Under pressure: the lifelong cardiovascular health of children and youth with primary hypertension

Global cardiovascular health promotion across the lifespan requires a comprehensive approach prioritising early life interventions. Paediatric hypertension is an increasingly recognised public health issue and an important modifiable risk factor for reducing future cardiovascular morbidity and mortality. This Review discusses the epidemiology, risk factors, diagnosis, and management of paediatric hypertension. We highlight the increasing prevalence of paediatric hypertension, its higher rates in low-income and middle-income countries (LMICs), and review its multifactorial causes globally, including genetic, environmental, and lifestyle influences. Barriers to early detection, particularly in LMICs, such as poor awareness of childhood-onset hypertension among families and health-care providers, are elucidated. Studies emphasising the short-term and long-term consequences of paediatric and youth hypertension and evidence-based diagnostic and management strategies, including non-pharmacological and pharmacological interventions, are also discussed. The management of hypertension in youth requires integrating public health strategies with clinical care to establish a robust foundation to improve lifelong health outcomes.