Prevalence and risk factors for hypertension among children and adolescents in Shaanxi Province, Northwestern China, according to the three hypertension guidelines

Prevalence and risk factors for hypertension among children and adolescents in Shaanxi Province, Northwestern China, according to the three hypertension guidelines | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Prevalence and risk factors for hypertension among children and adolescents in Shaanxi Province, Northwestern China, according to the three hypertension guidelines Minmin Li, Xinyan Wang, Jingjun Zhao, Nan Yang, Qianyun Wang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4251847/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 May, 2025 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract Thisstudy aimed to examine the prevalence and epidemiological characteristics of hypertension among children and adolescents aged 7-17 years in Shaanxi Province using three hypertension guidelines for children and adolescents. Data from the 2023 Shaanxi Student’s Health Surveillance Survey were used. Hypertension was defined according to three references, namely, the 2018 National Health Commission of the China (NHCC) pediatric blood pressure reference, the 2017 American Academy of Pediatrics (AAP) clinical practice guidelines, and the 2016 European Society of Hypertension guidelines. A log-binomial regression model was applied to assess the associations between hypertension and possible risk factors. A total of 220,497 students with an average age of 11.73 yearswere included in the analysis. The prevalence of hypertension was 11.73%, 15.75% and 10.04% according to the NHCC, APP and ESH guidelines,respectively. All three guidelines suggest that children who wereoverweight or obese or who lived in rural areas had significantly greater odds of having hypertension, and central and southern Shaanxi students had significantly lower odds of having hypertension. All three guidelines show that hypertension in children and adolescents seems to be a serious health problem in Shaanxi Province as well as in Northwestern China; thus, policymakers and public health practitioners should take immediate action to address the already established modifiable risk factors. Health sciences/Health care/Paediatrics Health sciences/Risk factors Figures Figure 1 Figure 2 Introduction Hypertension, also known as high blood pressure (HBP), is a major risk factor for the development of heart failure and cardiovascular disease (CVD) from childhood to adulthood and is associated with adverse cardiac and vascular changes that can in turn be associated with CVD events in adulthood 1 , 2 . Hypertension is also considered a major cause of poorer disability-adjusted life-years and substantially contributes to mortality and disability 3 . HBP was once considered a rare disease in children 4 but is now considered a major public health problem worldwide 5 – 7 . Previous pathophysiologic and epidemiologic evidence has suggested that childhood hypertension is associated with essential hypertension in adulthood and with lifelong CVD. Therefore, blood pressure (BP) measurement during childhood is a necessary component of preventive health care targeting this problem in children and adolescents. BP changes normally with increasing age and body size, which means that establishing a single set of values for systolic BP (SBP) and diastolic BP (DBP) elevation is difficult, especially for younger children. Thus, pediatric hypertension has traditionally been defined on the basis of age-specific, sex-specific, and height-specific normative values. In 2004, the US National Heart, Lung, and Blood Institute released its Fourth Report on the Diagnosis, Evaluation, and Treatment of High BP in Children and Adolescents, which recommended pediatric hypertension as a value that met or exceeded the sex-, age-, and height-specific 95th BP percentile 8 . In 2016 and 2017, the European Society of Hypertension (ESH) and American Academy of Pediatrics (AAP), respectively, updated their childhood hypertension management 9 , 10 . In 2018, the National Health Commission of the People’s Republic of China (NHCC) published a reference for screening for elevated blood pressure among children and adolescents aged 7–18 years 11 . After the publication of these guidelines, these statements caused active discussion. Their sensitivity was tested, and the percentage of reclassified children differed in some populations 10 , 12 , 13 . Antolini et al. reported that the AAP guidelines detected a greater incidence of hypertension than did the ESH guidelines 14 . Dong et al. observed a greater incidence of hypertension when using the definition in the AAP guidelines than when using the definition in the Fourth Report 15 . Despite the large number of studies that have assessed the prevalence of hypertension in children and adolescents, to our knowledge, estimates of the prevalence of childhood hypertension have not been made using the NHCC, ESH and AAP guidelines in Northwest China. In sparsely populated northwestern China, economic conditions are worse, and health services are less developed than in the eastern and coastal areas of China. Nearly half of the population of Northwest China lives in Shaanxi Province. Until recently, however, limited population-based data on the prevalence and epidemiological characteristics of hypertension in Shaanxi Province or Northwest China were available. The objective of this study was to investigate the prevalence and epidemiological characteristics of hypertension among children and adolescents aged 7–17 years in Shaanxi Province using the three hypertension guidelines for children and adolescents. We expect the results to provide the most updated information on the rate of hypertension among children and adolescents in Shaanxi Province, Northwest China. Results The final population included in the analyses consisted of 220,497 students aged 7–17 years, and 112,354 (50.95%) were boys. Table 2 shows the basic characteristics of this study population. The average age of our participants was 11.73 years. Of the total participants, 62.96% were urban, 21.37% were residing in northern Shaanxi, and 54.75% were residing in central Shaanxi. The average height, weight and BMI of our participants were 151.02 cm, 46.45 kg and 19.72 kg/m 2, respectively. Furthermore, 16.53% of participants were overweight, and 14.57% had obesity in the survey. The average SBP and DBP of our participants were 106.39 mmHg and 66.84 mmHg, respectively. Significant differences were observed in the distributions of participant age, area, region groups, educational level, SBP, DBP, height, weight, BMI and BMI status between male and female participants (Table 2 ). Table 1. NHCC, ESH and AAP definitions of pediatric hypertension NHCC guideline ESH guideline AAP guideline Normal blood pressure <13 years <90 th percentile <90 th percentile <90 th percentile 13-15 years <90 th percentile <90 th percentile <90 th percentile 16-17 years <90 th percentile <130/85mmHg <120/80mmHg Elevated or high-normal blood pressure <13 years 90 th to <95 th percentile or 120/80mmHg 90 th to <95 th percentile 90 th to <95 th percentile or ≥120/80mmHg 13-15 years 90 th to <95 th percentile or 120/80mmHg 90 th to <95 th percentile ≥120/80mmHg 16-17 years 90 th to <95 th percentile or 120/80mmHg 130-139/85-89mmHg ≥120/80mmHg High blood pressure <13 years ≥95 th percentile ≥95 th percentile ≥95 th percentile or ≥130/80mmHg 13-15 years ≥95 th percentile ≥95 th percentile ≥130/80mmHg 16-17 years ≥95 th percentile 140/90mmHg ≥130/80mmHg NHCC: National Health Commission of the People’s Republic of China. ESH: European Society of Hypertension. AAP: American Academy of Pediatrics Table 2 Basic characteristic of all participants Background characteristics All (%) Boy (%) Girl (%) P value N 220497 112354 108143 Age, mean (SD), (year) 11.73 ± 3.06 11.66 ± 3.04 11.80 ± 3.07 < 0.001 Age group < 0.001 7–12 years 128007 (58.05) 66387 (59.09) 61620 (56.98) 13–15 years 61097 (27.71) 30746 (27.37) 30351 (28.07) 16–17 years 31393 (14.24) 15221 (13.55) 16172 (14.95) Area < 0.001 Urban 138831 (62.96) 71289 (63.45) 67542 (62.46) Suburban 81666 (37.04) 41065 (36.55) 40601 (37.54) Region < 0.001 Northern 47120 (21.37) 24855 (22.12) 22265 (20.59) Central 120722 (54.75) 60902 (54.21) 59820 (55.32) Southern 52655 (23.88) 26597 (23.67) 26058 (24.10) Height, mean (SD), (cm) 151.02 ± 15.84 152.8 ± 17.44 149.2 ± 13.74 < 0.001 Weight, mean (SD), (kg) 46.45 ± 16.62 48.37 ± 18.28 44.44 ± 14.43 < 0.001 BMI, mean (SD), (kg/m 2 ) 19.72 ± 4.16 19.99 ± 4.34 19.44 ± 3.94 < 0.001 BMI status < 0.001 Normal weight 151904 (68.89) 71983 (64.07) 79921 (73.90) Overweight 36456 (16.53) 20521 (18.26) 15935 (14.74) Obesity 32137 (14.57) 19850 (17.67) 12287 (11.36) BP, mean (SD), (mmHg) SBP 106.39 ± 12.41 108.0 ± 12.93 104.7 ± 11.61 < 0.001 DBP 66.84 ± 8.03 66.96 ± 8.16 66.71 ± 7.89 < 0.001 BMI: Body Mass Index. BP: Blood Pressure. SBP: Systolic Blood Pressure. DBP: Diastolic Blood Pressure. The prevalence of hypertension was 11.73% (95% CI: 11.59, 11.86%), 10.04% (95% CI: 9.91, 10.16%) and 15.75% (95% CI: 15.60, 15.91%) according to the NHCC, ESH and AAP guidelines, respectively. The prevalence of pediatric hypertension according to the NHCC, ESH and AAP guidelines are compared in Table 3 . The prevalence of hypertension in 7–12-year-old and 13–15-year-old participants was 10.65% (95% CI 10.48, 10.82%) and 13.30% (95% CI 13.03, 13.57%), respectively, according to the NHCC guidelines and the ESH and AAP guidelines. The prevalence of hypertension in individuals aged 16–17 years was 13.03% (95% CI 12.66–13.40%) in the NHCC guidelines and 2.43% (95% CI 2.26–2.60%) in the ESH guidelines, representing a difference of more than six times. The results from subgroup analyses according to sex, area, region and BMI status showed that the prevalence of hypertension according to the NHCC guidelines was greater than that according to the ESH guidelines and lower than that according to the AAP guidelines. Table 3 Hypertension prevalence as defined in ESH, AAP guidelines, and HNC standard stratified by demographic characteristics. Explanatory variables NHCC prevalence (95% CI) ESH prevalence (95% CI) AAP prevalence (95% CI) Difference prevalence between NHCC and ESH (95%CI) Difference prevalence between NHCC and AAP (95%CI) All participants 11.73 (11.59, 11.86) 10.04 (9.91, 10.16) 15.75 (15.60, 15.91) 1.69 (1.51, 1.87)* -4.03 (-4.23, -3.83)* Age group 7–12 years 10.65 (10.48,10.82) 11.33 (11.16,11.50) 16.71 (16.51,16.92) -0.68 (-0.92,-0.43)* -6.06 (-6.33,-5.80)* 13–15 years 13.30 (13.03,13.57) 11.23 (10.98,11.48) 12.78 (12.51,13.04) 2.07 (1.70,2.44)* 0.52 (0.15,0.90)* 16–17 years 13.03 (12.66,13.40) 2.43 (2.26,2.60) 17.63 (17.21,18.05) 10.60 (10.19,11.01)* -4.60 (-5.16,-4.04)* Gender Boys 11.11 (10.93, 11.29) 10.78 (10.60,10.97) 17.78 (17.55, 18.00) 0.33 (0.07, 0.58)* -6.99 (6.70, 7.28)* Girls 12.36 (12.17, 12.56) 9.26 (9.08,9.43) 13.65 (13.45, 13.86) 3.11 (2.85,3.37)* -1.29 (-1.57,-1.01)* Area Urban 10.19 (9.99,10.40) 8.03 (7.84,8.21) 