UMass Chan Medical School Faculty Publications

UMMS Affiliation

Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences; Division of Epidemiology, Department of Population and Quantitative Health Sciences; Graduate School of Biomedical Sciences; UMass Worcester Prevention Research Center

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Document Type



Cardiovascular Diseases | Community-Based Research | Epidemiology | Pediatrics | Preventive Medicine


INTRODUCTION: The American Academy of Pediatrics (AAP) updated its blood pressure (BP) screening guidelines in 2017 to emphasize body weight as a risk factor. We provide contemporary, nationally representative estimates of prevalence of elevated and hypertensive BP among US children and examine sociodemographic prevalence differences, accounting for the influence of weight.

METHODS: We used cross-sectional data from children aged 8 to 17 years (N = 5,971; weighted N = 36,612,323) collected from 2011 through 2018 in 4 biennial cycles of the National Health and Nutrition Examination Survey (NHANES). Children's BP was categorized as normal, elevated, or hypertensive. Sociodemographic characteristics included were sex, age, race/ethnicity, family income, and education. Log binomial regression, with and without adjustment for weight (dichotomized at the 85th body mass index percentile), determined prevalence estimates and differences for elevated and hypertensive BPs with 95% CIs.

RESULTS: In NHANES data collected from 2011 through 2018, 7.2% (95% CI, 6.3%-8.3%) of US children had elevated BP, and 3.8% (95% CI, 3.3%-4.5%) had hypertensive BP according to 2017 AAP guidelines. Differences in prevalence of weight-adjusted elevated BP indicated higher prevalence among children aged 16 to 17 years compared with children aged 8 to 9 years (prevalence difference, +6.3%; 95% CI, 3.2%-9.4%), among males compared with females (+4.6%; 95% CI, 2.7%-6.4%), and among non-Latino Black children compared with non-Latino White children (+4.0%; 95% CI, 2.2%-5.8%). Crude hypertensive BP prevalence was highest among children aged 8 to 9 years, male children, and Mexican American children. The only difference remaining after weight adjustment was among children aged 8 to 9 years and 13 to 15 years.

CONCLUSION: Elevated BP was most prevalent among US children who were older, male, or non-Latino Black. Factors beyond inequalities in body weight may contribute to disparities in elevated BP.


blood pressure, UMCCTS funding

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Preventing Chronic Disease is a publication of the U.S. Government. This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be properly cited.

DOI of Published Version



Goulding M, Goldberg R, Lemon SC. Differences in Blood Pressure Levels Among Children by Sociodemographic Status. Prev Chronic Dis. 2021 Sep 16;18:E88. doi: 10.5888/pcd18.210058. PMID: 34529555; PMCID: PMC8462283. Link to article on publisher's site

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Journal/Book/Conference Title

Preventing chronic disease

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