Prevalence and Risk Factors of Hypertension in Schoolchildren from Central Thailand: A Cross‑Sectional Study

Lakkana Rerksuppaphol, Sanguansak Rerksuppaphol


Background: Hypertension (HTN) among children is a major health issue with mounting prevalence rates. The aim of this research is to assess the prevalence of HTN and its associated risk factors among apparently healthy schoolchildren.

Methods: We conducted a cross‑sectional study of schoolchildren in the academic year 2015 from 38 public primary schools in central Thailand for the prevalence and risk factors of HTN. Apparently healthy children aged 6‑12 years were included. Informed consents were obtained before participation. Hypertension was diagnosed as per the new reference cutoff levels recommended by the American Academy of Pediatrics.

Results: A total of 3,870 children with a median age of 9.5 years were included in the final analysis. The prevalence of obesity, overweight, and thinness among children was 15.7%, 13.6% and 5.2%, respectively. The overall prevalence of hypertension in the study population was 26.2%. HTN was significantly more prevalent in boys than girls (summary odds ratio (OR) 1.16 [95% confidence interval (CI) = 1.01‑1.34]). Overweight and obesity were among the associated risk factors of HTN in the enrolled children with (OR 2.44 [95% CI 1.98‑3.00]) and (OR 7.99 [95% CI 6.58‑9.70]), respectively. Obese children who had central obesity were at greater risk of hypertension (OR 9.16 [95% CI 7.45‑11.27]).

Conclusions: The prevalence of HTN among Thai children is markedly high. Obesity, overweight, and male gender are considerable risk factors of HTN in children. Routine blood pressure measurement and further studies are recommended to investigate the potential risks and to lessen the associated complications.


Blood pressure; child; hypertension; risk

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Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA,

Izzo Jr JL, et al. Seventh report of the joint national committee

on prevention, detection, evaluation, and treatment of high blood

pressure. Hypertension 2003;42:1206‑52.

Fakhri M, Sarokhani D, Ghiasi B, Dehkordi AH. Prevalence of

hypertension in cardiovascular disease in Iran: Systematic review

and meta‑analysis. Int J Prev Med 2020;11:56.

Solanki JD, Gadhavi BP, Makwana AH, Mehta HB, Shah CJ,

Gokhale PA. Early screening of hypertension and cardiac

dysautonomia in each hypertensive is needed‑inference from

a study of QTc interval in Gujarat, India. Int J Prev Med


Mortality GBD, Causes of Death C. Global, regional, and

national age‑sex specific all‑cause and cause‑specific mortality

for 240 causes of death, 1990‑2013: A systematic analysis for the

Global Burden of Disease Study 2013. Lancet 2015;385:117‑71.

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK,

He J. Global burden of hypertension: Analysis of worldwide

data. Lancet 2005;365:217‑23.

Aekplakorn W. The 5th Thai national health examination survey

Nonthaburi Health systems research institute. 2014.

Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S,

Sood NK, et al. Prevalence of sustained hypertension and

obesity in urban and rural school going children in Ludhiana.

Indian Heart J 2004;56:310‑4.

Riley M, Bluhm B. High blood pressure in children and

adolescents. Am Fam Phys 2012;85:693‑700.

Fallah Z, Qorbani M, Motlagh ME, Heshmat R, Ardalan G,

Kelishadi R. Prevalence of prehypertension and hypertension

in a nationally representative sample of Iranian children

and adolescents: The CASPIAN‑IV study. Int J Prev Med


Assadi F. Childhood hypertension: A problem of epidemic

proportion. Int J Prev Med 2014;5:S1‑3.

Anyaegbu EI, Dharnidharka VR. Hypertension in the teenager.

Pediatr Clin 2014;61:131‑51.

Blumenthal S, Epps R, Heavenrich R, Lauer R, Lieberman E,

Mirkin B, et al. Report of the task force on blood pressure

control in children. Pediatrics 1977;59:I‑II, 797‑820.