14.03 (13.79,14.26) 2.17 (1.89,2.45)* -3.83 (-4.15,-3.52)* Rural 12.63 (12.45,12.80) 11.22 (11.05,11.38) 16.77 (16.57,16.97) 1.41 (1.17,1.65)* -4.14 (-4.41,-3.88)* Region Northern 14.36 (14.04,14.68) 13.43 (13.12,13.73) 18.90 (18.55,19.25) 0.94 (0.49,1.38)* -4.54 (-5.01,-4.06)* Central 10.27 (10.10,10.44) 8.42 (8.26,8.58) 14.15 (13.95,14.35) 1.85 (1.61,2.08)* -3.88 (-4.14,-3.62)* Southern 12.71 (12.42,12.99) 10.70 (10.44,10.97) 16.62 (16.30,16.93) 2.01 (1.62,2.40)* -3.91 (-4.33,-3.48)* BMI status Normal 9.47 (9.33,9.62) 7.83 (7.69,7.97) 12.59 (12.42,12.76) 1.64 (1.44,1.84)* -3.12 (-3.34,-2.89)* Overweight 13.99 (13.63,14.35) 11.66 (11.33,11.99) 18.64 (18.24,19.04) 2.33 (1.84,2.81)* -4.65 (-5.18,-4.11)* Obesity 19.80 (19.37,20.24) 18.61 (18.19,19.04) 27.45 (26.96,27.93) 1.19 (0.58,1.80)* -7.64 (-8.30,-6.99)* NHCC: National Health Commission of the People’s Republic of China. ESH: European Society of Hypertension. AAP: American Academy of Pediatrics. BMI: Body Mass Index. *P < 0.05 Figure 2 shows the results of the unadjusted model, where obesity showed the strongest association with developing hypertension (UPR = 2.09, 95% CI 2.03–2.14). This was followed by overweight (UPR = 2.09, 95% CI 2.03–2.14), which was associated with greater odds of having hypertension according to NHCC guidelines. A similar result was also observed for the ESH and AAP guidelines. Table 4 describes the risk factors associated with hypertension according to the NHCC, ESH and AAP guidelines after all the possible risk factors were adjusted for in the log-binomial multivariate model. Compared with 7- to 12-year-old participants, 13- to 15-year-old participants had a greater incidence of hypertension according to the NHCC and ESH guidelines but a lower incidence of hypertension according to the AAP guidelines. Sixteen- to 17-year-old participants had a significantly lower incidence of hypertension according to the ESH guidelines but a greater incidence according to the NHCC and AAP guidelines. Moreover, girls had a significantly greater incidence of hypertension than boys did only according to the NHCC standard. However, according to the ESH and AAP guidelines, girls had a significantly lower incidence of hypertension than boys did. Students who lived in suburban areas were more likely to have hypertension than those who lived in urban areas according to all the guidelines. The prevalence of hypertension in children was lower in central and southern Shaanxi Province than in northern Shaanxi Province according to all guidelines. Furthermore, overweight and obesity increased the risk of hypertension among children according to all three guidelines. Table 4 Predictors of hypertension among children and adolescents using an adjusted log-binomial regression Explanatory variables HNCC ESH AAP PR (95%CI) P-value PR (95%CI) P-value PR (95%CI) P-value Age group 7–12 years 1.00 1.00 1.00 13–15 years 1.31(1.28,1.35) < 0.001 1.05(1.02,1.08) 0.003 0.81(0.79,0.83) < 0.001 16–17 years 1.33(1.29,1.38) < 0.001 0.24(0.22,0.26) < 0.001 1.16(1.13,1.19) < 0.001 Gender Boys 1.00 1.00 1.00 Girls 1.20(1.17,1.22) < 0.001 0.95(0.93,0.97) < 0.001 0.83(0.81,0.84) < 0.001 Area Urban 1.00 1.00 1.00 Suburban 1.19(1.16,1.23) < 0.001 1.16(1.13,1.19) < 0.001 1.14(1.12,1.17) < 0.001 Region Northern 1.00 1.00 1.00 Central 0.77(0.74,0.79) < 0.001 0.71(0.69,0.73) < 0.001 0.80(0.78,0.82) < 0.001 Southern 0.92(0.89,0.95) < 0.001 0.84(0.81,0.87) < 0.001 0.92(0.89,0.94) < 0.001 BMI status Normal 1.00 1.00 1.00 Overweight 1.49(1.45,1.54) < 0.001 1.51(1.46,1.56) < 0.001 1.45(1.41,1.49) < 0.001 Obesity 2.21(2.15,2.27) < 0.001 2.32(2.25,2.38) < 0.001 2.11(2.06,2.16) < 0.001 NHCC: National Health Commission of the People’s Republic of China. ESH: European Society of Hypertension. AAP: American Academy of Pediatrics. BMI: Body Mass Index. PR: Prevalence ratio. CI: Confidence interval. P-value: Probability value. Discussion A large population-based cross-sectional Student’s Health Surveillance study conducted in Shaanxi Province, Northwest China, investigated the prevalence and epidemiological characteristics of hypertension among children and adolescents in 2023. We found that the prevalence of hypertension was approximately 10.04–15.75% among those aged 7–17 years according to three different guidelines. Furthermore, the rate of hypertension differed significantly with respect to baseline characteristics among the participants in the surveillance areas. The prevalence of HBP varies widely across studies worldwide (ranging from 0.6–25.1%) performed at different times, in different manners, across age groups, and among populations of children and adolescents 17 . For instance, the prevalence of hypertension in Lithuanian adolescents aged 12–15 years is 22.2% 18 ; in 9-13-year-old Greek school children, it is 23% 19 . The prevalence in Portuguese children and adolescents aged 4 to 18 years it is 12.8% 20 , and in 10-18-year-old Polish schoolchildren, it is 8.9% 21 . In the US pediatric population, hypertension has been estimated to affect 0.1–0.3% of children aged 3–17 years 22 , and it affects 0.19 to 0.38 per 1000 children in Taiwan 23 . Our findings demonstrate the variations in the estimated prevalence of hypertension in Shaanxi Province according to the NHCC, ESH and AAP guidelines, which were developed to classify prehypertension and hypertension statuses in children and adolescents. Our results indicate that the overall and subgroup (sex, area, region, and BMI status) hypertension incidence determined using the AAP guidelines was significantly greater than that determined using the NHCC and ESH guidelines 15 , 24 – 26 . The use of the AAP guidelines resulted in a lower incidence of hypertension in the 13–15 years age subgroup than did the use of the NHCC guidelines. Differences in the prevalence of hypertension and the ability to detect hypertension in children may be attributable to variations in the diagnostic thresholds of those three guidelines. Differences in the cut-offs of hypertension diagnostic criteria can be achieved due to differences in the reference population (e.g., year of data collection, basic characteristics) and different inclusion and exclusion criteria 9 , 11 , 27 . Interestingly, all of the guidelines revealed a greater prevalence of hypertension among suburban students than among urban students. Suburban children and adolescents were 1.19, 1.16 and 1.14 times more likely to have hypertension according to the NHCC, ESH and AAP guidelines, respectively, than were urban children and adolescents. This finding is consistent with previous research 28 – 30 . However, the difference in BP can be explained by children in rural areas having increases in heart rates, glycolipid levels, and breastfeeding prevalence and decreases in SES status and physical activity compared with those in urban areas 29 . The high incidence of childhood hypertension is alarming in rural areas, and urgent intervention is needed to determine the main risk factors. Thus, health education should include interventions to target hypertension in children in rural areas. We also found that the incidence of hypertension varied geographically in the surveyed population. The prevalence of hypertension in central and southern Shaanxi was lower than that in northern Shaanxi. For geographical and sociocultural reasons, dietary patterns are different and population specific in each area 31 . The lowest scores of the equilibrium pattern were in northern Shaanxi, and the scores of the snack pattern were greater in northern Shaanxi than in central and southern Shaanxi 32 . Hence, geographical dietary differences in hypertension could exist in Shaanxi Province, with a greater prevalence in northern Shaanxi Province. These factors could explain in part the regional discrepancies in the incidence of hypertension in children across Shaanxi Province. However, further studies will be required to clarify the contributions of these factors. We observed that overweight and obese children and adolescents, respectively, had a greater possibility of developing hypertension according to all of the guidelines, which is consistent with other studies showing that blood pressure or hypertension are positively correlated with BMI and obesity 33 – 35 . For example, Indian children with obesity had a significantly greater incidence of hypertension than did normal weight children 36 . A large study consisting of 7 cross-sectional surveys conducted in China, Korea, Poland, the USA, India, Iran, and Tunisia revealed that the relationship between BMI and HBP began in the 25th BMI percentile 37 . The levels of BP increased in parallel with increasing BMI among Chinese boys and girls. This is possibly because some adipocyte-derived factors are linked to blood pressure control, and aberrant production and release of those factors may contribute to a high incidence of hypertension in overweight and obese individuals 35 , 38 , 39 . Thus, body weight control was equally effective in decreasing BP. Here, we report a large student-based cross-sectional survey conducted in Shaanxi Province in 113 counties or districts using a multistage sampling method, which reliably represents the recent prevalence of hypertension in children and adolescents in Shaanxi Province. However, the conclusions are limited by the scope of the study. First, as a cross-sectional survey, only the prevalence of HBP can be determined, and no conclusion can be drawn on the cause of HBP in this population. Second, all causes of HBP could not be included due to the limitations of our survey methods. For example, HBP causing only undetectable BP is difficult to identify in students; hence, we suspect that our data underestimate the prevalence and burden of HBP. Nevertheless, the current study is the largest survey in northwestern China, providing the most up-to-date data on HBP and filling a gap in the knowledge of this geographical region. Methods Study design and data source This study analyzed the cross-sectional survey data set of the 2023 Shaanxi Student’s Health Surveillance Survey. The survey was conducted between September and December 2023 in Shaanxi Province, Northwest China. Considering the imbalanced population distribution and economic level between urban and suburban areas in the province, a stratified multistage cluster sampling method was employed. In the urban city, we randomly selected eight schools as surveillance schools, and in the suburban county, five schools were randomly selected as the surveillance schools. In the selected school, 2 classes were randomly chosen from each grade. All students from the selected class participated in the survey (Fig. 1 ). A total of 647 schools were sampled within 113 prefectures in Shaanxi Province, and 221,004 students were included in the survey. However, we had to exclude 507 participants due to missing data or extreme abnormal values of BP, height and weight, resulting in a total of 220,497 participants for our analysis. BP measurements and definitions BP was measured using a standard mercury sphygmomanometer recommended for upper arm models