Obesity and season as determinants of high blood pressure in a school-based screening study


This school-based screening study assessed the prevalence of high blood pressure (BP) levels according to the European Society of Hypertension (ESH) 2016 guidelines. Moreover, risk factors for BP elevation, and the effect of geographic and seasonal factors on BP screening were investigated. BP and anthropometric measurements were obtained from 2832 children and adolescents, aged 6–18 years, during the period 2013–2016. Three BP measurements were performed using a mercury sphygmomanometer, and the mean of the last two was used for the analysis. Obesity was defined according to the International Obesity Task Force (IOTF) criteria. The prevalence of high–normal BP/hypertension and overweight/obesity was 3.7%/0.9%, and 22.9%/8.5%, respectively. The majority of the participants presenting high BP (≥90th percentile) were overweight or obese. Increased prevalence of high BP was observed during spring (5.5%) and winter (5%) compared with 2.5% in autumn (P<0.05). SBP z scores were higher in males, during spring and summer, and in urban areas. In conclusion, a low rate of high–normal and hypertensive BP levels was found despite the high prevalence of overweight and obesity. Overweight and obesity were associated with higher BP levels, but there was also a seasonal difference in the prevalence of high BP levels.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.


  1. 1.

    Falkner B, Lurbe E, Schaefer F. High blood pressure in children: clinical and health policy implications. J Clin Hypertens. 2010;12:261–76.

    Article  Google Scholar 

  2. 2.

    Stabouli S, Kotsis V, Zakopoulos N. Ambulatory blood pressure monitoring and target organ damage in pediatrics. J Hypertens. 2007;25:1979–86.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation. 2008;117:3171–80.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Chiolero A, Bovet P, Paradis G, Paccaud F. Has blood pressure increased in children in response to the obesity epidemic? Pediatrics. 2007;119:544–53.

    Article  PubMed  Google Scholar 

  6. 6.

    Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475–82.

    Article  PubMed  Google Scholar 

  7. 7.

    Stabouli S, Papakatsika S, Kotsis V. The role of obesity, salt and exercise on blood pressure in children and adolescents. Expert Rev Cardiovasc Ther. 2011;9:753–61.

    Article  PubMed  Google Scholar 

  8. 8.

    Chiolero A, Madeleine G, Gabriel A, Burnier M, Paccaud F, Bovet P. Prevalence of elevated blood pressure and association with overweight in children of a rapidly developing country. J Hum Hypertens. 2007;21:120–7.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society ofHypertension guidelines for themanagement of high blood pressure in children and adolescents. J Hypertens. 2016;34:1887–920 p.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7:284–94.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Talge NM, Mudd LM, Sikorskii A, Basso O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics. 2014;133:844–53.

    Article  PubMed  Google Scholar 

  12. 12.

    Xi B, Zhang T, Zhang M, Liu F, Zong X, Zhao M, et al. Trends in elevated blood pressure among US children and adolescents: 1999-2012. Am J Hypertens. 2016;29:217–25.

    Article  PubMed  Google Scholar 

  13. 13.

    Musil V, Majer M, Juresa V. Elevated blood pressure in school children and adolescents--prevalence and associated risk factors. Coll Antropol. 2012;36(Suppl 1):147–55.

    Article  PubMed  Google Scholar 

  14. 14.

    Chiolero A, Cachat F, Burnier M, Paccaud F, Bovet P. Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight. J Hypertens. 2007;25:2209–17.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Farajian P, Panagiotakos DB, Risvas G, Micha R, Tsioufis C, Zampelas A. Dietary and lifestyle patterns in relation to high blood pressure in children: the GRECO study. J Hypertens. 2015;33:1174–81.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Manios Y, Karatzi K, Protogerou AD, Moschonis G, Tsirimiagou C, Androutsos O, et al. Prevalence of childhood hypertension and hypertension phenotypes by weight status and waist circumference: the healthy growth study. Eur J Nutr. 2018;57:1147–55.

    Article  PubMed  Google Scholar 

  17. 17.

    Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.

    Article  Google Scholar 

  18. 18.

    Genovesi S, Giussani M, Pieruzzi F, Vigorita F, Arcovio C, Cavuto S, et al. Results of blood pressure screening in a population of school-aged children in the province of Milan: role of overweight. J Hypertens. 2005;23:493–7.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Chorin E, Hassidim A, Hartal M, Havakuk O, Flint N, Ziv-Baran T, et al. Trends in adolescents obesity and the association between BMI and blood pressure: a cross-sectional study in 714,922 healthy teenagers. Am J Hypertens. 2015;28:1157–63.

    Article  PubMed  Google Scholar 

  20. 20.

    Yang Q, Zhong Y, Merritt R, Cogswell ME. Trends in high blood pressure among United States adolescents across body weight category between 1988 and 2012. J Pediatr. 2016;169:166–173e3.

    Article  PubMed  Google Scholar 

  21. 21.

