Change in Weight Status and Development of Hypertension

Abstract

To examine the association of BMI percentile and change in BMI percentile to change in blood pressure (BP) percentile and development of hypertension (HTN). METHODS:This retrospective cohort included 101 606 subjects age 3 to 17 years from 3 health systems across the United States. Height, weight, and BPs were extracted from electronic health records, and BMI and BP percentiles were computed with the appropriate age, gender, and height charts. Mixed linear regression estimated change in BP percentile, and proportional hazards regression was used to estimate risk of incident HTN associated with BMI percentile and change in BMI percentile. RESULTS:The largest increases in BP percentile were observed among children and adolescents who became obese or maintained obesity. Over a median 3.1 years of follow-up, 0.3% of subjects developed HTN. Obese children ages 3 to 11 had twofold increased risk of developing HTN compared with healthy weight children. Obese children and adolescents had a twofold increased risk of developing HTN, and severely obese children had a more than fourfold increased risk. Compared with those who maintained a healthy weight, children and adolescents who became obese or maintained obesity had a more than threefold increased risk of incident HTN. CONCLUSIONS:We observed a strong, statistically significant association between increasing BMI percentile and increases in BP percentile, with risk of incident HTN associated primarily with obesity. The adverse impact of weight gain and obesity in this cohort over a short period underscores the early need for effective strategies for prevention of overweight and obesity. Research, Kaiser Permanente Colorado, Denver, Colorado; e Department of Pediatrics, Kaiser Permanente San Francisco, San Francisco, California; and f Division of Research, Kaiser Permanente Northern California, Oakland, California Dr Parker conceptualized the study design, assembled the data set, conducted all analyses, and drafted the initial manuscript; Dr Sinaiko conceptualized the overall study that developed these data, assisted in the development of the current study, and edited the manuscript; Dr Kharbanda contributed to study conceptualization and design and critically reviewed and provided feedback on the manuscript; Dr Margolis contributed to the study design and provided critical review for drafts of the manuscript; Drs Daley and Sherwood and Ms Trower contributed to the data collection and analysis and critically reviewed the fi nal manuscript; Dr Greenspan contributed to data collection and critically reviewed and provided feedback on the manuscript; Dr Lo contributed to the cohort assembly and data collection, critically reviewed study results, and provided content edits to the manuscript; Dr Magid participated in assembling the data set and reviewed study results and the initial manuscript; Dr O'Connor conceptualized the overall study and development of the current study, reviewed study results, and critically reviewed the manuscript; and all authors approved the...

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