that are certified according to international standard schemes that passed a comprehensive test for measurement reliability. Measurements were performed by trained health technicians after at least 5 min of rest. BP was measured three times (at 1–2 min intervals). The average of the three SBP and DBP measurements was calculated. If the values of the measurements were high or fluctuated, the students were asked to calm down, and the measurement was repeated. The instruments used for the measurements were checked and calibrated in advance. Hypertension was defined as a BP ≥ 95th percentile based on age, sex and height percentiles according to the NHCC guidelines. The ESH guidelines recommend a similar definition of hypertension for children younger than 16 years and a BP ≥ 140/90 mmHg for those aged 16 years and older. Pediatric hypertension was defined as a BP ≥ 95th percentile for sex, age, and height or 130/80 mm Hg for children younger than 13 years and ≥ 130/80 mm Hg for those aged 13 years and older as per the AAP guidelines. In our comparison of prevalence, we considered children with elevated BP (prehypertension or high normal BP) and hypertension identified by each guideline as having “elevated BP” (Table 1 ). General examinations and definitions In the survey, the demographic characteristics of each participant, including sex, age, area and region, were recorded. The height and weight were measured using standard and calibrated equipment. Weight was measured to the nearest 0.10 kg with a balance-beam scale while the subjects were wearing lightweight clothing. Height was measured to the nearest 0.1 cm using a stadiometer without shoes according to a standardized protocol. Body mass index (BMI) is a widely used measure of weight status in childhood; it was calculated as weight in kilograms divided by the square of height in meters. BMI was categorized as normal (< p85th), overweight (P85th to P95th) or obese (≥ P95th) according to the American Centers for Disease Control (CDC) and Prevention Growth in 2000 16 . Statistical analysis Continuous variables are presented as the mean (standard deviation, SD), and categorical variables are presented as frequencies (%). Significant differences among the variables were determined by t tests for normally distributed variables and chi-square tests for categorical data. We reported the prevalence of HBP and hypertension according to the three guidelines according to sex. Additional subgroup hypertension incidence data were collected according to age, sex, area, region and obesity status. We also estimated the absolute prevalence of hypertension as defined in the NHCC, ESH and AAP guidelines stratified by demographic characteristics, and all the reported prevalence rates are reported with 95% confidence intervals (CIs). Thereafter, we used a log-binomial regression model to identify the factors associated with hypertension, describing the results with prevalence ratios (PRs) and their 95% CIs and P values. We used SAS version 9.4 (SAS Institute, Cary, NC, USA) for all the statistical analyses. Conclusion The results of this study showed that HBP among children and adolescents is a serious health problem in Shaanxi Province, Northwestern China, particularly in North Shaanxi. Living in suburban areas and being overweight or obese were all positively correlated with HBP incidence among children and adolescents in the study areas. These findings may have important public health policy implications for pediatric HBP interventions in Northwest China. Declarations Competing intersets The authors declare no competing interests. Author Contribution Author contributionsData curation: Minmin Li, Xinyan Wang, Qianyun Wang, Tong Hui, Wei Shi. Formal analysis: Minmin Li, Ruhai Bai.Investigation: Jingjun Zhao , Nan Yang.Methodology: Minmin Li, Nan Yang. Project administration: Minmin Li, Xinyan Wang, Jingjun Zhao,, Wei Shi. Supervision: Jingjun Zhao, Qianyun Wang, Wei Shi. Writing – original draft: Minmin Li. Writing – review & editing: Minmin Li, Wei Shi, Ruhai Bai. Acknowledgement We would like to thank all participants and investigators in this study. Data Availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. References Khoury, M. and E.M. Urbina, Hypertension in adolescents: diagnosis, treatment, and implications . The Lancet Child & Adolescent Health, 2021. 5(5): p. 357–366. Song, P., et al., Global Prevalence of Hypertension in Children . JAMA Pediatrics, 2019. 173(12). Daniels, S.R., Understanding the Global Prevalence of Hypertension in Children and Adolescents . JAMA Pediatrics, 2019. 173(12). Chiolero, A., P. Bovet, and G. Paradis, Screening for elevated blood pressure in children and adolescents: a critical appraisal . JAMA Pediatr, 2013. 167(3): p. 266–73. Rahmoune., H., N. Boutrid., and B. Bioud, Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux . New England Journal of Medicine, 2014. 371(11): p. 1070–1073. Matthew L. Hansen, Paul W. Gunn, and D.C. Kaelber., Underdiagnosis of hypertension in children and adolescents . JAMA 2007. 298(8): p. 874–9. Yan., W., et al., Blood pressure percentiles by age and height for non-overweight Chinese children and adolescents_ analysis of the China Health and Nutrition Surveys 1991–2009 . BMC Pediatrics, 2013. 13:195: p. 1–9. Adolescents., N.H.B.P.E.P.W.G.o.H.B.P.i.C.a., The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics, 2004. 114(2 Suppl 4th Report): p. 555 – 76. Lurbe, E., et al., 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. Journal of Hypertension, 2016. 34(10): p. 1887–1920. Flynn JT, K.D., Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM;, Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents . Pediatrics, 2017. 140(3): p. e20171904. China, N.H.C.o.t.P.s.R.o., Reference of screening for elevated blood pressure among children and adolescents aged 7ཞ18 years . 2018, National Health Commission of the People’s Republic of China: China. p. 6. Di Bonito, P., et al., The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines . European Journal of Preventive Cardiology, 2020. 27(1): p. 8–15. Genovesi, S., et al., How to Apply European and American Guidelines on High Blood Pressure in Children and Adolescents. A Position Paper Endorsed by the Italian Society of Hypertension and the Italian Society of Hypertension and the Italian Society of Pediatrics . High Blood Press Cardiovasc Prev, 2020. 27(3): p. 183–193. Antolini, L., et al., Nomograms to identify elevated blood pressure values and left ventricular hypertrophy in a paediatric population . Journal of Hypertension, 2019. 37(6): p. 1213–1222. Dong, Y., et al., Updates to pediatric hypertension guidelines: influence on classification of high blood pressure in children and adolescents . J Hypertens, 2019. 37(2): p. 297–306. Ogden, C.L. and K.M. Flegal, Changes in terminology for childhood overweight and obesity . Natl Health Stat Report, 2010. 25: p. 1–5. Furdela, V., et al., Prevalence of arterial hypertension among Ukrainian students: the comparison of European and American guidelines . Pediatr Endocrinol Diabetes Metab, 2022. 28(2): p. 123–131. Kuciene, R. and V. Dulskiene, Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study . Sci Rep, 2019. 9(1): p. 9493. Karatzi, K., et al., Prevalence of hypertension and hypertension phenotypes by age and gender among schoolchildren in Greece: The Healthy Growth Study . Atherosclerosis, 2017. 259: p. 128–133. Maldonado, J., et al., An approach of hypertension prevalence in a sample of 5381 Portuguese children and adolescents. The AVELEIRA registry. "Hypertension in children" . Blood Press, 2011. 20(3): p. 153–7. Kaczmarek, M., et al., Who is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study . Eur J Pediatr, 2015. 174(11): p. 1461–73. Lo, J.C., et al., Prehypertension and hypertension in community-based pediatric practice . Pediatrics, 2013. 131(2): p. e415-24. Hsu, W.F., et al., A reappraisal of the prevalence of pediatric hypertension through a nationwide database in Taiwan . Sci Rep, 2021. 11(1): p. 4475. Fan, H. and X. Zhang, Difference in hypertension prevalence applying three childhood hypertension management guidelines in a national cohort study . Journal of Human Hypertension, 2020. 35(11): p. 1038–1045. Stabouli, S., J. Redon, and E. Lurbe, Redefining hypertension in children and adolescents: A review of the evidence considered by the European Society of Hypertension and American Academy of Pediatrics guidelines . Journal of Hypertension, 2020. 38(2): p. 196–200. Condren, M., et al., The impact of new guidelines on the prevalence of hypertension in children: A cross-sectional evaluation . The Journal of Clinical Hypertension, 2019. 21(4): p. 510–515. Khoury, M., et al., Clinical Implications of the Revised AAP Pediatric Hypertension Guidelines . Pediatrics, 2018. 142(2): p. e20180245. Yang, Y., et al., Prevalence trends of hypertension and influence factors among children and adolescents aged 7–17 years in China, 2011–2015: A serial cross-sectional study . Frontiers in Public Health, 2022. 10. Liang, X., et al., Prevalence and Risk Factors of Childhood Hypertension in Urban-Rural Areas of China: A Cross-Sectional Study. International Journal of Hypertension, 2020. 2020: p. 1–18. Yan, W., et al., Reevaluate secular trends of body size measurements and prevalence of hypertension among Chinese children and adolescents in past two decades . Journal of Hypertension, 2016. 34(12): p. 2337–2343. Hu, F.B., Dietary pattern analysis_ a new direction in nutritional epidemiology . Curr Opin Lipidol, 2002. 13(1): p. 3–9. Spradley, F.T., et al., Geographical variations in maternal dietary patterns during pregnancy associated with birth weight in Shaanxi province, Northwestern China . Plos One, 2021. 16(7). Leung, L.C.K., et al., Prevalence and risk factors for hypertension in Hong Kong Chinese adolescents: waist circumference predicts hypertension, exercise decreases risk . Archives of Disease in Childhood, 2011. 96(9): p. 804–809. Xu, H., et al., The Association of Hypertension with Obesity and Metabolic Abnormalities among Chinese Children . International Journal of Hypertension, 2011. 2011: p. 1–5. Dong, B., et al., Trends in Blood Pressure and Body Mass Index Among Chinese Children and Adolescents From 2005 to 2010 . American Journal of Hypertension, 2013. 26(8): p. 997–1004. Meena, J., et al., Prevalence of Hypertension among Children and Adolescents in India: A Systematic Review and Meta-Analysis . Indian Journal of Pediatrics, 2021. 88(11): p. 1107–1114. Wang, M., et al., Body mass index percentiles and elevated blood pressure among children and adolescents . J Hum Hypertens, 2020. 34(4): p. 319–325. Yiannikouris, F., et al., Adipokines and blood pressure control . Current Opinion in Nephrology and Hypertension, 2010. 19(2): p. 195–200. Willig, A.L., et al., Adjusting Adiposity and Body Weight Measurements for Height Alters the Relationship With Blood Pressure in Children . American Journal of Hypertension, 2010. 23(8): p. 904–910. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 May, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 07 Feb, 2025 Reviews received at journal 15 Jan, 2025 Reviews received at journal 03 Jan, 2025 Reviewers agreed at journal 01 Jan, 2025 Reviewers agreed at journal 30 Dec, 2024 Reviews received at journal 09 Sep, 2024 Reviewers agreed at journal 21 Aug, 2024 Reviewers invited by journal 21 Aug, 2024 Editor assigned by journal 05 Aug, 2024 Editor invited by journal 30 Apr, 2024 Submission checks completed at journal 30 Apr, 2024 First submitted to journal 11 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4251847","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":298336595,"identity":"fc13c543-93fe-468a-afd2-b454af658528","order_by":0,"name":"Minmin Li","email":"","orcid":"","institution":"Shaanxi Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Minmin","middleName":"","lastName":"Li","suffix":""},{"id":298336596,"identity":"feabbcb5-e006-409c-92c6-2c9365a4ac52","order_by":1,"name":"Xinyan Wang","email":"","orcid":"","institution":"Shaanxi Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Xinyan","middleName":"","lastName":"Wang","suffix":""},{"id":298336597,"identity":"f5f006cc-2721-4cc3-b5c3-75ea2459abc8","order_by":2,"name":"Jingjun Zhao","email":"","orcid":"","institution":"Shaanxi Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Jingjun","middleName":"","lastName":"Zhao","suffix":""},{"id":298336598,"identity":"b91afb80-9ddb-474f-8b8f-33d72296de9d","order_by":3,"name":"Nan Yang","email":"","orcid":"","institution":"Xi’an Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nan","middleName":"","lastName":"Yang","suffix":""},{"id":298336599,"identity":"15da34ac-d775-4d75-9daf-560c2e3dddb1","order_by":4,"name":"Qianyun Wang","email":"","orcid":"","institution":"Shaanxi Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Qianyun","middleName":"","lastName":"Wang","suffix":""},{"id":298336600,"identity":"77660f9d-8893-4776-a1e2-7dc24ba82280","order_by":5,"name":"Wei Shi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAm0lEQVRIiWNgGAWjYDACCcYGhg8GNnakaWGcUZCWTIoWBgZmng+HgHYRC+RnN7dJ2xgcYGZgP3x0A1FaDO4cbJPOMbjDx8CTlnaDOC0SiW23cwyeMTNI8JgRp0V+BlCLhcFhxgaitTDcAGphIEmLwY3E9p89BmnJbET7RX5G+mODH39s7PjZDx8j0mEwwEaa8lEwCkbBKBgFeAEASZMugdSpgnwAAAAASUVORK5CYII=","orcid":"","institution":"Shaanxi Provincial Center for Disease Control and Prevention","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Shi","suffix":""},{"id":298336601,"identity":"ebfe7848-ebd0-40a8-9e3b-2ffee0728c0b","order_by":6,"name":"Ruhai Bai","email":"","orcid":"","institution":"Children’s Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ruhai","middleName":"","lastName":"Bai","suffix":""},{"id":298336602,"identity":"8089836f-085f-4865-b871-e5efcba74c31","order_by":7,"name":"Tong Hui","email":"","orcid":"","institution":"Shaanxi Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Tong","middleName":"","lastName":"Hui","suffix":""}],"badges":[],"createdAt":"2024-04-11 10:33:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4251847/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4251847/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-01039-6","type":"published","date":"2025-05-30T15:57:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":56099361,"identity":"68b3c463-0646-4534-8daa-ea03f38efc4d","added_by":"auto","created_at":"2024-05-08 14:25:54","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":81906,"visible":true,"origin":"","legend":"\u003cp\u003eSampling flowchart\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4251847/v1/227f693df1b76b4ef8235494.jpg"},{"id":56099362,"identity":"ab1b9d12-dc75-4c53-8a3f-780f11eeedb9","added_by":"auto","created_at":"2024-05-08 14:25:54","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":189330,"visible":true,"origin":"","legend":"\u003cp\u003eUPR of factors associated with hypertension according to NHCC, ESH and AAP guideline.\u003c/p\u003e\n\u003cp\u003eUPR: Unadjusted prevalence ratio.\u003c/p\u003e\n\u003cp\u003eNHCC: National Health Commission of the People’s Republic of China.\u003c/p\u003e\n\u003cp\u003eESH: European Society of Hypertension.\u003c/p\u003e\n\u003cp\u003eAAP: American Academy of Pediatrics\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4251847/v1/b6d04ee1434e55de79109f61.jpg"},{"id":83782893,"identity":"639569b6-7960-48f1-a80a-f3f5bea79b8e","added_by":"auto","created_at":"2025-06-02 16:08:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1215328,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4251847/v1/6a2f1917-77b3-47bc-98ab-35338d131682.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and risk factors for hypertension among children and adolescents in Shaanxi Province, Northwestern China, according to the three hypertension guidelines","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHypertension, also known as high blood pressure (HBP), is a major risk factor for the development of heart failure and cardiovascular disease (CVD) from childhood to adulthood and is associated with adverse cardiac and vascular changes that can in turn be associated with CVD events in adulthood\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Hypertension is also considered a major cause of poorer disability-adjusted life-years and substantially contributes to mortality and disability\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. HBP was once considered a rare disease in children\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e but is now considered a major public health problem worldwide\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Previous pathophysiologic and epidemiologic evidence has suggested that childhood hypertension is associated with essential hypertension in adulthood and with lifelong CVD. Therefore, blood pressure (BP) measurement during childhood is a necessary component of preventive health care targeting this problem in children and adolescents.\u003c/p\u003e \u003cp\u003eBP changes normally with increasing age and body size, which means that establishing a single set of values for systolic BP (SBP) and diastolic BP (DBP) elevation is difficult, especially for younger children. Thus, pediatric hypertension has traditionally been defined on the basis of age-specific, sex-specific, and height-specific normative values. In 2004, the US National Heart, Lung, and Blood Institute released its Fourth Report on the Diagnosis, Evaluation, and Treatment of High BP in Children and Adolescents, which recommended pediatric hypertension as a value that met or exceeded the sex-, age-, and height-specific 95th BP percentile\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. In 2016 and 2017, the European Society of Hypertension (ESH) and American Academy of Pediatrics (AAP), respectively, updated their childhood hypertension management\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In 2018, the National Health Commission of the People\u0026rsquo;s Republic of China (NHCC) published a reference for screening for elevated blood pressure among children and adolescents aged 7\u0026ndash;18 years\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. After the publication of these guidelines, these statements caused active discussion. Their sensitivity was tested, and the percentage of reclassified children differed in some populations\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Antolini et al. reported that the AAP guidelines detected a greater incidence of hypertension than did the ESH guidelines\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Dong et al. observed a greater incidence of hypertension when using the definition in the AAP guidelines than when using the definition in the Fourth Report\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Despite the large number of studies that have assessed the prevalence of hypertension in children and adolescents, to our knowledge, estimates of the prevalence of childhood hypertension have not been made using the NHCC, ESH and AAP guidelines in Northwest China.\u003c/p\u003e \u003cp\u003eIn sparsely populated northwestern China, economic conditions are worse, and health services are less developed than in the eastern and coastal areas of China. Nearly half of the population of Northwest China lives in Shaanxi Province. Until recently, however, limited population-based data on the prevalence and epidemiological characteristics of hypertension in Shaanxi Province or Northwest China were available. The objective of this study was to investigate the prevalence and epidemiological characteristics of hypertension among children and adolescents aged 7\u0026ndash;17 years in Shaanxi Province using the three hypertension guidelines for children and adolescents. We expect the results to provide the most updated information on the rate of hypertension among children and adolescents in Shaanxi Province, Northwest China.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe final population included in the analyses consisted of 220,497 students aged 7\u0026ndash;17 years, and 112,354 (50.95%) were boys. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the basic characteristics of this study population. The average age of our participants was 11.73 years. Of the total participants, 62.96% were urban, 21.37% were residing in northern Shaanxi, and 54.75% were residing in central Shaanxi. The average height, weight and BMI of our participants were 151.02 cm, 46.45 kg and 19.72 kg/m\u003csup\u003e2,\u003c/sup\u003e respectively. Furthermore, 16.53% of participants were overweight, and 14.57% had obesity in the survey. The average SBP and DBP of our participants were 106.39 mmHg and 66.84 mmHg, respectively. Significant differences were observed in the distributions of participant age, area, region groups, educational level, SBP, DBP, height, weight, BMI and BMI status between male and female participants (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\n\u003cp\u003eTable 1. NHCC, ESH and AAP definitions of pediatric hypertension\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"879\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003eNHCC guideline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003eESH guideline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003eAAP guideline\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003eNormal blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;13 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;90\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;90\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;90\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e13-15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;90\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;90\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;90\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e16-17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;90\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;130/85mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;120/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003eElevated or high-normal blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;13 