Chen X, Wang Y. Tracking of blood pressure from childhood to

adulthood: A systematic review and meta‑regression analysis.

Circulation 2008;117:3171.

Drukteinis JS, Roman MJ, Fabsitz RR, Lee ET, Best LG,

Russell M, et al. Cardiac and systemic hemodynamic

characteristics of hypertension and prehypertension in

adolescents and young adults: The Strong Heart Study.

Circulation 2007;115:221‑7.

Lande MB, Adams H, Falkner B, Waldstein SR, Schwartz GJ,

Szilagyi PG, et al. Parental assessments of internalizing and

externalizing behavior and executive function in children with

primary hypertension. J Pediatr 2009;154:207‑12.

Urbina EM, Khoury PR, McCoy C, Daniels SR, Kimball TR,

Dolan LM. Cardiac and vascular consequences of prehypertension in youth. J Clin Hyperten 2011;13:332‑42.

World Health Organization. Growth reference 5‑19 years:

BMI‑for‑age (5‑19 years) [Internet]. [Last cited on 2020 Feb 20].

Available from:


Browning LM, Hsieh SD, Ashwell M. A systematic review of

waist‑to‑height ratio as a screening tool for the prediction of

cardiovascular disease and diabetes: 0·5 could be a suitable

global boundary value. Nutr Res Rev 2010;23:247‑69.

Flynn JT, Kaelber DC, Baker‑Smith CM, Blowey D, Carroll AE,

Daniels SR, et al. Clinical practice guideline for screening and

management of high blood pressure in children and adolescents.

Pediatrics 2017;140:e20171904.

Noubiap JJ, Essouma M, Bigna JJ, Jingi AM, Aminde LN,

Nansseu JR. Prevalence of elevated blood pressure in children and adolescents in Africa: A systematic review and meta‑analysis.

Lancet Public Health 2017;2:e375‑e86.4.

Bassareo PP, Mercuro G. Pediatric hypertension: An update on a

burning problem. World J Cardiol 2014;6:253‑9.

Das MK, Bhatia V, Sibal A. Prevalence of hypertension in urban

school children aged 5 to 10 years in North India. Int J Pediatr


Manios Y, Karatzi K, Protogerou AD, Moschonis G,

Tsirimiagou C, Androutsos O, et al. Prevalence of childhood

hypertension and hypertension phenotypes by weight status and

waist circumference: The Healthy Growth Study. Eur J Nutr


Narang R, Saxena A, Desai A, Ramakrishnan S, Thangjam RS,

Kulkarni S, et al. Prevalence and determinants of hypertension in

apparently healthy schoolchildren in India: A multi‑center study.

Eur J Prev Cardiol 2018;25:1775‑84.

Kumar P, Kumar D, Ranjan A, Singh CM, Pandey S,

Agarwal N. Prevalence of hypertension and its risk factors

among school going adolescents of Patna, India. J Clin Diag Res


Dinç G, Saatli G, Baydur H, Ozcan C. Hypertension and

overweight among Turkish adolescents in a city in Aegean

region of Turkey: A strong relationship in a population with a

relatively low prevalence of overweight. Anadolu Kardiyol Derg.


He Q, Ding ZY, Fong DY‑T, Karlberg J. Blood pressure is

associated with body mass index in both normal and obese

children. Hypertension 2000;36:165‑70.

Pearson T, Palaniappan L, Artinian N, Carnethon M, Criqui M,

Daniels S, et al. on behalf of the American Heart Association

Council on Epidemiology and Prevention. American Heart

Association guide for improving cardiovascular health at the

community level, 2013 update: A scientific statement for public

health practitioners, healthcare providers, and health policy

makers. Circulation 2013;127:1730‑53.

Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ.

Overweight, ethnicity, and the prevalence of hypertension in

school‑aged children. Pediatrics 2004;113:475‑82.

Paradis G, Lambert M, O’Loughlin J, Lavallée C, Aubin J,

Delvin E, et al. Blood pressure and adiposity in children and

adolescents. Circulation 2004;110:1832‑8.