Practical approach to evaluate and manage hypertension in youth: an International Society of Hypertension position paper

Abstract

Hypertension in children and adolescents is an increasingly prevalent global health concern and a strong predictor of adult cardiovascular and kidney disease. Variability in existing guidelines and limited applicability in low-resource settings hinder effective identification and management. This International Society of Hypertension (ISH) position paper provides practical, harmonized guidance for clinicians globally. To develop evidence-based, clinically relevant recommendations for the evaluation, diagnosis, and management of hypertension in youth, informed by multidisciplinary expertise from 12 countries. An expert panel undertook an iterative, consensus-driven synthesis of current evidence covering epidemiology, risk factors, blood pressure measurement, diagnostic evaluation, target organ injury, lifestyle therapy, pharmacological treatment, and long-term monitoring. Youth hypertension is driven by obesity, adverse childhood experiences, unhealthy lifestyle behaviors, and socioecological factors, with a disproportionately higher burden in low and middle-income countries. Accurate diagnosis requires standardized measurement using validated devices, proper cuff sizing, and out-of-office monitoring, particularly ambulatory blood pressure monitoring. Targeted investigations help distinguish primary from secondary hypertension and identify early organ injury. Lifestyle modification forms the foundation of treatment, while pharmacotherapy is indicated for persistent stage 2 hypertension, comorbid conditions, or evidence of organ damage. Structured transition to adult care is essential to improve long-term adherence and outcomes. Timely recognition and individualized management of youth hypertension are critical for reducing lifelong cardiovascular risk. This ISH position paper offers pragmatic, globally adaptable recommendations to enhance early detection, treatment, and continuity of care for children and adolescents with elevated blood pressure.