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003csup\u003eth\u003c/sup\u003e to \u0026lt;95\u003csup\u003eth\u003c/sup\u003e percentile or 120/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003csup\u003eth\u003c/sup\u003e to \u0026lt;95\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003csup\u003eth\u003c/sup\u003e to \u0026lt;95\u003csup\u003eth\u003c/sup\u003e percentile or \u0026ge;120/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e13-15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003csup\u003eth\u003c/sup\u003e to \u0026lt;95\u003csup\u003eth\u003c/sup\u003e percentile or 120/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003csup\u003eth\u003c/sup\u003e to \u0026lt;95\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;120/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e16-17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003csup\u003eth\u003c/sup\u003e to \u0026lt;95\u003csup\u003eth\u003c/sup\u003e percentile or 120/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e130-139/85-89mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;120/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003eHigh blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;13 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;95\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;95\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;95\u003csup\u003eth\u003c/sup\u003e percentile or \u0026ge;130/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e13-15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;95\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;95\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;130/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e16-17 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.107061503416855%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;95\u003csup\u003eth\u003c/sup\u003e percentile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.970387243735765%\" valign=\"top\"\u003e\n \u003cp\u003e140/90mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.815489749430522%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;130/80mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNHCC: National Health Commission of the People\u0026rsquo;s Republic of China. ESH: European Society of Hypertension. AAP: American Academy of Pediatrics\u003c/p\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristic of all participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBackground characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBoy (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGirl (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e220497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (SD), (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;12 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128007 (58.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66387 (59.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61620 (56.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61097 (27.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30746 (27.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30351 (28.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;17 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31393 (14.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15221 (13.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16172 (14.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138831 (62.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71289 (63.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67542 (62.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81666 (37.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41065 (36.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40601 (37.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47120 (21.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24855 (22.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22265 (20.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120722 (54.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60902 (54.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59820 (55.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52655 (23.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26597 (23.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26058 (24.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight, mean (SD), (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151.02\u0026thinsp;\u0026plusmn;\u0026thinsp;15.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152.8\u0026thinsp;\u0026plusmn;\u0026thinsp;17.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight, mean (SD), (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.45\u0026thinsp;\u0026plusmn;\u0026thinsp;16.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.37\u0026thinsp;\u0026plusmn;\u0026thinsp;18.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.44\u0026thinsp;\u0026plusmn;\u0026thinsp;14.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, mean (SD), (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.99\u0026thinsp;\u0026plusmn;\u0026thinsp;4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.44\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151904 (68.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71983 (64.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79921 (73.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36456 (16.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20521 (18.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15935 (14.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32137 (14.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19850 (17.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12287 (11.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBP, mean (SD), (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106.39\u0026thinsp;\u0026plusmn;\u0026thinsp;12.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.84\u0026thinsp;\u0026plusmn;\u0026thinsp;8.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.71\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI: Body Mass Index. BP: Blood Pressure. SBP: Systolic Blood Pressure. DBP: Diastolic Blood Pressure.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e The prevalence of hypertension was 11.73% (95% CI: 11.59, 11.86%), 10.04% (95% CI: 9.91, 10.16%) and 15.75% (95% CI: 15.60, 15.91%) according to the NHCC, ESH and AAP guidelines, respectively. The prevalence of pediatric hypertension according to the NHCC, ESH and AAP guidelines are compared in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The prevalence of hypertension in 7\u0026ndash;12-year-old and 13\u0026ndash;15-year-old participants was 10.65% (95% CI 10.48, 10.82%) and 13.30% (95% CI 13.03, 13.57%), respectively, according to the NHCC guidelines and the ESH and AAP guidelines. The prevalence of hypertension in individuals aged 16\u0026ndash;17 years was 13.03% (95% CI 12.66\u0026ndash;13.40%) in the NHCC guidelines and 2.43% (95% CI 2.26\u0026ndash;2.60%) in the ESH guidelines, representing a difference of more than six times. The results from subgroup analyses according to sex, area, region and BMI status showed that the prevalence of hypertension according to the NHCC guidelines was greater than that according to the ESH guidelines and lower than that according to the AAP guidelines.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHypertension prevalence as defined in ESH, AAP guidelines, and HNC standard stratified by demographic characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExplanatory variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNHCC\u003c/p\u003e \u003cp\u003eprevalence (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eESH\u003c/p\u003e \u003cp\u003eprevalence (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAAP\u003c/p\u003e \u003cp\u003eprevalence (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDifference prevalence between NHCC and ESH (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDifference prevalence between NHCC and AAP (95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.73 (11.59, 11.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.04 (9.91, 10.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.75 (15.60, 15.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.69 (1.51, 1.87)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.03 (-4.23, -3.83)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;12 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.65 (10.48,10.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.33 (11.16,11.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.71 (16.51,16.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.68 (-0.92,-0.43)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.06 (-6.33,-5.80)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.30 (13.03,13.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.23 (10.98,11.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.78 (12.51,13.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.07 (1.70,2.44)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.52 (0.15,0.90)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;17 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.03 (12.66,13.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.43 (2.26,2.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.63 (17.21,18.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.60 (10.19,11.01)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.60 (-5.16,-4.04)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.11 (10.93, 11.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.78 (10.60,10.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.78 (17.55, 18.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.33 (0.07, 0.58)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.99 (6.70, 7.28)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.36 (12.17, 12.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.26 (9.08,9.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.65 (13.45, 13.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.11 (2.85,3.37)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.29 (-1.57,-1.01)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.19 (9.99,10.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.03 (7.84,8.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.03 (13.79,14.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.17 (1.89,2.45)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.83 (-4.15,-3.52)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.63 (12.45,12.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.22 (11.05,11.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.77 (16.57,16.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.41 (1.17,1.65)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.14 (-4.41,-3.88)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.36 (14.04,14.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.43 (13.12,13.