Prevalence and Associated Factors of Hypertension Among School-Going Children in Hyderabad City, India: A Cross-Sectional Study

BackgroundChildhood hypertension is an increasingly important public health concern because elevated blood pressure during childhood predisposes individuals to hypertension and cardiovascular disease in adulthood.Although obesity is recognised as the principal modifiable risk factor, regional data from India remain heterogeneous.This study aimed to estimate the prevalence of hypertension and prehypertension among school-going children in Hyderabad and determine its association with body mass index (BMI) and other correlates of elevated blood pressure. MethodsWe report this school-based cross-sectional study.A total of 1,212 children aged 7-15 years from two government and two private schools in Hyderabad were studied between August 2014 and May 2015.Anthropometric and blood pressure measurements were obtained using standardised procedures.Blood pressure was measured three times during the same visit, at 0, 30, and 60 minutes, and the readings were averaged.Hypertension and prehypertension were defined by age-, sex-, and height-specific percentiles from the Fourth Report of the National High Blood Pressure Education Program Working Group.Associations were examined using chi-square tests, and independent factors with adjusted odds ratios (aOR) were identified by multivariable binary logistic regression. ResultsMean systolic blood pressure (SBP) and diastolic blood pressure (DBP) rose progressively across BP categories (normal BP, prehypertension, hypertension: 100.9-126.1 mmHg and 62.8-75.3mmHg, respectively; p < 0.001 for both), and both parameters correlated significantly with age and, more strongly, with BMI (ρ = 0.50-0.54and ρ = 0.31-0.35,respectively; p < 0.001).The overall prevalence of hypertension was 6.68% (95% CI: 5.41-8.23%)and prehypertension 8.09% (95% CI: 6.68-9.76%).Among 967 normalweight, 130 overweight, and 115 obese children, hypertension prevalence was 2.1% (95% CI: 1.3-3.2%),12.3% (95% CI: 7.5-18.7%),and 39.1% (95% CI: 29.2-49.9%),respectively (Pearson chi-square = 437, p < 0.001).In multivariable analysis, obesity (aOR: 8.60, 95% CI: 3.84-19.26)and overweight (aOR: 3.01, 95% CI: 1.33-6.79)remained strongly associated with hypertension, along with parental history of hypertension (aOR: 2.14, 95% CI: 1.12-4.09),mixed dietary pattern (aOR: 1.97, 95% CI: 1.07-3.61)and male sex (aOR: 1.93, 95% CI: 1.11-3.36).Model discrimination was good (AUC: 0.886, 95% CI: 0.84-0.93). ConclusionsIn this Hyderabad school-based study, prehypertension and hypertension were common and showed a strong, graded association with BMI category.Blood pressure showed a significant, graded rise across hypertension categories that was more strongly linked to BMI than to age.While cross-sectional design precludes causal inference, findings align with national pooled estimates.It implies that surveillance and school-based healthy weight initiatives with targeted blood pressure screening using repeated measurements should continue.Multi-centric, longitudinal studies using the latest criteria and ambulatory blood pressure monitoring are needed to confirm causality and secular trends.