Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight

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Abstract
Objective Most studies assess the prevalence of hypertension in pediatric populations based on blood pressure (BP) readings taken on a single visit. We determined the prevalence of hypertension measured on up to three visits in a Swiss pediatric population and examined the association between hypertension and overweight and selected other factors. Methods Anthropometric data and BP were measured in all children of the sixth school grade of the Vaud canton (Switzerland) in 2005–2006. ‘Elevated BP’ was defined according to sex-specific, age-specific and height-specific US reference data. BP was measured on up to two additional visits in children with elevated BP. ‘Hypertension’ was defined as ‘elevated BP’ on all three visits. Results Out of 6873 children, 5207 (76%) participated [2621 boys, 2586 girls; mean (SD) age, 12.3 (0.5) years]. The prevalence of elevated BP was 11.4, 3.8 and 2.2% on first, second and thirds visits, respectively; hence 2.2% had hypertension. Among hypertensive children, 81% had isolated systolic hypertension. Hypertension was associated with excess body weight, elevated heart rate and parents' history of hypertension. Of the children, 16.1% of boys and 12.4% of girls were overweight or obese (CDC criteria, body mass index ≥ 85th percentile). Thirty-seven percent of cases of hypertension could be attributed to overweight or obesity. Conclusions The proportion of children with elevated BP based on one visit was five times higher than based on three measurements taken at few-week intervals. Our data re-emphasize the need for prevention and control of overweight in children to curb the global hypertension burden.