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.90 (18.55,19.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.94 (0.49,1.38)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.54 (-5.01,-4.06)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.27 (10.10,10.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.42 (8.26,8.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.15 (13.95,14.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.85 (1.61,2.08)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.88 (-4.14,-3.62)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.71 (12.42,12.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.70 (10.44,10.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.62 (16.30,16.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.01 (1.62,2.40)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.91 (-4.33,-3.48)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.47 (9.33,9.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.83 (7.69,7.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.59 (12.42,12.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.64 (1.44,1.84)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.12 (-3.34,-2.89)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.99 (13.63,14.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.66 (11.33,11.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.64 (18.24,19.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.33 (1.84,2.81)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-4.65 (-5.18,-4.11)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.80 (19.37,20.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.61 (18.19,19.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.45 (26.96,27.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.19 (0.58,1.80)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-7.64 (-8.30,-6.99)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNHCC: National Health Commission of the People\u0026rsquo;s Republic of China. ESH: European Society of Hypertension. AAP: American Academy of Pediatrics. BMI: Body Mass Index.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the results of the unadjusted model, where obesity showed the strongest association with developing hypertension (UPR\u0026thinsp;=\u0026thinsp;2.09, 95% CI 2.03\u0026ndash;2.14). This was followed by overweight (UPR\u0026thinsp;=\u0026thinsp;2.09, 95% CI 2.03\u0026ndash;2.14), which was associated with greater odds of having hypertension according to NHCC guidelines. A similar result was also observed for the ESH and AAP guidelines.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e describes the risk factors associated with hypertension according to the NHCC, ESH and AAP guidelines after all the possible risk factors were adjusted for in the log-binomial multivariate model. Compared with 7- to 12-year-old participants, 13- to 15-year-old participants had a greater incidence of hypertension according to the NHCC and ESH guidelines but a lower incidence of hypertension according to the AAP guidelines. Sixteen- to 17-year-old participants had a significantly lower incidence of hypertension according to the ESH guidelines but a greater incidence according to the NHCC and AAP guidelines. Moreover, girls had a significantly greater incidence of hypertension than boys did only according to the NHCC standard. However, according to the ESH and AAP guidelines, girls had a significantly lower incidence of hypertension than boys did. Students who lived in suburban areas were more likely to have hypertension than those who lived in urban areas according to all the guidelines. The prevalence of hypertension in children was lower in central and southern Shaanxi Province than in northern Shaanxi Province according to all guidelines. Furthermore, overweight and obesity increased the risk of hypertension among children according to all three guidelines.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePredictors of hypertension among children and adolescents using an adjusted log-binomial regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExplanatory variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHNCC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eESH\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eAAP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;12 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.31(1.28,1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05(1.02,1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.81(0.79,0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;17 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.33(1.29,1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.24(0.22,0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.16(1.13,1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.20(1.17,1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95(0.93,0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.83(0.81,0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuburban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.19(1.16,1.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.16(1.13,1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.14(1.12,1.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.77(0.74,0.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.71(0.69,0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.80(0.78,0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.92(0.89,0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.84(0.81,0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.92(0.89,0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.49(1.45,1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.51(1.46,1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.45(1.41,1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.21(2.15,2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.32(2.25,2.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.11(2.06,2.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNHCC: National Health Commission of the People\u0026rsquo;s Republic of China. ESH: European Society of Hypertension. AAP: American Academy of Pediatrics. BMI: Body Mass Index. PR: Prevalence ratio. CI: Confidence interval. P-value: Probability value.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA large population-based cross-sectional Student\u0026rsquo;s Health Surveillance study conducted in Shaanxi Province, Northwest China, investigated the prevalence and epidemiological characteristics of hypertension among children and adolescents in 2023. We found that the prevalence of hypertension was approximately 10.04\u0026ndash;15.75% among those aged 7\u0026ndash;17 years according to three different guidelines. Furthermore, the rate of hypertension differed significantly with respect to baseline characteristics among the participants in the surveillance areas.\u003c/p\u003e \u003cp\u003eThe prevalence of HBP varies widely across studies worldwide (ranging from 0.6\u0026ndash;25.1%) performed at different times, in different manners, across age groups, and among populations of children and adolescents\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. For instance, the prevalence of hypertension in Lithuanian adolescents aged 12\u0026ndash;15 years is 22.2%\u003csup\u003e18\u003c/sup\u003e; in 9-13-year-old Greek school children, it is 23%\u003csup\u003e19\u003c/sup\u003e. The prevalence in Portuguese children and adolescents aged 4 to 18 years it is 12.8%\u003csup\u003e20\u003c/sup\u003e, and in 10-18-year-old Polish schoolchildren, it is 8.9%\u003csup\u003e21\u003c/sup\u003e. In the US pediatric population, hypertension has been estimated to affect 0.1\u0026ndash;0.3% of children aged 3\u0026ndash;17 years\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, and it affects 0.19 to 0.38 per 1000 children in Taiwan\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e Our findings demonstrate the variations in the estimated prevalence of hypertension in Shaanxi Province according to the NHCC, ESH and AAP guidelines, which were developed to classify prehypertension and hypertension statuses in children and adolescents. Our results indicate that the overall and subgroup (sex, area, region, and BMI status) hypertension incidence determined using the AAP guidelines was significantly greater than that determined using the NHCC and ESH guidelines\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. The use of the AAP guidelines resulted in a lower incidence of hypertension in the 13\u0026ndash;15 years age subgroup than did the use of the NHCC guidelines. Differences in the prevalence of hypertension and the ability to detect hypertension in children may be attributable to variations in the diagnostic thresholds of those three guidelines. Differences in the cut-offs of hypertension diagnostic criteria can be achieved due to differences in the reference population (e.g., year of data collection, basic characteristics) and different inclusion and exclusion criteria\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e Interestingly, all of the guidelines revealed a greater prevalence of hypertension among suburban students than among urban students. Suburban children and adolescents were 1.19, 1.16 and 1.14 times more likely to have hypertension according to the NHCC, ESH and AAP guidelines, respectively, than were urban children and adolescents. This finding is consistent with previous research\u003csup\u003e\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. However, the difference in BP can be explained by children in rural areas having increases in heart rates, glycolipid levels, and breastfeeding prevalence and decreases in SES status and physical activity compared with those in urban areas\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The high incidence of childhood hypertension is alarming in rural areas, and urgent intervention is needed to determine the main risk factors. Thus, health education should include interventions to target hypertension in children in rural areas.\u003c/p\u003e \u003cp\u003eWe also found that the incidence of hypertension varied geographically in the surveyed population. The prevalence of hypertension in central and southern Shaanxi was lower than that in northern Shaanxi. For geographical and sociocultural reasons, dietary patterns are different and population specific in each area\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. The lowest scores of the equilibrium pattern were in northern Shaanxi, and the scores of the snack pattern were greater in northern Shaanxi than in central and southern Shaanxi\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Hence, geographical dietary differences in hypertension could exist in Shaanxi Province, with a greater prevalence in northern Shaanxi Province. These factors could explain in part the regional discrepancies in the incidence of hypertension in children across Shaanxi Province. However, further studies will be required to clarify the contributions of these factors.