Childhood Blood Pressure Trends and Risk Factors for High Blood Pressure: The NHANES Experience 1988–2008

Study Questions:

Have blood pressure (BP) levels increased among children in the United States?


Population data from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES (1999–2008) were used. Children were ages 8-17 years. Body mass index (BMI) values were converted to age–sex-specific percentiles based on Centers for Disease Control and Prevention growth charts. A mean of three BP readings was obtained. If <3 readings were available, then the mean of all available readings was used. All BP measurements were obtained with a sphygmomanometer. The main outcome measure was elevated BP (systolic BP or diastolic BP ≥90th percentile or systolic BP/diastolic BP ≥120/80 mm Hg).


A total of 3,248 children from NHANES III (1988–1994) and 8,388 children in the continuous NHANES (1999–2008) were included in this analysis. There were significant increases in weight and BMI for both boys and girls. The percentage of overweight children (≥85th percentile) also significantly increased, and there were also large increases in waist circumference for boys and especially for girls. The prevalence of elevated BP increased from NHANES III to NHANES 1999–2008 (boys: 15.8-19.2%, p = 0.057; girls: 8.2-12.6%, p = 0.007). BMI (Q4 vs. Q1; odds ratio, 2.00; p < 0.001), waist circumference (Q4 vs. Q1; odds ratio, 2.14; p < 0.001), and sodium (Na) intake (≥3450 mg vs. <2300 mg/2000 calories; odds ratio, 1.36; p = 0.024) were independently associated with prevalence of elevated BP. Mean systolic BP, but not diastolic BP, was associated with increased Na intake in children (quintile 5 [Q5] vs. quintile 1 [Q1] of Na intake; beta =1.25 ± 0.58; p = 0.034).


The investigators concluded that prevalence of BP increased over time, in particular for girls. Na intake was independently associated with increase in systolic BP.


The observed increases in BMI, Na intake, and BP among children is concerning. Policy changes along with education of both parents, communities, and children are warranted to reduce such trends.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Hypertension

Keywords: Outcome Assessment (Health Care), Overweight, Body Weight, Blood Pressure, Risk Factors, Centers for Disease Control and Prevention (U.S.), Child, Waist Circumference, Body Mass Index, Cardiology, Cardiovascular Diseases, Obesity, Blood Pressure Determination, Nutrition Surveys, Hypertension

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