Prof. Dr. Csaba Bereczki, Head of Department at the Pediatric Clinic and Center for Pediatric Health within the SZTE Albert Szent-Györgyi Clinical Center, along with his research partners, Dr. Erzsébet Valéria Hidvégi and Dr. Andrea Emese Jakab, have developed a software application designed primarily to support family pediatricians in the more effective diagnosis of high blood pressure in children. The project received Proof of Concept (PoC) funding in 2025 at the 13th Innovation Day of the University of Szeged. We spoke with Prof. Dr. Csaba Bereczki about the innovation.
High blood pressure is becoming increasingly common among children and adolescents. Current estimates indicate that between 20 and 25 percent of children are overweight, depending on age, with some figures approaching 30 percent. This alone is alarming – yet even more concerning is that roughly one quarter of overweight or obese children already have elevated blood pressure. This growing burden has led Prof. Dr. Csaba Bereczki and his colleague, Dr. Andrea Jakab, to devote decades to researching pediatric hypertension.
High blood pressure traced back to childhood
Prof. Dr. Csaba Bereczki recalled that a related study was conducted several years ago at the Institute of Forensic Medicine at SZTE’s Albert Szent-Györgyi Clinical Center. As part of the research, autopsy records spanning the past century were analyzed to assess vascular condition and overall health status in individuals who had died from non-disease-related causes. The findings revealed clear differences between the sexes: elevated blood pressure tends to emerge earlier in men, while in women, estrogen provides significant vascular protection until menopause.
“The roots of adult high blood pressure can often be traced back to childhood – not only to adolescence, but in some cases even to the preschool years. The study mentioned earlier also showed that arterial plaques may already appear in obese children by the ages of 16 to 18, indicating that early vascular aging can begin at a very young age. It is therefore essential, even among healthcare professionals, to adhere to correct blood pressure measurement protocols. This is particularly important in overweight children, where the use of an incorrectly sized cuff can result in falsely high or low readings,” the professor explained.
Prof. Dr. Csaba Bereczki. Photo by Karina Bartha
Supporting primary care physicians
High blood pressure in children is defined using percentile charts that account for age, sex, and height. Based on these reference values, a child is considered hypertensive if the measured value exceeds the 95th percentile. In practical terms, this means that 95 out of 100 children with the same age, sex, and height have lower values, while only 5 have higher ones. The highest-risk group includes those with readings above the 99th percentile, indicating that only 1 percent of children have values at or above this level.
Professor Bereczki emphasized that diagnosing high blood pressure requires different approaches in overweight and normal-weight children. In children with excess weight, there is generally greater clinical tolerance, and initial management typically focuses on weight reduction. By contrast, in normal-weight children, elevated blood pressure is usually linked to a specific underlying cause, such as familial predisposition, cardiovascular or renal disease, or a hormonal disorder. “Our goal is to integrate this knowledge into a practical, easy-to-use system and make it accessible mainly to primary care physicians. A significant proportion of children – particularly in rural areas – are treated in mixed primary care practices, where the same physician cares for both adults and children. In these settings, pediatric expertise may be more limited,” the professor said.
Improving diagnostic accuracy
The application under development is designed to provide practical support for primary care physicians in clinical decision-making. It guides users through the correct procedure for measuring blood pressure and then performs a risk assessment. Based on this, it helps determine whether lifestyle changes are sufficient or whether referral for specialist evaluation or pharmacological treatment is warranted. “The application is based on the first Hungarian database compiled exclusively from normal-weight children. It is important to emphasize that medication should always be preceded by institutional evaluation. In pediatric cases, secondary causes of hypertension – such as cardiac, renal, or endocrine conditions – must be ruled out, as elevated blood pressure may not be attributable to excess weight alone,” Professor Bereczki said.
As the professor explained, the application analyzes the data entered by the physician. It begins by guiding users through the correct procedure for measuring blood pressure, after which systolic (upper) and diastolic (lower) values are entered, along with the child’s age, sex, weight, and additional parameters such as hip circumference, which help assess the degree of overweight or obesity. Based on these inputs, the system automatically performs a risk assessment, indicating whether the measured values are abnormal and estimating the likelihood of hypertension. It also stores patient data, enabling graphical display of changes over time during follow-up visits and allowing blood pressure trends to be monitored accurately.The role of physical activity and proper nutrition
Professor Bereczki emphasized that prevention remains a key challenge in primary care settings, where it does not always receive sufficient attention. “Prevention is the best medicine,” he noted. A key factor in this regard is excess weight, one of the strongest risk factors for childhood hypertension, which is why interventions often focus primarily on dietary changes. However, this alone is insufficient. Sustainable improvement requires regular physical activity alongside proper nutrition, particularly in light of children’s increasing screen time and low levels of physical activity.
