A study on prevalence of pre-hypertension in relation to various obesity indicators in tenth standard healthy school children aged 14 to 16 years

Salma Shaziya, Soumya M.


Background: This study was carried out to know the correlation and percentage prevalance of pre-hypertension among healthy 14 to 16 year 10th standard adolescent school children and its relation to obesity indicators BMI, waist circumference, waist/height ratio.

Methods: A cross sectional study done in schools of Madikeri taluka. 155 healthy adolescent school children of 10th standard aged 14-16 years were examined, Height, weight, waist circumference, blood pressure were measured using standard protocols. Children were categorized according to sex, government/private school and three obesity indicators separately using Indian standard percentile charts. Percentage prevalence of pre-hypertension (BP >90th percentile) varying with all variables noted. Data obtained analysed by descriptive and analytic statistics by using R statistical software and SSPS-16. P value <0.05 considered significant.

Results: Total prevalence of pre-hypertension was 16.13%, 68% boys and 32% girls. As the BMI percentile increases the percentage prevalence of pre-hypertension increases 10.8% at 50th, 25% at 50th to 23 Eq, 57.14% at 23Eq to 27Eq and 83% at >27 Eq. As per waist circumference percentage prevalence of high BP was 11.36% at <75th, 36.3% at 75th to 90th, and 50% at >95th percentile. As per waist/height ratio percentage prevalence was 11.9% at <75th, 41.66 % at 75th to 95th and 55.56% at >95th percentile. Prevalance of overweight according to BMI (>23 Eq) is 8.48%, WC (>90th p) is 7.77%, WHtR (>95th p ) is 5.81%. Correlation between all obesity indicators and pre-hypertension were highly significant (p value >0.001).

Conclusions: Percentage prevalence of pre-hypertension increases as the Percentile value of all three obesity indicators increases. Correlation between pre-hypertension and all three obesity indicators was highly significant with BMI the strongest.


Correlation Pre-hypertension, Prevalance, Obesity

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Hara M, Saitou E, Iwata F, Ikada T, Harada K. Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. J Atheroscler Thromb. 2002;9:127-13.

Bacopoulou F, Efthymiou, V, Landis G, Rentoumis A, Chrousos GP. Waist circumference, waist-to-hip ratio and waist-to-height ratio reference percentiles for abdominal obesity among Greek adolescents. BMC Pediatrics. 2015:15:50.

Prasad DS, Kabir Z, Dash AK, Das BC. Abdominal obesity, an independent cardiovascular risk factor in Indian subcontinent: A clinico epidemiological evidence summary. J Cardiovasc Dis Res. 2011;2:199-205.

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

Falkner B. Children and adolescents with obesity-associated high blood pressure. J Am Soc Hypertens. 2008;2:267-74

Redwine KM, Daniels SR. Pre-Hypertension in Adolescents: Risk and Progression; J Clin Hypertens (Greenwich). 2012;14(6):360-4.

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

Buch N, Goyal JP, Kumar N, Parmar I, Shah VB, Charan J. Prevalence of hypertension in school going children of Surat city, Western India. J Cardiovasc Dis Res. 2011;2:228-32.

Kirkendall WM, Feinleib M, Freis ED, Mark AL. American Heart Association. Recommendations for human blood pressure determination by sphygmomanometer. Hypertension. 1981;3:509-19.

Raj M, Sundaram KR, Paul M, Kumar RK. Blood Pressure distribution in Indian children. Indian Pediatr. 2010;47(17):473-4.

Kuriyan R. Waist circumference and waist for height percentiles in urban south Indian children aged 3-16 years. Indian pediatr. 2011;48(10):765-71.

Khadilkar V. Revised IAP growth charts for height, weight and body mass index for 5-18 year old children. Indian Pediatr. 2015;52:47-55.

Cleeman JI. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). The Journal of the American Medical Association. 2001;285(19):2486-97.

Cruz ML, Weigensberg MJ, Huang TTK, Bal G, Shaibi GQ. The metabolic syndrome in overweight hispanic yougth and the role of insulin sensitivity. Journal of Clinical Endocrinology and Metabolism. 2004;89(1):108-13.

WHO. The World Health Report 2002. Geneva, Switzerland: WHO, 2002.

Vivek V, Singh SK. Prevalence of hypertension in Gujarati School going children and adolescents in Anand district. National Journal of Community Medicine. 2012;3(3):452-7.

Maynard LM, Wisemandle W, Roche AF, Chumlea WC, Guo SS, Siervogel RM. Childhood body composition in relation to body mass index. Pediatrics. 2001;107(2):344-50.

Kahn HS, Imperatore G, Cheng YJ. A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth. J Pediatr. 2005;146(4):482-8.

James WP: Assessing obesity: are ethnic differences in body mass index and waist classification criteria justified? Obes Rev. 2005;6(3):179-81.

Dalton M, Cameron AJ, Zimmet PZ, Shaw JE, Jolley D, Dunstan DW, et al. Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med. 2003;254(6):555-63.

Ashwell M. The Ashwell shape chart- A public health approach to the metabolic risks of obesity. Int J Obes Relat Metab Disord. 1998;22 Suppl 3:S213.

Rajput R, Rajput M, Bairwa M, Singh J, Saini O, Shankar V. Waist height ratio: A universal screening tool for prediction of metabolic syndrome in urban and rural population of Haryana. Indian J Endocr Metab. 2014;18:394-9.

Wirix AJ, Kaspers PJ, Nauta J, Chinapaw MJ, Kist-van Holthe JE. Pathophysiology of hypertension in obese children: a systematic review. Obes Rev. 2015;16(10):831-42.

Chirag AB, Chavda, Kakkad KM, Damor P. A Study Of Prevalence Of Hypertension In School Children.Gujarat Medical Journal. 2013;68(2):79-81.

Cherian AT, Sarah CT. Prevalence of obesity and overweight in urban school children, Kochi, Kerla, Lakeshore Hospital, Eranakulam. Indian Pediatr. 2012;49:475-7.

McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message--'keep your waist circumference to less than half your height'. Int J Obes (Lond). 2006;30(6):988-92.

Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid andeffective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005;56(5):303-7.

Sung RY, So HK, Choi KC, Nelson EA, Li AM, Yin JA, et al. Waist circumference and waist-to-height ratio of Hong Kong Chinese children. BMC Public Health. 2008;8:324.

Kajale NA, Khadilka AV, Chiplonkar SA, Khadilkar VV. Body Fat Indices for Identifying Risk of Hypertension in Indian Children. Indian Pediatr. 2014;51:555-60.

Grober Gratz D, Widhalm K, De Zwan M. Body mass index or waist circumference which is the better predictor for hypertension and dyslipidemia in overweight/obese children and adolescents? Association of cardiovascular risk to body mass index or waist circumference. Horm Res Pediatr. 2013;80(3):170-8.

Mishra PE, Shastri L, Thomas T, Duggan C, Bosch R, Mcdonald CM, et al. Waist-to-Height Ratio as an Indicator of High Blood Pressure in Urban Indian School Children.Indian Pediatr. 2015;52(15):773-8.