Research Article: Prevalence of high blood pressure and association with obesity in Spanish schoolchildren aged 4–6 years old

Date Published: January 31, 2017

Publisher: Public Library of Science

Author(s): Noelia Martín-Espinosa, Ana Díez-Fernández, Mairena Sánchez-López, Irene Rivero-Merino, Lidia Lucas-De La Cruz, Montserrat Solera-Martínez, Vicente Martínez-Vizcaíno, Yan Li.


The prevalence of high blood pressure in children is increasing worldwide, largely, but not entirely, driven by the concurrent childhood obesity epidemic. The aims of this study were to examine the prevalence of prehypertension and hypertension in 4-to-6-year-old Spanish schoolchildren, and to evaluate the association between different blood pressure (BP) components with different adiposity indicators.

Cross-sectional study including a sample of 1.604 schoolchildren aged 4-to-6-years belonging to 21 schools from the provinces of Ciudad Real and Cuenca, Spain. We measured height, weight, body mass index (BMI), fat mass percentage (%FM), triceps skinfold thickness (TST), waist circumference (WC), systolic and diastolic BP, mean arterial pressure and pulse pressure.

The estimates of prevalence of prehypertension and hypertension were 12.3% and 18.2%, respectively. In both sexes, adiposity indicators were positively and significantly associated with all BP components (p<0.001), thus schoolchildren in the higher adiposity categories had significantly higher BP levels (p<0.001). Our results show a high prevalence of high blood pressure in Spanish children. Moreover, high levels of adiposity are associated with high blood pressure in early childhood, which support that it could be related to cardiovascular risk later in life.

Partial Text

Over the last decade, epidemiologic studies have reported an increase in children’s blood pressure (BP) levels [1], as well as in the prevalence of prehypertension and hypertension [2–6] largely, but not entirely, driven by a concurrent increase in childhood obesity. This fact has been accompanied by an increased recognition of the importance of BP measurements in children. However, the importance of monitoring BP levels in the pediatric age goes beyond its association with obesity because it has been consistently reported that, independently of body mass index (BMI), BP levels track from childhood to adulthood [7, 8], and that BP levels in childhood predict young adult cardiovascular risk [9]. Despite the extensively reported increase in the prevalence of high BP in the pediatric population worldwide, only a few studies have examined BP estimates in Spanish children, reporting that this prevalence ranged from 1.7% to 3.2% [10, 11].

Of the 2.407 schoolchildren invited to participate in the study, 1.604 (66.63%) agreed to participate. Out of these, 788 were girls (49.10%). No significant differences were observed between the mean age of the girls and boys. Summary statistics of all variables are shown in Table 1.

Studies estimating prevalence of high blood pressure in children ≤ 6 years old are scarce across the world, and none have been performed in Spain. This study shows that high blood pressure prevalence in children aged 4-to-6 years from Castilla-La Mancha, Spain, was 27.5% and 30.6% in boys and girls, respectively. Furthermore, the prevalence of prehypertension and hypertension in the total sample was 12.3% and 18.2%, respectively. Likewise, a positive relationship between adiposity categories and BP levels has been found.

Our data show a high prevalence of prehypertension and hypertension in Spanish children younger than 6 years. These findings are important from a clinical and public health point of view because they support the idea that early detection of a prehypertensive and hypertensive status in young children may help to prevent the cardiovascular disease in adulthood in Spanish population.




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