Hypertension is a silent condition that can cause heart, kidney, and vascular damage before symptoms ever appear; childhood hypertension, or persistently elevated blood pressure, often shows no symptoms, yet can set the stage for serious health issues in adulthood.
Now, a groundbreaking national study is tackling this problem head-on, with the Mandela University team leading the provincial focus and gathering the largest dataset of any participating institution.
This largest South African dataset on children’s blood pressure could transform diagnosis and save lives.
The goal is to develop the country’s first locally developed, evidence-based blood pressure norms for children, replacing international charts that don’t reflect South Africa’s diverse population.
Mandela University’s Department of Human Movement Science Head, Dr Aayesha Kholvadia (right), is leading the Eastern Cape research as part of the national initiative to establish normative blood pressure values for South African children.
“This work is critical for improving early detection, prevention, and long-term management of cardiovascular disease, particularly in under-resourced communities where children are disproportionately affected,” she explains.
Boots on the ground
The Childhood Hypertension Consortium of Africa (CHCA) study began in 2022 and will run until 2027, involving over 22 000 children aged five to under 18 across the country.
Mandela University joined in 2021, leveraging years of community health outreach in public schools and its partnerships with the Department of Education.
As the Eastern Cape lead, Dr Kholvadia oversees a multidisciplinary team that includes postgraduate students, academic staff and trained undergraduate assistants — particularly from HMS and Biokinetics programmes. The national study is led by Prof Ruan Kruger.
“Our work is community-based and positions the university as a leader in child health research in public schools,” says Dr Kholvadia. “We are committed to transforming health outcomes in under-resourced communities.”
The team visits quintile 1 to 5 schools across the Gqeberha region, with parental consent and ethical approval in place. Learners undergo anthropometric and blood pressure screenings using validated devices. Four readings are taken per child, and sophisticated algorithms calculate the average, ensuring accuracy.
SCIENCE MEETS SERVICE: Mandela University students are playing a vital role in the Childhood Hypertension Consortium of Africa (CHCA) study involving 22 000 children aged five to 18 across South Africa.
A life saved
A Grade 6 learner from a local quintile 1 school recorded dangerously high readings during a Nelson Mandela University screening. Referral led to a diagnosis of an underlying kidney condition — a potentially life-saving intervention. “We’ve also had parents thank us for tips that helped them start exercising together at home,” says Dr Kholvadia.
What is childhood hypertension?
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Defined as consistently elevated blood pressure in children under 18.
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Assessed relative to percentiles for age, sex, and height.
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Above the 90th percentile = elevated.
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Above the 95th percentile = hypertension.
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Example: A systolic BP above 120 mmHg in a 10-year-old may be cause for concern, depending on growth parameters.
Why early detection matters
If left unchecked, high blood pressure in children can cause early vascular ageing, heart strain, kidney disease, and increase the likelihood of hypertension in adulthood.
“Early intervention saves lives,” stresses Dr Kholvadia. “Children with undiagnosed hypertension are at greater risk of complications in adolescence and adulthood. Our goal is to shift from reaction to proactive prevention, especially in vulnerable communities.”
Primary hypertension in children is often linked to poor diet, obesity, and physical inactivity, while secondary hypertension can stem from conditions like kidney disease or hormonal disorders. Urban and higher-income schools tend to report higher prevalence — but the Eastern Cape’s rural and peri-urban areas are not immune, especially as lifestyles change.
Science meets service
The study is more than just data collection — it’s active health promotion. Alongside screenings, the Mandela team runs wellness talks, distributes educational materials and demonstrates physical activity routines.
Undergraduate biokinetics students play a key role, leading exercise sessions and engaging with both learners and staff. “By integrating screening into our outreach programmes, we combine teaching, research, and service,” says Dr Kholvadia. “It’s a model that benefits both the community and our students’ learning.”
Crucially, any child with a concerning blood pressure reading receives feedback and referral for follow-up care — ensuring no warning signs are ignored.
Leading the numbers nationally
South Africa currently relies on U.S. and European blood pressure norms for children — a mismatch that can lead to underdiagnosis or misclassification. This project will produce the first African-specific reference charts, adjusted for age, sex, and height.
“Our leadership role showcases an interdisciplinary model of research and health promotion,” says Dr Kholvadia. “By engaging directly with learners, parents, and educators, Nelson Mandela University is not only contributing to science but also shaping policy and practice for a healthier future.”
Looking ahead
The ultimate goal of the study is to develop Africa’s first evidence-based blood pressure guidelines for children, improve early diagnosis, and reduce long-term cardiovascular risks.
Short-term goals include completing data collection in Nelson Mandela Bay and boosting community awareness. Medium-term goals are to publish the normative BP charts and assess interventions’ impact. Long-term goals involve integrating BP screening into the national school health system — even adding it to the Road to Health booklet — and advocating for policy changes mandating routine checks in schools.
For Dr Kholvadia, the message is clear: “Childhood hypertension is silent, deadly, but preventable. With the right tools, policies, and community engagement, we can make sure it never goes unnoticed again.”