Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Prevalence of hypertension and prehypertension and its association with anthropometrics among children: a cross-sectional survey in Tianjin, China

Journal of Human Hypertension volume 32, pages 789–798 (2018)Cite this article

Subjects

Abstract

To characterize the prevalence of hypertension and prehypertension and its association with four anthropometrics among children aged 7–15 years in Tianjin, China, a school-based cross-sectional survey was conducted from May to August 2010. Multistage random cluster sampling was used to select the participants. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) were measured. Hypertension and prehypertension were identified according to the definition of United State Fourth Report. Logistic regression, linear regression and the area under receiver operating curves (AUC) was used for assessing the association. Among 1898 eligible children, the prevalence of hypertension and prehypertension was 6% and 6.6%, respectively. No statistically significant differences were found between boys and girls. Both linear and logistic regression showed that the four anthropometrics were all positively related to blood pressure value or the risk of prehypertension and hypertension. Of the four anthropometrics, BMI might be the most sensitive indicator for predicting elevated blood pressure, followed by WC and WHtR, whereas WHR had the lowest predicting capacity, with the AUCs being 0.72 (0.68,0.75), 0.69 (0.65,0.73), 0.67 (0.63,0.71), and 0.61 (0.57,0.65), respectively. A significantly increased prevalence of hypertension was observed when BMI > P90 percentiles, but for prehypertension, the risk of prehypertension began to increase when BMI was still at a median level. In conclusion, four anthropometrics all had positive relationship with elevated blood pressure. BMI and WC were superior to WHtR and WHR in predicting elevated blood pressure among children and adolescents.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Whitworth JA. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983–92.

    Article  Google Scholar 

  2. Chen L, Simonsen N, Liu L. Racial differences of pediatric hypertension in relation to birth weight and body size in the United States. PLoS One. 2015;10:e0132606.

    Article  Google Scholar 

  3. Kelly RK, Thomson R, Smith KJ, Dwyer T, Venn A, Magnussen CG. Factors affecting tracking of blood pressure from childhood to adulthood: The Childhood Determinants of Adult Health Study. J Pediatr. 2015;167:1422–8.e2.

    Article  Google Scholar 

  4. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.

    Article  Google Scholar 

  5. Xi B, Liang Y, Reilly KH, Wang Q, Hu Y, Tang W. Trends in prevalence, awareness, treatment, and control of hypertension among Chinese adults 1991-2009. Int J Cardiol. 2012;158:326–9.

    Article  Google Scholar 

  6. Wang J, Zhang L, Wang F, Liu L, Wang H. Prevalence, awareness, treatment, and control of hypertension in China: results from a national survey. Am J Hypertens. 2014;27:1355–61.

    Article  CAS  Google Scholar 

  7. Liang YJ, Xi B, Hu YH, Wang C, Liu JT, Yan YK, et al. Trends in blood pressure and hypertension among Chinese children and adolescents: China Health and Nutrition Surveys 1991-2004. Blood Press. 2011;20:45–53.

    Article  Google Scholar 

  8. Xi B, Liang Y, Mi J. Hypertension trends in Chinese children in the national surveys, 1993 to 2009. Int J Cardiol. 2013;165:577–9.

    Article  Google Scholar 

  9. Xi B, Li H, Li S, Mi J. Recent prevalence of hypertension among Chinese children and adolescents based on 2010 China national blood pressure references. Int J Cardiol. 2014;174:870–1.

    Article  Google Scholar 

  10. Dong B, Wang Z, Ma J. Urban-rural disparity in blood pressure among Chinese children: 1985-2010. Eur J Public Health. 2016;26:569–75.

    Article  Google Scholar 

  11. Friedman GD, Selby JV, Quesenberry CP Jr, Armstrong MA, Klatsky AL. Precursors of essential hypertension: body weight, alcohol and salt use, and parental history of hypertension. Prev Med. 1988;17:387–402.

    Article  CAS  Google Scholar 

  12. Juhola J, Oikonen M, Magnussen CG, Mikkila V, Siitonen N, Jokinen E, et al. Childhood physical, environmental, and genetic predictors of adult hypertension: the cardiovascular risk in young Finns study. Circulation. 2012;126:402–9.

