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Body mass index percentiles and elevated blood pressure among children and adolescents

Journal of Human Hypertension volume 34, pages 319–325 (2020)Cite this article

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Abstract

It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6–17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th–24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14–1.41; P < 0.001) in the 25th–49th percentile subgroup, 1.55 (95% CI, 1.39–1.73; P < 0.001) in the 50th–74th percentile subgroup, and 2.17 (95% CI, 1.92–2.46; P < 0.001) in the 75th–84th percentile subgroup, respectively, after adjustment for sex, age, race/ethnicity, height and country. Additionally, the corresponding ORs for elevated BP were 1.21 (95% CI, 1.10–1.32; P < 0.001), 1.55 (95% CI, 1.42–1.69; P < 0.001), and 1.80 (95% CI, 1.62–2.01; P < 0.001), respectively. In conclusion, a BMI in the 25th–84th percentiles, within the accepted normal weight range, was associated with an increased risk of elevated and high BP among children and adolescents. It is important for children and adolescents to keep a BMI at a low level in order to prevent and control hypertension.

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Acknowledgements

We thank the US and Chinese Centers for Disease Control and Prevention and University of North Carolina for sharing their valuable data.

Funding

This work was supported by the Young Scholars Program of Shandong University (2015WLJH51), the National Institutes of Health (NIH; grants R01-HD30880, DK056350, R24-HD050924, and R01-HD38700), and a national school-based surveillance program funded by the Iran Ministry of Health. Dr Yajun Liang has received the grant from Karolinska Institutet, Sweden (2018-01590). The funders have no role in the study design, survey process, data analysis, and article preparation.

Author information

Author notes

  1. These authors contributed equally: Mingming Wang, Roya Kelishadi, Anuradha Khadilkar, Young Mi Hong, Tadeusz Nawarycz, Małgorzata Krzywińska-Wiewiorowska, Hajer Aounallah-Skhiri, Yajun Liang

Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, Shandong University, Jinan, China

    Mingming Wang, Liu Yang & Bo Xi

  2. Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

    Roya Kelishadi & Gelayol Ardalan

  3. Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India

    Anuradha Khadilkar, Vaman Khadilkar, Shashi Chiplonkar, Neha Kajale & Veena Ekbote

  4. Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea

    Young Mi Hong & Hae Soon Kim

  5. Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland

    Tadeusz Nawarycz & Lidia Ostrowska-Nawarycz

  6. Department of Epidemiology and Hygiene, Poznan University of Medical Sciences, Poznan, Poland

    Małgorzata Krzywińska-Wiewiorowska, Alicja Krzyżaniak & Barbara Stawińska-Witoszyńska

  7. National Institute of Public Health (INSP), Nutrition Surveillance and Epidemiology in Tunisia (SURVEN) Research Laboratory, 1002, Tunis, Tunisia

    Hajer Aounallah-Skhiri

  8. Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Mohammad Esmaeil Motlagh

  9. Cardiovascular Epidemiology and Prevention, Research Laboratory, Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia

    Habiba Ben Romdhane

  10. Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Ramin Heshmat

  11. Nutrition Surveillance and Epidemiology Unit (SURVEN), National Institute of Nutrition and Food Technology, Tunis, Tunisia

    Jalila El Ati

  12. Department of Epidemiology, Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran

    Mostafa Qorbani

  13. Institut de Recherche pour le Développement (IRD), UMR NUTRIPASS IRD-UM-SupAgro, Montpellier, France

    Pierre Traissac

  14. Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China

    Min Zhao

  15. Department of Epidemiology and Health Statistics, School of Public Health, Jining Medical University, Jining, China

    Xia Liu

  16. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    Yajun Liang

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  1. Mingming Wang
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Correspondence to Bo Xi.

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Wang, M., Kelishadi, R., Khadilkar, A. et al. Body mass index percentiles and elevated blood pressure among children and adolescents. J Hum Hypertens 34, 319–325 (2020). https://doi.org/10.1038/s41371-019-0215-x

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