High Blood Pressure in School Children: Prevalence and Risk Factors

Ximena Urrutia-Rojas; Christie U. Egbuchunam; Sejong Bae; John Menchaca; Manuel Bayona; Patrick A. Rivers; Karan P. Singh

Disclosures

BMC Pediatr 

In This Article

Abstract and Background

Background: The purpose of this study was to determine the prevalence of high blood pressure (HBP) and associated risk factors in school children 8 to 13 years of age.
Methods: Elementary school children (n = 1,066) were examined. Associations between HBP, body mass index (BMI), gender, ethnicity, and acanthosis nigricans (AN) were investigated using a school based cross-sectional study. Blood pressure was measured and the 95th percentile was used to determine HBP. Comparisons between children with and without HBP were utilized. The crude and multiple logistic regression adjusted odds ratios were used as measures of association.
Results: Females, Hispanics, overweight children, and children with AN had an increased likelihood of HBP. Overweight children (BMI ≥ 85th percentile) and those with AN were at least twice as likely to present with HBP after controlling for confounding factors.
Conclusion: Twenty one percent of school children had HBP, especially the prevalence was higher among the overweight and Hispanic group. The association identified here can be used as independent markers for increased likelihood of HBP in children.

In 2002, the National Center for Health Statistics revealed that the prevalence of hypertension was 28.7% among Americans 20-74 years of age; and that 84.9% of women and 72.7% of men 75 years of age and older have hypertension.[1] The prevalence of hypertension in African Americans 20 years of age and older, was 40.9% and 37.8% for females and males, respectively. In Caucasians of the same age group, the prevalence was 24.5% for females and 28.8% for males. In Hispanics of this same age group, the prevalence of hypertension was 25% for females and 30.6% for males.[1] Over the past two decades, studies have shown that "essential" hypertension (i.e., hypertension of unknown etiology), can be found among children and adolescents. These particular blood pressure (BP) patterns show a strong correlation to adulthood hypertension.[2,3,4,5] According to the recommendations of the 1996 task force report on BP in children and adolescents, BP measurements should be incorporated into the routine pediatric examination of children three years of age and older.[2] Although the prevalence of hypertension during childhood is lower than that seen in adulthood, this condition is not rare in children, thus stressing the importance of evaluating BP.[6] The prevalence of hypertension among children reported by various studies ranges from 5.4% to 19.4%.[11]

Factors known to affect BP among children include age, sex, body size, race/ethnicity, obesity, and socioeconomic status.[2,7,11,12] Several studies have demonstrated a rise in the mean systolic blood pressure (SBP) accompanying age increases in children.[2,5,13,14,15] One study reported that children with a SBP > 90th percentile have a tendency to remain in the same percentile over time.[16] Gender differences in BP exist irrespective of age, race or other relevant factors.[13,17,18] Rosner et al. showed that the mean levels of SBP was higher in boys 12-14 years of age.[19] Other studies report higher BP levels in African American and Hispanic school-age children, when compared to Caucasian children.[19,20,21,22,23,24,25] Yet, other studies have reported no correlation between BP and ethnicity, particularly after adjusting for height, age and gender.[15,18,26,27,28,29]

Obesity is a main effector of BP in children.[14,15,25,30,31,32,33] Hypertension, as well as dyslipidemia, type 2 diabetes, orthopedic problems, sleep apnea, and gall bladder disease, is one of many complications associated with obesity in children.[34] The percentage of obese children and adolescents has more than doubled since the early 1970s.[35] Obesity is also associated with development of acanthosis nigricans (AN), a skin lesion characterized by hyperpigmentation and a velvety thickening that occurs on the skin folds usually around the neckline. AN, as well as hypertension, are associated with hyperinsulinemia.[36,37] The increasing prevalence of obesity in children, the fact that BP in adulthood can be predicted by childhood and adolescent BP patterns, and that hypertension is one of the most important risk factors for cardiovascular disease; emphasizes the importance of assessing BP as a risk factor for hypertension and its complications as early as possible. The present study examined HBP in school-aged children and as well as the potential associations between demographic and physical factors.

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