Trends and risk factors of hypertension in US Children and Adolescents, 1999–2023

We aimed to assess trends in elevated blood pressure (EBP) and hypertension among US children and adolescents before and after the COVID-19 pandemic using data from 25,916 participants aged 8-19 years in NHANES 1999-2023. Survey-weighted multinomial logistic regression was used to examine associations of sociodemographic, nutritional and other factors with EBP and hypertension overall and across subgroups during the pre-pandemic cycles (2015-2020) and post-pandemic cycles (2021-2023). Among children (n = 10,616), EBP prevalence decreased from 4.3% in 1999-2002 to 3.5% in 2021-2023 (P = 0.36), and hypertension declined from 3.3% to 2.3% (P = 0.025). Among adolescents (n = 15,300), EBP declined from 10.0% to 9.4% (P = 0.46), and hypertension prevalence fell from 8.3% to 5.1% (P < 0.001). From 2015-2023, obesity was strongly associated with both EBP and hypertension in children (odds ratio [OR] 1.78, 95% CI 1.02-3.10) and adolescents (OR 1.89, 95% CI 1.30-2.74). In children, higher dietary fat intake was associated with greater odds of EBP, and higher sodium intake with greater odds of hypertension. In adolescents, older age, male sex and non-Hispanic Black race were additional risk factors. Comparing pre-pandemic (2015-2020) with post-pandemic (2021-2023) cycles, EBP prevalence in adolescents decreased (11.6% vs 9.42%, P = 0.46) and hypertension prevalence in children changed modestly (2.53% vs 2.26%, P = 0.025). Despite concerns about pandemic-related increases in obesity, pediatric EBP and hypertension prevalence remained stable or declined from 2015 to 2023, with adiposity remaining the dominant modifiable correlate.