Prevalence and predictors of pediatric high blood pressure: An Egyptian school-based survey

Prevalence and predictors of pediatric high blood pressure: An Egyptian school-based survey | 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 Research Article Prevalence and predictors of pediatric high blood pressure: An Egyptian school-based survey Ehab Elrewany, Hassan Farag Mohamed Farag, Sherif Omar Osman, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8730799/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Apr, 2026 Read the published version in BMC Public Health → Version 1 posted 15 You are reading this latest preprint version Abstract Background Childhood hypertension (HTN) is a substantial public health problem due to its rising trend and strong correlation with adulthood HTN with its long-term sequelae. It has notable unmodifiable and modifiable risk factors. The current study aimed to portray blood pressure (BP) profile and identify the correlates associated with abnormal BP readings among preparatory schoolchildren in El-Beheira Governorate, Egypt. Methods using a multistage random sampling, from El Beheira governorate 15 districts, Damanhur was chosen where 4 preparatory schools (two for boys + two for girls) and 856 students aged 11–14 years were recruited for a cross-sectional study. A pre-designed structured interview questionnaire having socio-demographic information; habitual and family history data; besides anthropometric and three BP measurements were obtained for each student. BP was classified according to the new American normative BP in healthy children and adolescents. Results Students boys and girls were equally distributed (50%), with an average age of 13.3 ± 0.66 years. Among the students, 27% were obese/overweight and 40% didn’t exercise regularly. The frequency of elevated BP and HTN was 9.1% and 6.9%, respectively. High BP predominated with girls (odds ratio (OR) = 2.811), physical inactivity (≤ once weekly: OR = 30.366, & 2–3 times weekly: OR = 19.364), high risk diet (OR = 4.302), added table salt (OR = 13.374), family history of HTN (OR = 2.003), overweight (OR = 3.718), obesity (OR = 8.444), and abdominal obesity (OR = 4.016), ( p < 0.05). Conclusions The bottom line is that childhood high BP represents an alarming public health problem that should be seriously considered. Screening of schoolchildren has explicitly unveiled the high frequency of high BP (elevated BP and HTN) among preparatory schoolchildren tipped the scales in favor of the importance of lifestyle modification in rectifying childhood high BP levels. Children hypertension elevated blood pressure school-based survey Figures Figure 1 Background Over the past 20 years, there has been a secular escalating tendency of childhood hypertension (HTN). Song et al in their systematic review and meta-analysis of 47 articles to estimate the global prevalence of pediatric HTN noticed a gradual rising trend of 75%-79% between 2000 and 2015. The prevalence of childhood HTN was lowest in the 1990s (1.26%), modest in the 2000s (3.3%), and peaked in the period of 2010–2014 (6.02%). (1) In line with Song analysis, Crouch et al in their systematic review and meta-analysis of 41 articles from African countries among children aged 3–19 years deduced duplication of the estimated pooled prevalence of pediatric HTN after 2015 (10%) compared to before 2015 (5.6%). (2) The global meta-analysis of childhood BP profile is alarming; it revealed an overall elevated BP and HTN prevalence of 9.67% and 4% respectively with the highest HTN prevalence in the African and Eastern Mediterranean Regions (6.94% and 5.26% respectively). (1) The meta-analysis of BP among African children yielded an overall elevated BP and HTN prevalence of 11.38% and 7.45% respectively. (2) Unlike adults, the blood pressure (BP) status in children and adolescents (1–18 years) is assessed against the normative distribution of BP in healthy children after adjustment to the child sex, age, and height. Several childhood BP distribution norms have been developed. The most recent of which has been developed by the American Academy of Pediatrics (AAP) in the clinical practice guidelines for screening of the childhood BP in 2017. (3) The BP profile in children and adolescents is staged as normal, elevated BP, stage 1, or stage 2 HTN based on readings and classification according to the percentiles. Childhood HTN is considered when the systolic BP (SBP) and/ or diastolic BP (DBP) readings are ≥ 95th percentile on at least 3 separate occasions. (4) Clinically, high BP in childhood is often asymptomatic and discovered incidentally. The signs and symptoms commonly associated with high BP are headache, vomiting, chest pain, palpitation, shortness of breath, and seizures. (5) Persistence of elevated BP and development of HTN in childhood dramatically damage the blood vessels of the vital organs and prematurely develop long-term complications of the cardiovascular system (left ventricular hypertrophy, coronary artery diseases and strokes), eyes, and kidneys. (6, 7) High BP in younger children is usually secondary to an underlying cause. By time, older children, like adults, are more likely to have primary HTN associated with the same unmodifiable (age, sex, family history, and ethnicity) and modifiable (excess weight, smoking, unhealthy diets, and physical inactivity) risk factors. (8) Obesity has been shown to be the most paramount risk factor for elevated BP during childhood. Several studies have endorsed the strong association between body mass index (BMI) and elevated BP in childhood worldwide. (9, 10) Moreover, childhood BP could be affected by different dietary habits like unhealthy high intake of saturated/trans fats, free sugars, and sodium with low consumption of fruits and vegetables. (11) In addition, strong positive correlation was revealed between sedentary behaviors and high BP