HYPERTENSION IN CHILDREN WITH OBESITY: A COMPARISON OF THE EFFECTIVENESS OF PHARMACOTHERAPY AND LIFESTYLE MODIFICATION

Anita Strzykała; Igor Szlegiel; Oktawia Gwiaździńska; Jakub Lewandowski; Denis Myszak

doi:10.31435/ijitss.2(50).2026.5851

Authors

Anita Strzykała Independent Researcher, Szczecin, Poland https://orcid.org/0009-0003-5392-2199
Igor Szlegiel Independent Researcher, Szczecin, Poland https://orcid.org/0009-0000-8271-8945
Oktawia Gwiaździńska Independent Researcher, Szczecin, Poland https://orcid.org/0009-0001-1212-4276
Jakub Lewandowski Independent Researcher, Szczecin, Poland https://orcid.org/0009-0006-2477-8660
Denis Myszak Independent Researcher, Szczecin, Poland https://orcid.org/0000-0001-5275-3141

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5851

Keywords:

Pediatric Hypertension; Childhood Obesity; Obesity-Related Hypertension; Lifestyle Modification; Pharmacotherapy; Target Organ Damage

Abstract

Aim: Hypertension in children with obesity is an increasingly common clinical problem characterized by complex pathophysiology and an early potential for target organ damage. The aim of this study was to compare the effectiveness of pharmacotherapy and lifestyle modification in the treatment of hypertension in children with obesity, taking into account the impact of both strategies on blood pressure levels, weight reduction, target organ damage, metabolic profile, treatment safety, and the durability of disease control.

Materials and methods: A narrative review of the structured literature was conducted, incorporating clinical guidelines, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and cross-sectional studies retrieved from PubMed/MEDLINE, PubMed Central, Cochrane Library, Embase, and Web of Science. Publications addressing epidemiology, pathophysiology, the effectiveness of non-pharmacological and pharmacological interventions, and their impact on target organs were included.

Results: The analysis indicates that lifestyle modification, including weight reduction, increased physical activity, dietary improvement, and reduced sedentary behavior, acts directly on the underlying cause of the disease and improves the metabolic profile, although it requires a longer time to achieve its full effect. Antihypertensive pharmacotherapy, particularly ACE inhibitors and ARBs, acts more rapidly and predictably, which is especially important in patients with stage 2 hypertension, symptomatic disease, target organ damage, or concomitant diabetes and chronic kidney disease.

Conclusions: The greatest clinical benefit is achieved with combined treatment, which integrates rapid hemodynamic control with simultaneous intervention on obesity and other components of cardiometabolic risk. The findings indicate that non-pharmacological treatment should form the foundation of therapy in every child with obesity and hypertension, whereas pharmacotherapy should be introduced in high-risk situations or when lifestyle interventions are insufficiently effective. The optimal management model requires individualization, interdisciplinary care, and long-term monitoring.

References

Flynn, J. T., Kaelber, D. C., Baker-Smith, C. M., Blowey, D., Carroll, A. E., Daniels, S. R., et al. (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140(3), e20171904.

Flynn, J. T., Urbina, E. M., Brady, T. M., Falkner, B., Daniels, S. R., Gidding, S. S., et al. (2023). Pediatric primary hypertension: An underrecognized condition: A scientific statement from the American Heart Association. Hypertension, 80(6), e101–e111.

Brady, T. M. (2017). Obesity-related hypertension in children. Frontiers in Pediatrics, 5, 197.

Jeong, S. I., & Kim, S. H. (2024). Obesity and hypertension in children and adolescents. Clinical Hypertension, 30(1), 23.

Wühl, E. (2019). Hypertension in childhood obesity. Acta Paediatrica, 108(1), 37–43.

Tran, A. H., Walsh, A., & Urbina, E. M. (2025). Hypertension, obesity, and target organ injury in children. Current Hypertension Reports, 27(1), 12.

Chung, J., Robinson, C. H., Yu, A., Bamhraz, A. A., Ewusie, J. E., Sanger, S., et al. (2023). Risk of target organ damage in children with primary ambulatory hypertension: A systematic review and meta-analysis. Hypertension, 80(6), 1183–1196.

Litwin, M., Niemirska, A., Sladowska, J., Antoniewicz, J., Daszkowska, J., Wierzbicka, A., et al. (2010). Regression of target organ damage in children and adolescents with essential hypertension. Pediatric Nephrology, 25(12), 2489–2499.

Lande, M. B., & Kupferman, J. C. (2018). Treatment of hypertension-induced target organ damage in children and adolescents. Current Pharmaceutical Design, 24(37), 4378–4384.