    Article  Google Scholar 

  13. Group SR, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16.

    Article  Google Scholar 

  14. Hu J, Chu GP, Huang FF, Zhou YK, Teng CG, Yang HB, et al. Relation of body mass index (BMI) to the prevalence of hypertension in children: a 3years’ school-based prospective study in Suzhou, China. Int J Cardiol. 2016;222:270–4.

    Article  Google Scholar 

  15. Zhu H, Zhang X, Li MZ, Xie J, Yang XL. Prevalence of type 2 diabetes and pre-diabetes among overweight or obese children in Tianjin, China. Diabet Med. 2013;30:1457–65.

    Article  CAS  Google Scholar 

  16. Liu Y, Kuang MH, Liu Y, Yang Q-T, Xie X-X, Rang W-Q. Prevalence of hypertension among children and adolescents in china: a meta-analysis. Chinese J Child Health Care. 2017;25:59-62.

  17. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555–76.

  18. Group of China Obesity Task Force. Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Zhonghua Liu Xing Bing Xue Za Zhi. 2004;25:97–102.

  19. Wang Y, Mi J, Shan XY, Wang QJ, Ge KY. Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. Int J Obes. 2007;31:177–88.

    Article  CAS  Google Scholar 

  20. Ruo ran LV, Zheng X, Ying S, Li xin T, Wei G. Study on normal waist-to-hip ratio of children and adolescents in Beijing. Chin. J Sch Health. 2012;06:750–1.

    Google Scholar 

  21. Ma GS, Ji CY, Ma J, Mi J, Sung R, Xiong F, et al. Waist circumference reference values for screening cardiovascular risk factors in Chinese children and adolescents aged 7-18 years. Zhonghua Liu Xing Bing Xue Za Zhi . 2010;31:609–15.

    CAS  PubMed  Google Scholar 

  22. Schwandt P. Defining central adiposity in terms of clinical practice in children and adolescents. Int J Prev Med. 2011;2:1–2.

    PubMed  PubMed Central  Google Scholar 

  23. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.

    Article  CAS  Google Scholar 

  24. Zhai Y, Li WR, Shen C, Qian F, Shi XM. Prevalence and correlates of elevated blood pressure in chinese children aged 6-13 years: a Nationwide School-Based Survey. Biomed Environ Sci. 2015;28:401–9.

    PubMed  Google Scholar 

  25. Larkins N, Teixeira-Pinto A, Banks E, Gunasekera H, Cass A, Kearnes J, et al. Blood pressure among Australian Aboriginal children. J Hypertens. 2017;35:1801–7.

    Article  CAS  Google Scholar 

  26. Rosner B, Cook NR, Daniels S, Falkner B. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988-2008. Hypertension. 2013;62:247–54.

    Article  CAS  Google Scholar 

  27. Martinovic M, Belojevic G, Evans GW, Kavaric N, Asanin B, Pantovic S, et al. Hypertension and correlates among Montenegrin school children-a cross-sectional study. Public Health. 2017;147:15–19.

    Article  CAS  Google Scholar 

  28. Zhao Y, Wang L, Xue B, Wang Y. Associations between general and central obesity and hypertension among children: The Childhood Obesity Study in China Mega-Cities. Sci Rep. 2017;7:16895.

    Article  Google Scholar 

  29. Dasgupta K, O’Loughlin J, Chen S, Karp I, Paradis G, Tremblay J, et al. Emergence of sex differences in prevalence of high systolic blood pressure: analysis of a longitudinal adolescent cohort. Circulation. 2006;114:2663–70.

    Article  Google Scholar 

  30. Yang Y, Dong B, Wang S, Dong Y, Zou Z, Fu L, et al. Prevalence of high blood pressure subtypes and its associations with BMI in Chinese children: a national cross-sectional survey. BMC Public Health. 2017;17:598.

    Article  Google Scholar 

  31. Ebrahimi H, Emamian MH, Hashemi H, Fotouhi A. Prevalence of prehypertension and hypertension and its risk factors in Iranian school children: a population-based study. J Hypertens. 2018. https://doi.org/10.1097/HJH.0000000000001789.

