
- Falkner B, Gidding SS, Ramirez-Garnica G, et al. The relationship of body mass index and blood pressure in primary care pediatric patients. J Pediatr 2006; 148:195.
- Belfort MB, Rifas-Shiman SL, Rich-Edwards J, et al. Size at birth, infant growth, and blood pressure at three years of age. J Pediatr 2007; 151:670.
- Vale S, Trost SG, Rêgo C, et al. Physical Activity, Obesity Status, and Blood Pressure in Preschool Children. J Pediatr 2015; 167:98.
- Freedman DS, Goodman A, Contreras OA, et al. Secular trends in BMI and blood pressure among children and adolescents: the Bogalusa Heart Study. Pediatrics 2012; 130:e159.
- Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995; 25:305.
- Muntner P, He J, Cutler JA, et al. Trends in blood pressure among children and adolescents. JAMA 2004; 291:2107.
- Obarzanek E, Wu CO, Cutler JA, et al. Prevalence and incidence of hypertension in adolescent girls. J Pediatr 2010; 157:461.
- Cheung EL, Bell CS, Samuel JP, et al. Race and obesity in adolescent hypertension. Pediatrics 2017; 139.
- Jung FF, Ingelfinger JR. Hypertension in childhood and adolescence. Pediatr Rev 1993; 14:169.
- Niiranen TJ, McCabe EL, Larson MG, et al. Heritability and risks associated with early onset hypertension: multigenerational, prospective analysis in the Framingham Heart Study. BMJ 2017; 357:j1949.
- Hunt SC, Ellison RC, Atwood LD, et al. Genome scans for blood pressure and hypertension: the National Heart, Lung, and Blood Institute Family Heart Study. Hypertension 2002; 40:1.
- Kaplan NM. Primary hypertension: Pathogenesis. In: Kaplan's Clinical Hypertension, 8th ed, Kaplan NM (Ed), Lippincott Williams & Wilkins, Philadelphia 2002. p.58.
- Ward R. Familial aggregation and genetic epidemiology of blood pressure. In: Hypertension: Pathophysiology, Diagnosis and Management, Laragh J, Brenner B (Eds), Raven Press, New York 1990. p.81.
- Havlik RJ, Feinleib M. Epidemiology and genetics of hypertension. Hypertension 1982; 4:III121.
- Biron P, Mongeau JG, Bertrand D. Familial aggregation of blood pressure in 558 adopted children. Can Med Assoc J 1976; 115:773.
- Annest JL, Sing CF, Biron P, Mongeau JG. Familial aggregation of blood pressure and weight in adoptive families. II. Estimation of the relative contributions of genetic and common environmental factors to blood pressure correlations between family members. Am J Epidemiol 1979; 110:492.
- Christian JC. Twin studies of blood pressure. In: Children's Blood Pressure, Report of the 85th Ross Conference on Pediatric Research, 1985. p.51.
- Feinleib M, Garrison R, Borhani N, et al. Studies of hypertension in twins. In: Epidemiology and Control of Hypertension, Paul 0 (Ed), Stratton Intercontinental Medical Book Corp, New York 1975. p.3.
- Martin RM, Ness AR, Gunnell D, et al. Does breast-feeding in infancy lower blood pressure in childhood? The Avon Longitudinal Study of Parents and Children (ALSPAC). Circulation 2004; 109:1259.
- Wilson AC, Forsyth JS, Greene SA, et al. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998; 316:21.
- Lawlor DA, Najman JM, Sterne J, et al. Associations of parental, birth, and early life characteristics with systolic blood pressure at 5 years of age: findings from the Mater-University study of pregnancy and its outcomes. Circulation 2004; 110:2417.
- Ocón-Pujadas J, Mora-Maciá J. White coat hypertension and related phenomena. A clinical approach. Drugs 1993; 46 Suppl 2:95.
- Hornsby JL, Mongan PF, Taylor AT, Treiber FA. 'White coat' hypertension in children. J Fam Pract 1991; 33:617.
- Sorof JM, Poffenbarger T, Franco K, Portman R. Evaluation of white coat hypertension in children: importance of the definitions of normal ambulatory blood pressure and the severity of casual hypertension. Am J Hypertens 2001; 14:855.
- Matthews KA, Woodall KL, Allen MT. Cardiovascular reactivity to stress predicts future blood pressure status. Hypertension 1993; 22:479.
- Kavey RE, Kveselis DA, Atallah N, Smith FC. White coat hypertension in childhood: evidence for end-organ effect. J Pediatr 2007; 150:491.
- Davis EF, Lazdam M, Lewandowski AJ, et al. Cardiovascular risk factors in children and young adults born to preeclamptic pregnancies: a systematic review. Pediatrics 2012; 129:e1552.
- Flynn JT, Ng DK, Chan GJ, et al. The effect of abnormal birth history on ambulatory blood pressure and disease progression in children with chronic kidney disease. J Pediatr 2014; 165:154.
- Wyszyńska T, Cichocka E, Wieteska-Klimczak A, et al. A single pediatric center experience with 1025 children with hypertension. Acta Paediatr 1992; 81:244.
- Arar MY, Hogg RJ, Arant BS Jr, Seikaly MG. Etiology of sustained hypertension in children in the southwestern United States. Pediatr Nephrol 1994; 8:186.
- Kopp JB, Smith MW, Nelson GW, et al. MYH9 is a major-effect risk gene for focal segmental glomerulosclerosis. Nat Genet 2008; 40:1175.
- Dillon MJ. The diagnosis of renovascular disease. Pediatr Nephrol 1997; 11:366.
- Deal JE, Snell MF, Barratt TM, Dillon MJ. Renovascular disease in childhood. J Pediatr 1992; 121:378.
- Piercy KT, Hundley JC, Stafford JM, et al. Renovascular disease in children and adolescents. J Vasc Surg 2005; 41:973.
- Fossali E, Signorini E, Intermite RC, et al. Renovascular disease and hypertension in children with neurofibromatosis. Pediatr Nephrol 2000; 14:806.
- RISK FACTORS
- - Monogenic disorders
- White coat hypertension
- Prenatal and neonatal factors
- Primary hypertension
- Secondary hypertension
- - Renal parenchymal disease
- - Renovascular disease
- - Renal tubular disease
- - Endocrinologic disease
- - Cardiac disease
- - Drugs and toxins
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