Urbina, E. M. (2018). Cardiac and vascular target organ damage in pediatric hypertension. Frontiers in Pediatrics, 6, 148.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLOS Medicine, 18(3), e1003583.

Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2019). Cochrane handbook for systematic reviews of interventions (2nd ed.). Wiley.

Tiplady, A., Mynard, J. P., et al. (2022). Lifestyle interventions for elevated blood pressure in childhood: Approaches and outcomes. Current Hypertension Reports, 24(11), 589–598.

Zhou, J., et al. (2025). Effects of exercise interventions on blood pressure in children and adolescents with overweight or obesity: A systematic review and meta-analysis of randomized controlled trials. Journal of Adolescent Health, 76(3), 361–369.

Huerta-Uribe, N., et al. (2023). Physical activity interventions for cardiopulmonary fitness in obese children and adolescents: A systematic review and meta-analysis. BMC Pediatrics, 23(1), 558.

Dionne, J. M., Harris, K. C., Benoit, G., Feber, J., Poirier, L., Padwal, R. S., et al. (2018). Pharmacological treatment of arterial hypertension in children and adolescents: A network meta-analysis. Hypertension, 72(2), 306–313.

Becton, L. J., Shatat, I. F., & Flynn, J. T. (2014). Anti-hypertensive drugs in children and adolescents. World Journal of Cardiology, 6(5), 234–244.

Blowey, D. L. (2012). Update on the pharmacologic treatment of hypertension in pediatrics. The Journal of Clinical Hypertension, 14(6), 383–387.

Falkner, B. (2010). Obesity and the role of lifestyle and dietary intervention in the management of pediatric hypertension. Journal Médical Libanais, 58(3), 171–174.

Ho, M., Garnett, S. P., Baur, L. A., Burrows, T., Stewart, L., Neve, M., & Collins, C. (2012). Effectiveness of lifestyle interventions in child obesity: Systematic review with meta-analysis. Pediatrics, 130(6), e1647–e1671.

Seo, Y. G., Lim, H., Kim, Y., Ju, Y. S., Lee, H. J., Jang, H. B., Park, S. I., & Park, K. H. (2024). Efficacy of lifestyle interventions to treat pediatric obesity: A systematic review and multivariate meta-analysis of randomized controlled trials. Obesity Reviews, 25(11), e13817.

Sim, L. A., Lebow, J., Wang, Z., Koball, A., Murad, M. H., & Prasad, C. (2016). Brief primary care obesity interventions: A meta-analysis. Pediatrics, 138(4), e20160149.

Smith, J. D., et al. (2024). High blood pressure in children aged 3 to 12 years old with overweight or obesity. Childhood Obesity, 20(8), 581–589.

Falkner, B., DeLoach, S., Keith, S. W., & Gidding, S. S. (2013). High risk blood pressure and obesity increase the risk for left ventricular hypertrophy in African-American adolescents. The Journal of Pediatrics, 162(1), 94–100.

Kelly, A. S., Barlow, S. E., Rao, G., Inge, T. H., Hayman, L. L., Steinberger, J., et al. (2013). Severe obesity in children and adolescents: Identification, associated health risks, and treatment approaches: A scientific statement from the American Heart Association. Circulation, 128(15), 1689–1712.

Brady, T. M., & Feld, L. G. (2021). Obesity-related hypertension in pediatrics, the impact of American Academy of Pediatrics guidelines. Nutrients, 13(8), 2586.

Bell, C. S., Samuel, J. P., & Samuels, J. A. (2019). Prevalence of hypertension in children: Applying the new American Academy of Pediatrics clinical practice guideline. Hypertension, 73(1), 148–152.

Brady, T. M., Redwine, K. M., & Flynn, J. T. (2025). Pediatric hypertension: A toolkit for optimizing lifestyle and medication adherence. Exploration of Medicine.

Lo, J. C., et al. (2021). Impact of pediatric obesity on diurnal blood pressure assessment and cardiovascular risk markers in youth. Frontiers in Pediatrics, 9, 596142.

Hussain, A., Ahmed, S. B., et al. (2025). Healthcare resource utilisation and costs associated with hypertension in children and adolescents: A population-based cohort study. The Lancet Regional Health—Americas, 48, 101157.

Patel, N., et al. (2025). Behavior-change lifestyle interventions for the treatment of overweight and obesity in children and adolescents: A scoping review. Annals of the New York Academy of Sciences, 1543(1), 31–41.

Gimpel, C., & Wühl, E. (2007). Hypertension and target organ damage in children and adolescents. Journal of Hypertension, 25(10), 1998–2000.