Hypertension (high blood pressure) enjoys global infamy as a “silent killer” that cuts across age, class, race and postal code.
That’s largely because many people with hypertension feel perfectly fine until they have a heart attack, stroke or show signs of kidney damage.
For children, the silence can become even more deadly. That’s because many adults — parents, teachers and even some doctors — still think of hypertension as mostly an “old people’s problem”.
They could not be more wrong.
Globally, paediatric (childhood) hypertension rates have almost doubled over the past two decades. Recent African and South African research paints a quietly alarming picture.
Paediatric hypertension in South Africa appears with unsettling frequency across studies published in 2024 and 2025, often exceeding global averages.
So too does the frequency of “elevated” or “high normal” blood pressure in South African children. That’s medical speak for hypertension not yet diagnosed but already nudging children’s arteries, hearts and kidneys in the wrong direction.
However, Johannesburg paediatric nephrologist Errol Gottlich said there is no epidemic of hypertension in South African children. Rather, there is “an increasing concern” about this condition in children.
“The real epidemic,” he said, “is childhood obesity”.
Hypertension is more likely a consequence of “a crisis of poor lifestyle and an obsessive immersion in the digital world”.
He joins experts who stress that risk factors for obesity and hypertension are effectively built into the environment. They believe serious prevention needs to move urgently beyond lectures and into policy.
Hypertension is more likely a consequence of ‘a crisis of poor lifestyle and an obsessive immersion in the digital world’.
— Errol Gottlich, paediatric nephrologist
Gottlich has been in paediatric nephrology practice at the Morningside Mediclinic and Wits University Donald Gordon Medical Centre since 2006. He is also an honorary professor in the paediatric nephrology department at the University of Pretoria, involved in training paediatric registrars and nephrology fellows.
He said that obesity is one of the main drivers of hypertension.
It starts “practically in nappies and now stretches through all school ages. In adults, obesity has almost become a norm, with the same social blindness seeping into childhood.”
As a medical problem, obesity in all ages has become almost invisible as it is ubiquitous, Gottlich said. It is happening against a backdrop of rapid urbanisation, the growth of the ultra-processed food industry, high salt intake and shrinking activity levels.
“Highly processed foods are cheaper, quicker and more accessible than home-cooked meals, especially in families where parents are both working,” he said.
“Healthy options are often more expensive, pushing families towards energy-dense, nutrient-poor products loaded with fat, salt and calories.”
An aggravating factor is the “dramatic reduction” in physical activity among South African children.
“Obesity itself becomes a barrier to movement, as overweight children feel physically uncomfortable and self-conscious in sporting activities,” Gottlich said.
Children have fewer safe neighbourhood spaces for informal play. They are also “over-involved in the digital world”.
Add maternal health problems, low birth weight, prematurity and chronic stress affecting all socioeconomic groups, and the cardiovascular deck and hypertension risk are stacked against some children globally long before they have learnt to read.
Why, then, is childhood hypertension still not taken seriously? Reasons that it stays under the radar include:
- No symptoms. Most children with hypertension or pre-hypertension feel well. When symptoms, such as headaches, nosebleeds or fatigue do appear they are easily blamed on and dismissed as school stress, screens or “growing pains”.
- Measurement problems. Accurate blood pressure readings are more difficult to achieve in children than they are in adults. They require the right cuff size, a calm child, repeated readings on different days and age, sex and height-specific reference charts. In many African and low-resource settings the equipment and testing facilities are simply not there.
- Lack of data and guidelines. A minority of African countries have published data on childhood hypertension and there is a shortage of context-appropriate guidelines and training. Even globally, paediatric thresholds and categories differ between guidelines.
- Perception lag. The dangerous idea that paediatric hypertension is rare. It is a hangover from an earlier era.
The true extent of childhood hypertension in South Africa is “most likely hidden”, said Gottlich.
He attributes this to poor awareness among primary-care health practitioners as well as the limited number of paediatric nephrologists ― only 23.
“Many children never get to see one of us and are either not seen at all or seen in clinics or by GPs,” Gottlich said.
“That makes it hard to quantify the prevalence of hypertension or the change over the past decade.”
Obese children are no longer automatically seen as unwell and are not routinely taken for proper assessment, including blood pressure checks, he said.
In this landscape, hypertension in a child is often “an incidental finding”. Crucially, if there is concern about a child’s health, Gottlich urged parents to arrange for a full examination, including a blood pressure reading and urine test.
He endorses US Mayo Clinic guidance that children should start having blood pressure checks routinely from the age of three at well-child visits. If they already have high blood pressure or are at higher risk, they should have blood pressure checks at every visit.
The checks should begin soon after birth if children have a condition that increases the hypertension risk, such as premature birth, low birth weight, congenital heart disease, autoimmune conditions and certain kidney problems.
If a child’s blood pressure is elevated, there should be a referral for further management, Gottlich said. Once diagnosed, clinicians should take hypertension “very seriously”.
They need to look hard for secondary causes beyond obesity such as kidney disease, vascular abnormalities or hormonal problems.
When investigations come back negative, specialist medical advice may sound straightforward: lose weight and move more.
Uncomfortable truth
“That advice is rarely successful,” Gottlich said, “because family dynamics often drive obesity. And if parents don’t buy into lifestyle change, which they mostly don’t, doctors have to depend on medication for blood pressure control.”
An uncomfortable truth also emerging from research globally is that hypertension effectively has a “memory”.
It’s why children with higher-than-average readings are more likely to become adults with hypertension. It applies even when their numbers hover in the “borderline” elevated zone for years.
Beginning in childhood, rising blood pressure levels are shown to fuel a pipeline of adults needing lifelong medication and repeated clinic visits. For a tragic minority, this fuels expensive dialysis, kidney transplant cardiac interventions.
By adolescence many children already show signs of “target organ” changes that were once seen only in adults in middle age.
These changes include thickened heart muscle, stiffened arteries and early kidney stress. They make it more likely that a young person will suffer a stroke, heart attack or kidney failure in what should be the prime of life — in their 30s or 40s, or even earlier.
Health systems in low- and middle-income countries are already buckling under the dual load of infectious diseases and chronic non-communicable diseases. Factor in a generation of young adults with “old people’s arteries” and the statistics grow more grim.
The bad news is that it is not easy to reverse these negative bodily changes. The good news is that it is possible.
Back to basics
Gottlich’s prescription is disarmingly simple, practical and shared by experts globally.
For parents, clinics and schools it all “comes back to basics”. It involves educating adults about affordable healthy choices, dramatically cutting processed and fast foods, sharply reducing time on digital devices and promoting exercise as part of everyday life, not an optional extra.
Prevention, particularly, needs to move proactively beyond lectures and into policy.
This includes regulating salt levels in processed foods and bread; making healthy school meals and safe-play spaces a non-negotiable part of basic education and designing cities where walking, cycling and active play are normal, not exceptional, initiatives.
Hypertension in children is unlikely to have the drama of an outbreak disease. There will be no nightly news bulletins, no dramatic curves — just a slow, almost inaudible tightening of the vital pipes that keep young bodies alive.
And while Africa is sounding the alarm on obesity and hypertension early, it is not because the continent is uniquely flawed. It simply lays bare what happens when rapid social change collides with old inequities and fragile health systems. It is a reminder that low-income and disadvantaged families everywhere are living a quieter version of the same story and that better-off families are not exempt.
Awareness, in this context, is an instruction, not a slogan. Every increase on a child’s blood-pressure chart is a message from their future self, asking the adults in their lives not to look away.
The global rise in hypertension in children is effectively a call to “listen” to quiet, stressed arteries.
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