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High Blood Pressure in Children Aged 3 to 12 Years Old With Overweight or Obesity
James T Nugent1, Kaitlin R Maciejewski2, Emily B Finn1
1Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
Insights
High blood pressure (BP) is common in children aged 3-12 with overweight or obesity. Increased obesity severity correlates with higher BP, and Stage 2 BP accurately predicts sustained hypertension.
Area of Science:
- Pediatric Cardiology
- Obesity Medicine
- Public Health
Background:
- Childhood obesity is a growing public health concern.
- Overweight and obesity in children are associated with increased risk of cardiovascular complications, including hypertension.
- Early identification and management of hypertension in pediatric populations are crucial.
Purpose of the Study:
- To determine the prevalence of high blood pressure (BP) in young children (3-12 years) with overweight/obesity.
- To examine the association between Body Mass Index (BMI) classification and the prevalence of high BP.
- To assess the diagnostic accuracy of a single high BP reading for identifying sustained hypertension over multiple visits.
Main Methods:
- Utilized pre-intervention data from the iPOP-UP trial, including 76,214 children aged 3-12 with BMI in the 85th percentile or higher.
- BP percentiles were calculated from the first recorded visit, with hypertensive BP defined by the 2017 American Academy of Pediatrics guideline.
- Multivariable logistic regression analyzed the association between BMI severity and hypertensive BP, and specificity of Stage 2 BP for sustained hypertension was evaluated.
Main Results:
- The prevalence of elevated or hypertensive BP was 31% among children with overweight/obesity.
- Prevalence increased with obesity severity: 27% (overweight), 33% (Class I), 39% (Class II), and 49% (Class III).
- Stage 2 hypertensive BP at initial visit demonstrated high specificity (99.1%) for sustained hypertension over three visits.
Conclusions:
- High BP is prevalent in children aged 3-12 with overweight/obesity, with a clear association between higher obesity severity and increased hypertension risk.
- Children with overweight/obesity presenting with Stage 2 BP are highly likely to have sustained hypertension and warrant prompt evaluation.
- These findings underscore the importance of BP screening in pediatric obesity management.
Abstract:
Objective: (1) To describe the prevalence of high blood pressure (BP) and the association with BMI in young children with overweight/obesity; (2) to evaluate the accuracy of a single high BP to diagnose sustained hypertension over three visits. Methods: We used pre-intervention data from the Improving Pediatric Obesity Practice Using Prompts (iPOP-UP) trial. We included children aged 3-12 years with BMI ≥85th percentile at well-visits in 2019-2021 at 84 primary care practices in 3 US health systems in the Northeast, Midwest, and South. BP percentiles were calculated from the first visit with BP recorded during the study period. Hypertensive-range BP was defined by the 2017 American Academy of Pediatrics guideline. We tested the association between BMI classification and hypertensive BP using multivariable logistic regression. Results: Of 78,280 children with BMI ≥85th percentile, 76,214 (97%) had BP recorded during the study period (mean 7.4 years, 48% female, 53% with overweight, and 13% with severe obesity). The prevalence of elevated or hypertensive BP was 31%, including 27% in children with overweight and 33%, 39%, and 49% with class I, II, and III obesity, respectively. Higher obesity severity was associated with higher odds of hypertensive BP in the multivariable model. Stage 2 hypertensive BP at the initial visit had specificity of 99.1% (95% confidence interval 98.9-99.3) for detecting sustained hypertension over ≥3 visits. Conclusions: High BP is common in 3- to 12-year-olds with overweight/obesity, with higher obesity severity associated with greater hypertension. Children with overweight/obesity and stage 2 BP are likely to have sustained hypertension and should be prioritized for evaluation. Trial Registration: ClinicalTrials.gov Identifier: NCT05627011.
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