Prevalence of High Blood Pressure Is on the Rise in Youth

Prevalence of High Blood Pressure Is on the Rise in Youth

After many years in decline, prevalences of high blood pressure and pre–high blood pressure are on the rise in children and adolescents.

Investigators analyzed data from three nationally representative health surveys (1963– 2002) to examine trends in age-adjusted blood pressure (BP) in children aged 8 to 17 years and to explore the effect of increasing childhood obesity on BP trends.

General and abdominal obesity increased over time in all racial and ethnic groups studied (non-Hispanic blacks, non-Hispanic whites, and Mexican Americans). By 2002, the prevalence of BMI at or above the 95th percentile had increased from 5% (in 1963–1970) to 22% in blacks, from 6% to 14% in whites, and from 11% (in 1982–1984) to 24% in Mexican Americans. Rates of high BP (HBP; systolic or diastolic BP $≥$ 95th percentile) declined between 1963 and 1988 and increased thereafter. Between 1988 and 2002, prevalences of pre-HBP (systolic or diastolic BP $≥$ 90th and <95th percentile) and HBP increased 2.3% and 1.0%, respectively, overall. The increase in pre-HBP was significant among blacks and Mexican Americans, and the increase in HBP was significant among Mexican American males and white females. The mean increase in diastolic BP was greater than that of systolic BP. Males tended to have a slightly greater prevalence of HBP than females. The upward trend in BP began 10 years after the increase in obesity. Abdominal obesity correlated better than BMI with both HBP and pre-HBP in all ethnic groups. The rise in obesity had the greatest effect on HBP in blacks and Mexican Americans and on pre-HBP in Mexican Americans only.

Comment: These data reinforce concerns that obesity leads to early-onset HBP and that racial and ethnic disparities exist for both conditions. Waist circumference should be monitored along with BMI, and abdominal obesity should raise a red flag for HBP risk. Therefore, we must look for HBP and pre-HBP in the pediatric population and view obesity management as an antihypertensive treatment.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine October 10, 2007