In Depth: High Blood Pressure Is on the Rise in China’s Grade Schoolers

China, already grappling with a massive adult hypertension crisis involving nearly 300 million patients, is now witnessing an alarming rise in high blood pressure among children and adolescents. This public health challenge is intensifying, as emphasized by Shi Lin, director of cardiovascular medicine at the Children’s Medical Center of Capital Medical University. Survey data from 2007 indicated that 1.9% of children aged 3 to 17 had hypertension; by 2024, that figure had nearly doubled to 3.7%, suggesting a significant increase in prevalence for a pediatric disease. Shi’s interest in childhood hypertension was sparked by a severe case in 2011, where a 7-year-old developed paralysis due to undetected long-term high blood pressure resulting from renal artery stenosis. Shi later realized that both overall prevalence and cases of “primary hypertension” correlated with lifestyle factors had been rising steadily, mirroring global trends[para. 1][para. 2][para. 3][para. 4][para. 5].

A global meta-analysis published in The Lancet Child & Adolescent Health in November 2025 showed that around 3.2% of children under 19 had hypertension in 2000, but this rose to about 6% by 2020, impacting an estimated 114 million children and adolescents worldwide. Despite the seriousness, hypertension in children often goes unrecognized due to minimal parental awareness and mild or absent symptoms. Many children, like the case of Lili, a 7-year-old diagnosed only after repeated dizziness episodes, are only identified when monitored carefully[para. 6][para. 7][para. 8][para. 9].

Recent years have seen striking increases in prevalence, with national rates for childhood hypertension in China estimated at around 5%. Age is a key risk modifier: less than 1% among preschoolers, 2-3% among elementary school students, and up to 8.8% among adolescents aged 12-17, as found in a 2021 study. Some cases involve severe hypertension with systolic pressure as high as 180mmHg. With these trends, an estimated 6.8 million children in China may be living with primary hypertension today[para. 10][para. 11][para. 12][para. 13].

The primary driver is obesity, which has grown sharply—childhood obesity rates rose from 12.7 million in 1990 to 33.4 million in 2021 among Chinese children aged 5 to 14. One-third of overweight or obese children have hypertension, compared to 2.4% in healthy-weight peers. Pandemic-era lifestyle changes, sedentary behavior, increased screen time, unhealthy diets high in salt and fat, and escalating academic pressure and anxiety have also fueled these trends. Anxiety further elevates risk by raising sympathetic nervous system activity and disrupting sleep, compounding physiological stress[para. 14][para. 15][para. 16][para. 17][para. 18][para. 19][para. 20][para. 21].

Yet, the majority of cases go undetected and untreated, representing only the “tip of the iceberg.” A lack of early symptoms leads to delayed diagnosis—a 16-year-old discovered her critical hypertension only after a hospitalization for hearing loss. Screening is scant: out of an estimated 93,000 potential pediatric hypertension cases in Beijing, fewer than 10,000 are diagnosed and treated annually in major hospitals. Domestic and international experts therefore recommend routine blood pressure checks for children over age 3[para. 22][para. 23][para. 24][para. 25][para. 26].

Despite a doubling in pediatric hypertension prevalence in the past decade, awareness and intervention remain limited. Only recently have governmental policies begun to address the issue, with several new plans launched since 2024 to encourage weight management. Experts advocate for early screening at schools and community clinics and monitoring of four high-risk groups: obese children, those with a family history, premature infants, and those born underweight. Projections suggest that the number of overweight and obese Chinese children aged 5 to 14 will reach 35.2 million by 2050, highlighting the urgent need for sustained public health attention[para. 27][para. 28][para. 29][para. 30][para. 31][para. 32][para. 33][para. 34][para. 35].