Rising Youth Hypertension and Its Long-Term Impact on Coronary Disease: Two New Data Sets

The global burden of hypertension is increasingly shifting to younger populations, with childhood and adolescent high blood pressure now recognized as a critical public health issue. Two new studies, one global and one longitudinal, together show how early in life the condition manifests and how far its consequences extend.

A worldwide meta-analysis, published in The Lancet Child & Adolescent Health, documents a rise of 200% in hypertension across childhood and adolescence. A large cohort study, published in JAMA Cardiology, followed more than 10,000 Swedish adolescents for nearly 40 years, demonstrating that even “elevated” blood pressure in late adolescence predicts a substantially higher burden of coronary atherosclerosis by middle age.

Reviewed together, these findings outline a continuous, decades-long trajectory: from increasingly common elevated BP in youth to measurable coronary disease in adulthood. They also underscore the need to reframe pediatric and adolescent BP as an active, modifiable cardiovascular risk factor—one that warrants earlier detection, more accurate measurement, and earlier intervention than is routine today, the studies' authors concurr.

Pediatric Hypertension Doubles Over 2 Decades

The meta-analysis in The Lancet reports that the global prevalence of hypertension in children and adolescents has almost doubled over the past two decades, rising from roughly 3.2% in 2000 to 6.2% in 2020, affecting an estimated 114 million young people worldwide. The researchers suggested that obesity may be a signifcant driver of the increase, reporing that nearly 1 in 5 youth with obesity have hypertension, compared with fewer than 1 in 30 among peers with healthy weight. As they noted, “obesity can cause other health problems, such as insulin resistance and changes in blood vessels, which make it harder to keep blood pressure within a healthy range.”

For their analyses, investigators reviewed 96 studies that involved more than 443,000 children in 21 countries and found that how BP is measured can substantially alter estimates of prevalence. Hypertension confirmed by a heatlh care professional across at least 3 office vitis is associated with a prevalence of approximately 4.3%. When values obtained from ambulatory or home blood pressure monitoring were included, the rate of sustained hypertension rose to 6.7%, according to the study. The researchers stressed the potential for underdiagnosis in their assessment, given the finding that 9.2% of children globally are affected by masked hypertension. On the other hand, white coat hypertension was estimated at approximately 5.2%, suggesting misclassification of a notable proportion of children. Another sobering finding, they noted, is that an additional 8.2% of youth worldwide have BP levels above normal but below the hypertension threshold.

Early Hypertension Linked to Future Coronary Artery Disease

The complementary cohort study in JAMA Cardiology links these rising adolescent BP trends to coronary disease decades later. Swedish investigators matched blood pressure measured in late adolescence (mean age 18.3 years) in more than 10,000 men undergoing military conscription (1972–1987) with coronary CT angiography findings in middle age (median age 57.8 years). Adolescents with stage 2 hypertension (systolic 140 mm Hg or greater or diastolic 90 mm Hg or greater) had an odds ratio (OR) of 1.84 (95% CI, 1.40–2.42) for severe (51% or greater) coronary stenosis compared with peers with normal BP, calculated as an adjusted prevalence of 10.1% vs 6.9%.

Even blood pressure in what the 2025 American College of Cardiology/American Heart Association guidelines label the “elevated” range (systolic 120–129 mm Hg, diastolic less than 80 mm Hg) carried a higher risk of 31% (OR, 1.31 (95% CI, 1.02–1.68). “A strong dose-response association was observed between 2025 ACC/AHA BP categories and coronary stenosis on CCTA particularly for severe stenosis,” the authors wrote, adding that the results “highlight the importance of early-life focus on BP prevention strategies.”

The group also repored that systolic BP proved more predictive of future disease than diastolic BP. Adolescents with stage 2 systolic hypertension (140 mm Hg or greater) had an adjusted OR of 1.97 (95% CI, 1.50–2.60) for severe stenosis compared with those whose systolic BP was less than 120 mm Hg. The found that the asociations remained robust in multiple sensitivity analyses, persisted after adjustment for confounders including BMI, smoking duration, and educational level, and were consistent across both 2025 ACC/AHA and 2024 European Society of Cardiology BP categories.

Strengths and Limitations

A signficant strenght of the study, the nearly 40-year follow-up reduced concerns about reverse causation and enabled the use of direct imaging endpoints rather than relying solely on registry-based clinical events.

Authors of both studies do acknowledge some limitations, including heterogeneous BP measurement protocols and gaps in regional data in the global analysis and enrollment of only men in the Swedish cohort study as well as the exposure to residual confounding. The Swedish researchers add that CCTA findings, although highly informative, do not capture downstream cardiovascular events or mortality.

What the Aggregate Evidence Means

The collective evidence reinforces that hypertension prevention, detection, and management must begin well before adulthood. The Lancet authors stress the substantial and growing global burden of pediatric hypertension and the need for more consistent diagnostic approaches. The Swedish cohort adds that adolescent BP below 120/80 mm Hg appears to confer the lowest midlife coronary risk, supporting early intervention even for modest elevations. Given that absolute increases of several percentage points in severe coronary stenosis carry meaningful population-level impact, the case for systematic screening, wider use of out-of-office measurements, and earlier lifestyle and weight interventions is strong.

References

1. Zhou J, Shan S, Wu J, et al. Global prevalence of hypertension among children and adolescents aged 19 years or younger: an updated systematic review and meta-analysis. Lancet Child Adolesc Health. Published online November 12, 2025. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(25)00281-0/abstract
2. Herraiz-Adillo A, Eriksson H, Ahlqvist VH, et al. Blood pressure in adolescence and athersclerosis in middle age. JAMA Cardiol. Published online November 19, 2025. doi:10.1001/jamacardio.2025.4271