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Paul Muntner, PhD; Jiang He, MD, PhD; Jeffrey A. Cutler, MD; Rachel P. Wildman, PhD; Paul K. Whelton, MD, MSc

JAMA. 2004;291:2107-2113.

Context  The prevalence of overweight among children and adolescents increased between 1988 and 2000. The change in blood pressure among children and adolescents over that time and the role of overweight is unknown.

Objective  To examine trends in systolic and diastolic blood pressure among children and adolescents between 1988 and 2000.

Design, Setting, and Population  Two serially conducted cross-sectional studies using nationally representative samples of children and adolescents, aged 8 to 17 years, from the third National Health and Nutrition Examination Survey (NHANES III) conducted in 1988-1994 (n = 3496) and NHANES 1999-2000 (n = 2086).

Main Outcome Measures  Systolic and diastolic blood pressure levels.

Results  In 1999-2000, the mean (SE) systolic blood pressure was 106.0 (0.3) mm Hg and diastolic blood pressure was 61.7 (0.5) mm Hg. After adjustment for age, mean systolic blood pressure was 1.6 mm Hg higher among non-Hispanic black girls (P = .11) and 2.9 mm Hg higher among non-Hispanic black boys (P<.001) compared with non-Hispanic whites. Among Mexican Americans, girls' systolic blood pressure was 1.0 mm Hg higher (P = .21) and boys' was 2.7 mm Hg higher (P<.001) compared with non-Hispanic whites (P<.001). With further adjustment for body mass index, these differences were attenuated. After age, race/ethnicity, and sex standardization, systolic blood pressure was 1.4 (95% confidence interval [CI], 0.6-2.2) mm Hg higher (P<.001) and diastolic blood pressure was 3.3 (95% CI, 2.1-4.5) mm Hg higher in 1999-2000 (P<.001) compared with 1988-1994. With further adjustment for differences in the body mass index distribution in 1988-1994 and 1999-2000, the increase in systolic blood pressure was reduced by 29% and diastolic blood pressure was reduced by 12%.

Conclusions  Blood pressure has increased over the past decade among children and adolescents. This increase is partially attributable to an increased prevalence of overweight.

Author Affiliations: Departments of Epidemiology (Drs Muntner, He, Wildman, and Whelton) and Medicine (Drs Muntner, He, and Whelton), School of Public Health and Tropical Medicine, School of Medicine, Tulane University, New Orleans, La; and Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Cutler).

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