JAMA Pediatr. 2025 Dec 1. doi: 10.1001/jamapediatrics.2025.4943. Online ahead of print.
ABSTRACT
IMPORTANCE: The prevalence of high blood pressure in children is increasing, with health consequences reaching into adulthood. Individual-level interventions may help address the burden of high blood pressure at a population level, but there is less evidence from pediatric settings.
OBJECTIVE: To assess the effectiveness of school- or community-based lifestyle interventions to reduce high blood pressure in children (aged 3-18 years) and identify components that support effectiveness.
EVIDENCE REVIEW: Ovid MEDLINE, Embase, and PubMed were searched for studies from June 2013 to March 2024. Randomized clinical trials and quasi-experimental studies were assessed using the following strict inclusion criteria: longer than 6-month intervention duration, participants aged 3 to 18 years, major aim to modify cardiometabolic risk, and measurement of blood pressure before and after the intervention. Interventions aimed at specific patient groups were excluded. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools. Blood pressure before and after the intervention was extracted, with the mean difference in blood pressure recorded. Data analysis was performed from June 2023 to July 2024.
FINDINGS: A total of 27 studies were included, of which 13 reported a beneficial effect on blood pressure; 24 studies targeted physical activity, 15 targeted nutrition, 16 targeted education, and 11 included family involvement. Of 14 multicomponent studies, 9 reported a beneficial effect on blood pressure.
CONCLUSIONS AND RELEVANCE: In this systematic review, results indicate that lifestyle interventions can have a beneficial effect on blood pressure in the pediatric population, with multicomponent designs targeting both physical activity and nutrition showing the most promise. Future research should aim to further clarify intervention design and physical activity dosage, feasibility, and scalability, along with the long-term success of interventions that promote healthy blood pressure in children.
PMID:41324936 | DOI:10.1001/jamapediatrics.2025.4943