    Article  CAS  Google Scholar 

  32. Okpokowuruk FS, Akpan MU, Ikpeme EE. Prevalence of hypertension and prehypertension among children and adolescents in a semi-urban area of Uyo Metropolis, Nigeria. Pan Afr Med J. 2017;28:303.

    Article  Google Scholar 

  33. Wang J, Zhu Y, Jing J, Chen Y, Mai J, Wong SH, et al. Relationship of BMI to the incidence of hypertension: a 4 years’ cohort study among children in Guangzhou, 2007–11. BMC Public Health. 2015;15:782.

    Article  Google Scholar 

  34. Pazin DC, Rosaneli CF, Olandoski M, Oliveira ERN, Baena CP, Figueredo AS, et al. Waist circumference is associated with blood pressure in children with normal body mass index: a cross-sectional analysis of 3,417 school children. Arq Bras Cardiol. 2017;109:509–15.

  35. Dong B, Wang Z, Song Y, Wang HJ, Ma J. Understanding trends in blood pressure and their associations with body mass index in Chinese children, from 1985 to 2010: a cross-sectional observational study. BMJ Open. 2015;5:e009050.

    Article  Google Scholar 

  36. Ma C, Wang R, Liu Y, Lu Q, Lu N, Tian Y, et al. Performance of obesity indices for screening elevated blood pressure in pediatric population: Systematic review and meta-analysis. Medicine. 2016;95:e4811.

    Article  Google Scholar 

  37. Dong B, Wang Z, Wang HJ, Ma J. Associations between adiposity indicators and elevated blood pressure among Chinese children and adolescents. J Hum Hypertens. 2015;29:236–40.

    Article  CAS  Google Scholar 

  38. Kryst L, Woronkowicz A, Kowal M, Pilecki MW, Sobiecki J. Abdominal obesity screening tools in the aspects of secular trend. Anthropol Anz. 2016;73:295–312.

    Article  Google Scholar 

  39. Lu X, Shi P, Luo CY, Zhou YF, Yu HT, Guo CY, et al. Prevalence of hypertension in overweight and obese children from a large school-based population in Shanghai, China. BMC Public Health. 2013;13:24.

    Article  Google Scholar 

  40. Liang Jj, Chen Yj, Jin Y, Yang Wh, Mai Jc, Ma J, et al. Comparison of adiposity measures in the identification of children with elevated blood pressure in Guangzhou, China. J Hum Hypertens. 2015;29:732.

    Article  Google Scholar 

  41. Koren D, Marcus CL, Kim C, Gallagher PR, Schwab R, Bradford RM, et al. Anthropometric predictors of visceral adiposity in normal-weight and obese adolescents. Pediatr Diabetes. 2013;14:575–84.

    Article  Google Scholar 

  42. Tu W, Eckert GJ, DiMeglio LA, Yu Z, Jung J, Pratt JH. Intensified effect of adiposity on blood pressure in overweight and obese children. Hypertension. 2011;58:818–24.

    Article  CAS  Google Scholar 

  43. Meng L, Liang Y, Liu J, Hu Y, Yan Y, Mi J. Prevalence and risk factors of hypertension based on repeated measurements in Chinese children and adolescents. Blood Press. 2013;22:59–64.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by Tianjin Science and Technology Development Fund for Colleges and Universities (No: 20080132), National Natural Science Foundation of China (No: 81602922), and Ministry of Education Humanities and Social Science Fund (No: 13YJCZH281).

Author contributions

HZ conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. XZ designed the sampling method, and coordinated and supervised data collection at schools, and approved the final manuscript as submitted. YL, BL, and JX conducted the data collection, carried out the initial analyses, and approved the final manuscript as submitted. JX gave critical comments on data analysis, revised the earlier version of the manuscript, and approved the final manuscript as submitted.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China

    Yali Lu, Benmai Luo, Juan Xie & Hong Zhu

  2. Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China

    Xin Zhang

Authors
  1. Yali Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benmai Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hong Zhu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lu, Y., Luo, B., Xie, J. et al. Prevalence of hypertension and prehypertension and its association with anthropometrics among children: a cross-sectional survey in Tianjin, China. J Hum Hypertens 32, 789–798 (2018). https://doi.org/10.1038/s41371-018-0088-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-018-0088-4

This article is cited by

Search

Advanced search

Quick links