\u003c/p\u003e \u003cp\u003eWe observed that overweight and obese children and adolescents, respectively, had a greater possibility of developing hypertension according to all of the guidelines, which is consistent with other studies showing that blood pressure or hypertension are positively correlated with BMI and obesity\u003csup\u003e\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. For example, Indian children with obesity had a significantly greater incidence of hypertension than did normal weight children\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. A large study consisting of 7 cross-sectional surveys conducted in China, Korea, Poland, the USA, India, Iran, and Tunisia revealed that the relationship between BMI and HBP began in the 25th BMI percentile\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. The levels of BP increased in parallel with increasing BMI among Chinese boys and girls. This is possibly because some adipocyte-derived factors are linked to blood pressure control, and aberrant production and release of those factors may contribute to a high incidence of hypertension in overweight and obese individuals\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Thus, body weight control was equally effective in decreasing BP.\u003c/p\u003e \u003cp\u003eHere, we report a large student-based cross-sectional survey conducted in Shaanxi Province in 113 counties or districts using a multistage sampling method, which reliably represents the recent prevalence of hypertension in children and adolescents in Shaanxi Province. However, the conclusions are limited by the scope of the study. First, as a cross-sectional survey, only the prevalence of HBP can be determined, and no conclusion can be drawn on the cause of HBP in this population. Second, all causes of HBP could not be included due to the limitations of our survey methods. For example, HBP causing only undetectable BP is difficult to identify in students; hence, we suspect that our data underestimate the prevalence and burden of HBP. Nevertheless, the current study is the largest survey in northwestern China, providing the most up-to-date data on HBP and filling a gap in the knowledge of this geographical region.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design and data source\u003c/h2\u003e\n \u003cp\u003eThis study analyzed the cross-sectional survey data set of the 2023 Shaanxi Student\u0026rsquo;s Health Surveillance Survey. The survey was conducted between September and December 2023 in Shaanxi Province, Northwest China. Considering the imbalanced population distribution and economic level between urban and suburban areas in the province, a stratified multistage cluster sampling method was employed. In the urban city, we randomly selected eight schools as surveillance schools, and in the suburban county, five schools were randomly selected as the surveillance schools. In the selected school, 2 classes were randomly chosen from each grade. All students from the selected class participated in the survey (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). A total of 647 schools were sampled within 113 prefectures in Shaanxi Province, and 221,004 students were included in the survey. However, we had to exclude 507 participants due to missing data or extreme abnormal values of BP, height and weight, resulting in a total of 220,497 participants for our analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eBP measurements and definitions\u003c/h2\u003e\n \u003cp\u003eBP was measured using a standard mercury sphygmomanometer recommended for upper arm models that are certified according to international standard schemes that passed a comprehensive test for measurement reliability. Measurements were performed by trained health technicians after at least 5 min of rest. BP was measured three times (at 1\u0026ndash;2 min intervals). The average of the three SBP and DBP measurements was calculated. If the values of the measurements were high or fluctuated, the students were asked to calm down, and the measurement was repeated. The instruments used for the measurements were checked and calibrated in advance.\u003c/p\u003e\n \u003cp\u003eHypertension was defined as a BP\u0026thinsp;\u0026ge;\u0026thinsp;95th percentile based on age, sex and height percentiles according to the NHCC guidelines. The ESH guidelines recommend a similar definition of hypertension for children younger than 16 years and a BP\u0026thinsp;\u0026ge;\u0026thinsp;140/90 mmHg for those aged 16 years and older. Pediatric hypertension was defined as a BP\u0026thinsp;\u0026ge;\u0026thinsp;95th percentile for sex, age, and height or 130/80 mm Hg for children younger than 13 years and \u0026ge;\u0026thinsp;130/80 mm Hg for those aged 13 years and older as per the AAP guidelines. In our comparison of prevalence, we considered children with elevated BP (prehypertension or high normal BP) and hypertension identified by each guideline as having \u0026ldquo;elevated BP\u0026rdquo; (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eGeneral examinations and definitions\u003c/h2\u003e\n \u003cp\u003eIn the survey, the demographic characteristics of each participant, including sex, age, area and region, were recorded. The height and weight were measured using standard and calibrated equipment. Weight was measured to the nearest 0.10 kg with a balance-beam scale while the subjects were wearing lightweight clothing. Height was measured to the nearest 0.1 cm using a stadiometer without shoes according to a standardized protocol. Body mass index (BMI) is a widely used measure of weight status in childhood; it was calculated as weight in kilograms divided by the square of height in meters. BMI was categorized as normal (\u0026lt;\u0026thinsp;p85th), overweight (P85th to P95th) or obese (\u0026ge;\u0026thinsp;P95th) according to the American Centers for Disease Control (CDC) and Prevention Growth in 2000\u003csup\u003e16\u003c/sup\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eContinuous variables are presented as the mean (standard deviation, SD), and categorical variables are presented as frequencies (%). Significant differences among the variables were determined by t tests for normally distributed variables and chi-square tests for categorical data. We reported the prevalence of HBP and hypertension according to the three guidelines according to sex. Additional subgroup hypertension incidence data were collected according to age, sex, area, region and obesity status. We also estimated the absolute prevalence of hypertension as defined in the NHCC, ESH and AAP guidelines stratified by demographic characteristics, and all the reported prevalence rates are reported with 95% confidence intervals (CIs). Thereafter, we used a log-binomial regression model to identify the factors associated with hypertension, describing the results with prevalence ratios (PRs) and their 95% CIs and P values. We used SAS version 9.4 (SAS Institute, Cary, NC, USA) for all the statistical analyses.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study showed that HBP among children and adolescents is a serious health problem in Shaanxi Province, Northwestern China, particularly in North Shaanxi. Living in suburban areas and being overweight or obese were all positively correlated with HBP incidence among children and adolescents in the study areas. These findings may have important public health policy implications for pediatric HBP interventions in Northwest China.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting intersets\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor contributionsData curation: Minmin Li, Xinyan Wang, Qianyun Wang, Tong Hui, Wei Shi. Formal analysis: Minmin Li, Ruhai Bai.Investigation: Jingjun Zhao , Nan Yang.Methodology: Minmin Li, Nan Yang. Project administration: Minmin Li, Xinyan Wang, Jingjun Zhao,, Wei Shi. Supervision: Jingjun Zhao, Qianyun Wang, Wei Shi. Writing \u0026ndash; original draft: Minmin Li. Writing \u0026ndash; review \u0026amp; editing: Minmin Li, Wei Shi, Ruhai Bai.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank all participants and investigators in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhoury, M. and E.M. Urbina, \u003cem\u003eHypertension in adolescents: diagnosis, treatment, and implications\u003c/em\u003e. The Lancet Child \u0026amp; Adolescent Health, 2021. 5(5): p. 357\u0026ndash;366.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong, P., et al., \u003cem\u003eGlobal Prevalence of Hypertension in Children\u003c/em\u003e. JAMA Pediatrics, 2019. 173(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaniels, S.R., \u003cem\u003eUnderstanding the Global Prevalence of Hypertension in Children and Adolescents\u003c/em\u003e. JAMA Pediatrics, 2019. 173(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiolero, A., P. Bovet, and G. Paradis, \u003cem\u003eScreening for elevated blood pressure in children and adolescents: a critical appraisal\u003c/em\u003e. JAMA Pediatr, 2013. 167(3): p. 266\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRahmoune., H., N. Boutrid., and B. Bioud, \u003cem\u003eAntimicrobial Prophylaxis for Children with Vesicoureteral Reflux\u003c/em\u003e. New England Journal of Medicine, 2014. 371(11): p. 1070\u0026ndash;1073.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatthew L. Hansen, Paul W. Gunn, and D.C. Kaelber., \u003cem\u003eUnderdiagnosis of hypertension in children and adolescents\u003c/em\u003e. JAMA 2007. 298(8): p. 874\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan., W., et al., \u003cem\u003eBlood pressure percentiles by age and height for non-overweight Chinese children and adolescents_ analysis of the China Health and Nutrition Surveys 1991\u0026ndash;2009\u003c/em\u003e. BMC Pediatrics, 2013. 13:195: p. 1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdolescents., N.H.B.P.E.P.W.G.o.H.B.P.i.C.a., \u003cem\u003eThe fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.\u003c/em\u003e Pediatrics, 2004. 114(2 Suppl 4th Report): p. 555\u0026thinsp;\u0026ndash;\u0026thinsp;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLurbe, E., et al., 2016 \u003cem\u003eEuropean Society of Hypertension guidelines for the management of high blood pressure in children and adolescents.\u003c/em\u003e Journal of Hypertension, 2016. 34(10): p. 1887\u0026ndash;1920.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlynn JT, K.D., Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM;, \u003cem\u003eClinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents\u003c/em\u003e. Pediatrics, 2017. 140(3): p. e20171904.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChina, N.H.C.o.t.P.s.R.o., \u003cem\u003eReference of screening for elevated blood pressure among children and adolescents aged 7ཞ18 years\u003c/em\u003e. 2018, National Health Commission of the People\u0026rsquo;s Republic of China: China. p. 6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Bonito, P., et al., \u003cem\u003eThe American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines\u003c/em\u003e. European Journal of Preventive Cardiology, 2020. 