The global prevalence of childhood hypertension in reported to be approximately 4% with an increasing rate shown across the age range of 6–19 years from 2000 to 2015 [1]. This may be in part due to the increase in the prevalence of obesity, in whom the prevalence of hypertension is 15.27% [1]. Similarly in a birth cohort study of 975 subjects with BP measurement up to 38 years of age, hypertensive trajectory was found in 4.2% of the subjects [2]. Childhood hypertension increases the risk of developing hypertension in adulthood as well as increasing the risk of cardiovascular disease. In a study of 5035 subjects that followed blood pressure trajectory from childhood to adulthood, the odds ratio for developing hypertension in adulthood was higher in those whose blood pressure increased or remained high from childhood to adolescence compared with those who had persistently normal blood pressure [3]. Also, In a study that measured blood pressure from 7 months to 20 years of age and carotid IMT from 13 to 26 years of age, higher cumulative blood pressure in early life was significantly associated with greater carotid intima media thickness in young adulthood, suggesting that hypertension at a young age may contribute to the progression of subclinical atherosclerosis [4]. Although high blood pressure in childhood is strongly associated with increase in the risk of cardiovascular events and mortality in adulthood [5], high blood pressure in childhood was not associated with a higher risk of atherosclerosis if resolved to normal blood pressure in adulthood [6], suggesting the importance of hypertension screening and early management in children. The lifetime cardiovascular risk of pediatric hypertension cannot be overstated as studies have shown that lifetime risk of cardiovascular disease at 30 years of age was 63.3% compared to 46.1% for subjects with normal blood pressure [7]. Therefore, early diagnosis and treatment, whether by lifestyle modification and/or medications, is imperative to reduce cardiovascular morbidity when these children come into adulthood. Subjects with major risk factors for childhood hypertension such as family history of hypertension, obesity, male gender, low birthweight should undergo frequent screening for hypertension [1, 8]. Among the major risk factors, hereditability has been reported to account for 25–60% of hypertension [9].

In the study by Park et al., data from 16,464 individuals (3250 girls between 10 and 18 years of age, 3664 boys between 10 and 18 years of age, 9550 parents) from the 2007–2020 Korean National Health and Nutrition Examination Survey (KNHANES) was analyzed [10]. They found an overall prevalence of adolescent hypertension of 9.5%, with the risk of hypertension increasing by 3-fold with both parental hypertension and 1.5-fold when one of the parents has hypertension. In male adolescents with both parental hypertension, the prevalence of hypertension was 27.6%, which is similar to the overall prevalence in the adult Korean population [10]. What is interesting about this study is that even in non obese adolescents, the odds ratio for hypertension with both parental hypertension was similar to those with obese adolescents (3.61 for non obese versus 2.99 for obese adolescents) regardless of gender [10]. This shows that while the potentially bad lifestyles of the parents with hypertension may confound their association with offspring hypertension, the genetic factor is an important risk factor unto itself. One of the major limitations of this study was the relatively high prevalence of hypertension in the study compared to previous reports. This may be due to the fact that the diagnosis of hypertension was defined according to the BP measurement from a single visit. Studies have shown that multiple screening results in decreasing the prevalence of childhood hypertension. In a study by Mcniece et al., a cross-sectional analysis of BP in 6790 adolescents (11–17 years) across 3 screening visits was done [11]. While the initial screening resulted in hypertension prevalence of 9.4%, similar to the study by Park et al., the final prevalence of hypertension was 3.2% after 3 screenings which was more in line with the accepted prevalence. Similarly, in a study of 44,396 children (6–17 years) in China, the prevalence of hypertension after 3 screening visits was 4% [12]. Also, as the use of aneroid sphygmomanometer has been shown to be associated with higher prevalence of childhood hypertension compared to mercury sphygmomanometer (7.23% versus 4.59%), the use of a non mercurial device (Greenlight 300) in 2020 may have influenced the overall prevalence of the study by Park et al. [1, 10]. Lastly, as white coat hypertension is present in up to 50% of childhood hypertension, future studies to analyze the association of parental hypertension with sustained childhood hypertension, confirmed by out of office BP measurements, is needed [13]. Nevertheless, the message is loud and clear. Strict adherence to the recommendation of yearly BP screening needs to be enforced in children, especially among those with major risk factors such as parental hypertension and obesity. Also, efforts to identify children at risk and implementing healthy lifestyles is imperative to reducing the risk of cardiovascular disease throughout their lifetime.