    Lurbe E, Torro MI, Alvarez-Pitti J, Redon P, Redon J. Central blood pressure and pulse wave amplification across the spectrum of peripheral blood pressure in overweight and obese youth. J Hypertens. 2016;34:1389–95.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Sorof JM. Systolic hypertension in children: benign or beware? Pediatr Nephrol. 2001;16:517–25.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Ma C, Zhang T, Xi B. Prevalence of elevated blood pressure among US children, 2013–4. J Clin Hypertens. 2016;18:1071–2.

    Article  Google Scholar 

  24. 24.

    McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr. 2007;150:640–4e1.

    Article  Google Scholar 

  25. 25.

    Gamborg M, Byberg L, Rasmussen F, Andersen PK, Baker JL, Bengtsson C, et al. Birth weight and systolic blood pressure in adolescence and adulthood: meta-regression analysis of sex- and age-specific results from 20 nordic studies. Am J Epidemiol. 2007;166:634–45.

    Article  PubMed  Google Scholar 

  26. 26.

    Tan M, Cai L, Ma J, Jing J, Ma Y, Chen Y. The association of gestational age and birth weight with blood pressure among children: a Chinese national study. J Hum Hypertens. 2018;32:651–9.

    Article  PubMed  Google Scholar 

  27. 27.

    Perng W, Rifas-Shiman SL, Kramer MS, Haugaard LK, Oken E, Gillman MW, et al. Early weight gain, linear growth, and mid-childhood blood pressure: a prospective study in project viva. Hypertension. 2016;67:301–8.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Falkner B, Hulman S, Kushner H. Effect of birth weight on blood pressure and body size in early adolescence. Hypertension. 2004;43:203–7.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Lule SA, Elliott AM, Smeeth L, Webb EL. Is birth weight associated with blood pressure among African children and adolescents? A systematic review. J Dev Orig Health Dis. 2018;9:1–11.

    Article  Google Scholar 

  30. 30.

    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  PubMed  Google Scholar 

  31. 31.

    Brook RD, Weder AB, Rajagopalan S. “Environmental Hypertensionology” the effects of environmental factors on blood pressure in clinical practice and research. J Clin Hypertens. 2011;13:836–42.

    Article  Google Scholar 

  32. 32.

    Miersch A, Vogel M, Gausche R, Siekmeyer W, Pfäffle R, Dittrich K, et al. Influence of seasonal variation on blood pressure measurements in children, adolescents and young adults. Pediatr Nephrol. 2013;28:2343–9.

    Article  PubMed  Google Scholar 

  33. 33.

    Modesti PA. Season, temperature and blood pressure: a complex interaction. Eur J Intern Med. 2013;24:604–7.

    Article  PubMed  Google Scholar 

  34. 34.

    Shephard RJ, Aoyagi Y. Seasonal variations in physical activity and implications for human health. Eur J Appl Physiol. 2009;107:251–71.

    Article  PubMed  Google Scholar 

  35. 35.

    Beaney T, Schutte AE, Tomaszewski M, Ariti C, Burrell LM, Castillo RR, et al. May measurement month 2017: an analysis of blood pressure screening results worldwide. Lancet Glob Heal. 2018;6:e736–743.

    Article  Google Scholar 

  36. 36.

    Climate-Data.org. Climate Kastoria [Internet], n.d., [cited 26 Dec 2018]. https://en.climate-data.org/europe/greece/kastoria/kastoria-1370/

  37. 37.

    Allwood MA, Gaffey AE, Vergara-Lopez C, Stroud LR. Stress through the mind of the beholder: preliminary differences in child and maternal perceptions of child stress in relation to child cortisol and cardiovascular activity. Stress. 2017;20:341–9.

    Article  PubMed  Google Scholar 

  38. 38.

    Shepard JD,al’, Absi M, Whitsett TL, Passey RB, Lovallo WR. Additive pressor effects of caffeine and stress in male medical students at risk for hypertension. Am J Hypertens. 2000;13:475–81.

    CAS  Article  PubMed  Google Scholar 

  39. 39.

    El Sayed K, Macefield VG, Hissen SL, Joyner MJ, Taylor CE. Blood pressure reactivity at onset of mental stress determines sympathetic vascular response in young adults. Physiol Rep. 2018;6:e13944.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Authors’ contributions

TN: performed data collection, drafted the initial paper, revised and approved the final version; SS: analyzed the data, edited, revised, and approved the final version; KP and NP: edited, revised, and approved the final version; CA: analyzed the data; KK and FP: supervised the study, revised, and approved the final draft; VK: designed the study, edited, revised, and approved the final version.

Author information



Corresponding author

Correspondence to Thomaitsa Nika.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures in the study werein accordance with the ethical standards of the Greek Ministry of National Education, the National Educational Institute and the Ethics Committee of Aristotle University of Thessaloniki, which approved the study protocol (65104/Γ7/15–05–2013).

Informed consent

Informed consent was obtained from all individual participants included in the study and their parents or legal guardians.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nika, T., Stabouli, S., Kollios, K. et al. Obesity and season as determinants of high blood pressure in a school-based screening study. J Hum Hypertens 33, 277–285 (2019). https://doi.org/10.1038/s41371-019-0168-0

Download citation

Further reading


Quick links