27(1): p. 8\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGenovesi, S., et al., \u003cem\u003eHow to Apply European and American Guidelines on High Blood Pressure in Children and Adolescents. A Position Paper Endorsed by the Italian Society of Hypertension and the Italian Society of Hypertension and the Italian Society of Pediatrics\u003c/em\u003e. High Blood Press Cardiovasc Prev, 2020. 27(3): p. 183\u0026ndash;193.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntolini, L., et al., \u003cem\u003eNomograms to identify elevated blood pressure values and left ventricular hypertrophy in a paediatric population\u003c/em\u003e. Journal of Hypertension, 2019. 37(6): p. 1213\u0026ndash;1222.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong, Y., et al., \u003cem\u003eUpdates to pediatric hypertension guidelines: influence on classification of high blood pressure in children and adolescents\u003c/em\u003e. J Hypertens, 2019. 37(2): p. 297\u0026ndash;306.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgden, C.L. and K.M. Flegal, \u003cem\u003eChanges in terminology for childhood overweight and obesity\u003c/em\u003e. Natl Health Stat Report, 2010. 25: p. 1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFurdela, V., et al., \u003cem\u003ePrevalence of arterial hypertension among Ukrainian students: the comparison of European and American guidelines\u003c/em\u003e. Pediatr Endocrinol Diabetes Metab, 2022. 28(2): p. 123\u0026ndash;131.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuciene, R. and V. Dulskiene, \u003cem\u003eAssociations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study\u003c/em\u003e. Sci Rep, 2019. 9(1): p. 9493.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaratzi, K., et al., \u003cem\u003ePrevalence of hypertension and hypertension phenotypes by age and gender among schoolchildren in Greece: The Healthy Growth Study\u003c/em\u003e. Atherosclerosis, 2017. 259: p. 128\u0026ndash;133.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaldonado, J., et al., \u003cem\u003eAn approach of hypertension prevalence in a sample of 5381 Portuguese children and adolescents. The AVELEIRA registry. \"Hypertension in children\"\u003c/em\u003e. Blood Press, 2011. 20(3): p. 153\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaczmarek, M., et al., \u003cem\u003eWho is at higher risk of hypertension? Socioeconomic status differences in blood pressure among Polish adolescents: a population-based ADOPOLNOR study\u003c/em\u003e. Eur J Pediatr, 2015. 174(11): p. 1461\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLo, J.C., et al., \u003cem\u003ePrehypertension and hypertension in community-based pediatric practice\u003c/em\u003e. Pediatrics, 2013. 131(2): p. e415-24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsu, W.F., et al., \u003cem\u003eA reappraisal of the prevalence of pediatric hypertension through a nationwide database in Taiwan\u003c/em\u003e. Sci Rep, 2021. 11(1): p. 4475.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan, H. and X. Zhang, \u003cem\u003eDifference in hypertension prevalence applying three childhood hypertension management guidelines in a national cohort study\u003c/em\u003e. Journal of Human Hypertension, 2020. 35(11): p. 1038\u0026ndash;1045.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStabouli, S., J. Redon, and E. Lurbe, \u003cem\u003eRedefining hypertension in children and adolescents: A review of the evidence considered by the European Society of Hypertension and American Academy of Pediatrics guidelines\u003c/em\u003e. Journal of Hypertension, 2020. 38(2): p. 196\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCondren, M., et al., \u003cem\u003eThe impact of new guidelines on the prevalence of hypertension in children: A cross-sectional evaluation\u003c/em\u003e. The Journal of Clinical Hypertension, 2019. 21(4): p. 510\u0026ndash;515.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoury, M., et al., \u003cem\u003eClinical Implications of the Revised AAP Pediatric Hypertension Guidelines\u003c/em\u003e. Pediatrics, 2018. 142(2): p. e20180245.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang, Y., et al., \u003cem\u003ePrevalence trends of hypertension and influence factors among children and adolescents aged 7\u0026ndash;17 years in China, 2011\u0026ndash;2015: A serial cross-sectional study\u003c/em\u003e. Frontiers in Public Health, 2022. 10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang, X., et al., \u003cem\u003ePrevalence and Risk Factors of Childhood Hypertension in Urban-Rural Areas of China: A Cross-Sectional Study.\u003c/em\u003e International Journal of Hypertension, 2020. 2020: p. 1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan, W., et al., \u003cem\u003eReevaluate secular trends of body size measurements and prevalence of hypertension among Chinese children and adolescents in past two decades\u003c/em\u003e. Journal of Hypertension, 2016. 34(12): p. 2337\u0026ndash;2343.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu, F.B., \u003cem\u003eDietary pattern analysis_ a new direction in nutritional epidemiology\u003c/em\u003e. Curr Opin Lipidol, 2002. 13(1): p. 3\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpradley, F.T., et al., \u003cem\u003eGeographical variations in maternal dietary patterns during pregnancy associated with birth weight in Shaanxi province, Northwestern China\u003c/em\u003e. Plos One, 2021. 16(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeung, L.C.K., et al., \u003cem\u003ePrevalence and risk factors for hypertension in Hong Kong Chinese adolescents: waist circumference predicts hypertension, exercise decreases risk\u003c/em\u003e. Archives of Disease in Childhood, 2011. 96(9): p. 804\u0026ndash;809.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu, H., et al., \u003cem\u003eThe Association of Hypertension with Obesity and Metabolic Abnormalities among Chinese Children\u003c/em\u003e. International Journal of Hypertension, 2011. 2011: p. 1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong, B., et al., \u003cem\u003eTrends in Blood Pressure and Body Mass Index Among Chinese Children and Adolescents From 2005 to 2010\u003c/em\u003e. American Journal of Hypertension, 2013. 26(8): p. 997\u0026ndash;1004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeena, J., et al., \u003cem\u003ePrevalence of Hypertension among Children and Adolescents in India: A Systematic Review and Meta-Analysis\u003c/em\u003e. Indian Journal of Pediatrics, 2021. 88(11): p. 1107\u0026ndash;1114.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, M., et al., \u003cem\u003eBody mass index percentiles and elevated blood pressure among children and adolescents\u003c/em\u003e. J Hum Hypertens, 2020. 34(4): p. 319\u0026ndash;325.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYiannikouris, F., et al., \u003cem\u003eAdipokines and blood pressure control\u003c/em\u003e. Current Opinion in Nephrology and Hypertension, 2010. 19(2): p. 195\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWillig, A.L., et al., \u003cem\u003eAdjusting Adiposity and Body Weight Measurements for Height Alters the Relationship With Blood Pressure in Children\u003c/em\u003e. American Journal of Hypertension, 2010. 23(8): p. 904\u0026ndash;910.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4251847/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4251847/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThisstudy aimed to examine the prevalence and epidemiological characteristics of hypertension among children and adolescents aged 7-17 years in Shaanxi Province using three hypertension guidelines for children and adolescents. Data from the 2023 Shaanxi Student’s Health Surveillance Survey were used. Hypertension was defined according to three references, namely, the 2018 National Health Commission of the China (NHCC) pediatric blood pressure reference, the 2017 American Academy of Pediatrics (AAP) clinical practice guidelines, and the 2016 European Society of Hypertension guidelines. A log-binomial regression model was applied to assess the associations between hypertension and possible risk factors. A total of 220,497 students with an average age of 11.73 yearswere included in the analysis. The prevalence of hypertension was 11.73%, 15.75% and 10.04% according to the NHCC, APP and ESH guidelines,respectively. All three guidelines suggest that children who wereoverweight or obese or who lived in rural areas had significantly greater odds of having hypertension, and central and southern Shaanxi students had significantly lower odds of having hypertension. All three guidelines show that hypertension in children and adolescents seems to be a serious health problem in Shaanxi Province as well as in Northwestern China; thus, policymakers and public health practitioners should take immediate action to address the already established modifiable risk factors.\u003c/p\u003e","manuscriptTitle":"Prevalence and risk factors for hypertension among children and adolescents in Shaanxi Province, Northwestern China, according to the three hypertension guidelines","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-08 14:25:49","doi":"10.21203/rs.3.rs-4251847/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-07T15:18:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-15T09:05:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-03T08:02:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"193112582494568778625499217398751147566","date":"2025-01-01T07:37:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339825056643656083154168817957947185861","date":"2024-12-30T17:06:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-09T12:33:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227904429433743135101568387920346989383","date":"2024-08-21T13:49:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-21T13:10:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-05T11:09:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-30T10:11:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-30T10:08:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-04-11T10:32:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"77ec518c-4807-4b9e-ad04-e33be25781f2","owner":[],"postedDate":"May 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":31473384,"name":"Health sciences/Health care/Paediatrics"},{"id":31473385,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-06-02T16:01:23+00:00","versionOfRecord":{"articleIdentity":"rs-4251847","link":"https://doi.org/10.1038/s41598-025-01039-6","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-30 15:57:29","publishedOnDateReadable":"May 30th, 2025"},"versionCreatedAt":"2024-05-08 14:25:49","video":"","vorDoi":"10.1038/s41598-025-01039-6","vorDoiUrl":"https://doi.org/10.1038/s41598-025-01039-6","workflowStages":[]},"version":"v1","identity":"rs-4251847","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4251847","identity":"rs-4251847","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}