Current evidence suggests that dietary changes alone are insufficient. For example, consuming whole-grain products does not lead to meaningful improvement unless it is part of a broader lifestyle shift. “Ideally, children should engage in at least 150 minutes of aerobic activity per week – that is, moderate-intensity exercise performed in sessions of 20 to 60 minutes, averaging at least 30 minutes of physical activity per day,” the professor said. He also emphasized that lasting change requires genuine commitment and internal motivation. Early intervention, however, significantly increases the likelihood of reducing the number of adults who go on to develop cardiovascular disease.
What lies in our genes
Professor Bereczki explained that ongoing research has examined the extent to which childhood hypertension persists into adulthood. Some findings suggest that familial factors extending across generations – including the health status of grandparents – may also influence a child’s risk profile. At the same time, certain biological factors remain beyond our control. “A well-known example is the historical case of enslaved populations transported from Africa to the United States. These groups had adapted to diets relatively low in salt and calories. In a markedly different nutritional environment, characterized by higher calorie and salt intake, rates of obesity, hypertension, and kidney disease increased significantly in later generations of the African American population. The underlying reason is that their genetic constitution has not adapted to the new environment quickly enough,” he explained.
The professor also noted that during periods of restricted calorie and salt intake – such as wartime – autopsy records showed a marked decline in severe atherosclerosis and vascular disease. “This demonstrates that while genetic factors cannot be eliminated entirely, environmental influences on disease development can be significantly modified,” he explained. However, in practice, current lifestyle patterns do not reflect this potential: widespread consumption of ultra-processed foods, high caloric intake, and sedentary behavior suggest that cardiovascular problems may become even more severe by the time the next generation reaches middle age. Type 2 diabetes must also be considered in this context, given its close association with both lifestyle factors and genetic predisposition.
Prof. Dr. Csaba Bereczki. Photo by Karina Bartha
The importance of early education
“According to a German study, overweight children can be successfully helped to lose weight up to the age of five, with lasting effects into adulthood. This highlights the critical role of the preschool years, when healthy eating habits should already be established and regular physical activity should become part of the child’s daily routine. This early period represents a key turning point: once it is missed, managing weight gain becomes significantly more difficult and requires considerably greater effort. Without the early establishment of healthy habits, children are far more likely to struggle with excess weight in adulthood and face the associated health risks,” said Professor Bereczki.
The professor also noted that it is uncommon for two normal-weight parents to have an overweight child, underscoring the importance of educating parents alongside children. “In essence, this is a form of family-level intervention. It is unlikely to be effective if, for example, a parent consumes large portions, prefers high-fat foods, and is physically inactive, as children tend to adopt the patterns they observe at home. Without the involvement of the entire family, lasting results are rarely achieved,” he explained.
The professor also emphasized that several countries – including Australia, and increasingly European nations – are taking steps to limit young people’s use of social media in order to protect their mental health. Australia has already introduced concrete measures: in December 2025, it became the first country to legally restrict access to social media platforms (such as TikTok, Facebook, Instagram, YouTube, and Snapchat) for those under the age of 16.
The measures taken in Australia reflect a broader concern: adolescents are spending increasing amounts of time consuming online content while engaging less in physical activity. The psychological impact is also significant. Constant pressure to conform, exposure to idealized body images, and the expectation of a ‘model-like’ physique place a considerable burden on young people, as these standards are unattainable for many. This can lead not only to low self-esteem but also to serious mental health issues. Social media use has also been associated with an increased risk of suicidal ideation among adolescents. For this reason, it is essential to promote a more realistic and healthy body image, support the maintenance of a normal weight, and encourage an active lifestyle.
Launch planned for May
The application’s further development and commercialization are coordinated by the university’s technology transfer company, SZTE TTC Zrt. The team has already secured grant funding to support the project. Beta testing of the system is set to begin in March, involving five family physicians from primary care districts in and around Szeged. If the pilot phase proves successful, the system is expected to be officially presented in May at the Kávészünet (‘Coffee Break’) conference – one of the most significant annual professional events of the National Association of Primary Care Pediatricians.
“Our goal is for the application to become an integral part of comprehensive cardiovascular prevention in childhood and adolescence. Over the long term – within a five- to ten-year timeframe – we expect its use to lead to measurable improvements in the number of adults affected by cardiovascular disease,” Prof. Dr. Csaba Bereczki concluded.
Original Hungarian article by Tímea Fülöp
In the feature photo: Prof. Dr. Csaba Bereczki. Photo by Karina Bartha