levels. (12) Undetected high childhood BP is so common. Factors contributing to such under-recognition are unawareness of childhood high BP and its significance, work overflow, no measurement of child BP, poor staff training, complexity of the diagnostic technique, need for repeated visits for confirmation, misinterpretation of BP readings, and poor perception of primary HTN and its effects in children. (13, 14) Elevated BP in childhood is an unseen source of HTN in adulthood. BP tracking from childhood through adulthood has shown an eminent correlation between higher BP in childhood through adulthood with onset of HTN in early adulthood. (15) Methods The current study aimed to portray the distribution of the blood pressure profile of preparatory schoolchildren in El-Beheira Governorate, Egypt and to identify correlates associated with high blood pressure. A cross-sectional study was conducted in 4 randomly selected governmental preparatory schools in Damanhur district of El Behera Governorate, Egypt. From a previous study, the prevalence of abnormal BP among schoolchildren was 9.7%. (16) Using margin of error of 2.5%, design effect of 1.5, and confidence level of 95%, the minimum required sample size was 807 students. A total of 856 apparently healthy preparatory schoolchildren aged 11–14 years at the selected schools were eligible and actually participated in the study. The sample size was calculated using Epi-info software. Sampling approach was adopted using simple random sampling (SRS), Damanhur was selected among the 15 districts of El-Behera governorate. Then, Damanhur district was subdivided geographically into four semi-equal divisions (A, B, C, & D). Using SRS, the first division was selected and titled A. Using a toss, division A was randomly assigned to a girls’ preparatory school. Divisions B, C, and D were alternatively assigned to boys, girls, and boys’ preparatory schools. According to the division assignment, a list of the public boys or girls’ preparatory schools was prepared in each division. Four preparatory schools were randomly selected from the prepared lists: two girls’ schools from divisions A and C and two boys’ schools from divisions B and D. At each school, 3–6 classes were randomly selected (1–2 classes per grade). Within each class, all eligible children were included in the study. All participants were interviewed for filling a pre-designed, structured questionnaire (Supplementary file 1) including the following: (a) Socio-demographic data: age, sex, class grade, parents’ level of education. (b) Personal habits of cigarettes smoking and physical activity frequency. (c) Dietary habits: adding table salt and ten questions were posted to inquire about the frequency of different food items. Except for adding table salt question, the frequency of the ten different food items [1- vegetables, 2- fruits, 3- salted food, 4- ketchup, mayonnaise, or other sauces, 5- processed meat, 6- fried food, 7- fast food, 8- chocolate and biscuits, 9- soft drinks, and 10- canned juices] was categorized as follows: never, once monthly, once weekly, 2–3 times weekly, and daily. The frequencies of never, once monthly, and once weekly were scored 1 for intake of vegetables and fruits. While the frequencies of 2–3 times weekly and daily were scored 0. Conversely the frequency of other remaining food items including were scored as 0 for never, once monthly, once weekly and 1 for 2–3 times weekly and daily. Scores of 0 and 1 indicate low risk and high risk respectively. The total score of the ten questions ranged from 0 to 10. A cutoff point of 5 was arbitrarily chosen to determine the level of dietary risk as follows: <5: low risk and ≥ 5 high risk. (d) Family history of chronic diseases: HTN, cardiac diseases, diabetes mellitus (DM), and obesity. Then the following measurements were obtained: (a) Anthropometric measurements: weight in kilogram (kg), height in centimeter (cm), and waist circumference (cm) were measured according to the procedures described by Gibson 2023. (17) BMI was calculated as weight (kg) to height in meter (m) square (kg/ m 2 ). Evaluation of BMI based on the score of centile was interpreted as follows: underweight: BMI for age below 5th centile, normal: BMI for age from above or equal to 5th centile to below 85th centile, overweight: BMI for age equal to or above 85th centile but less than 95th centile, and obese: BMI for age equal to or above 95th centile. (18) Waist (cm) to height (cm) ratio was calculated. A cutoff of 0.5 was used to define abdominal obesity for both sexes. (19) (b) Blood pressure measurement: using a mercury sphygmomanometer, in the seated position with supported back, using appropriate cuff for children, exposed right arm, and with at least a 10-min rest period prior to its measurement. Three measurements were taken for each participant with 2-minute interval, and the average was recorded. Students with abnormal BP readings (elevated BP, stage 1 HTN & stage 2 HTN) were rechecked three times on 3 consecutive days to confirm the diagnosis. (20) BP of the studied students was classified according to the new American normative BP in healthy children and adolescents as follows: Children aged 1–13 years: Normal BP: <90th percentile, elevated BP: ≥90th - <95th percentile or 120/80 mm Hg - <95th percentile (whichever was lower), stage 1 HTN: ≥95th - 13 years: Normal BP: <120/<80 mmHg, elevated BP: 120/<80 mmHg − 129/<80 mm Hg, stage 1 HTN: 130/ 80–139/ 89 mm Hg, and stage 2 HTN: ≥140/90 mm Hg. (4) All participants with stage 2 HTN were immediately referred for medical consultation. Statistical analysis Collected data were coded, revised, cleaned, tabulated, and analyzed through IBM SPSS Statistics version 27 using the appropriate descriptive and analytical statistics. The descriptive statistics included the percentages (%), arithmetic mean (X̅), and standard deviation (SD) which described various qualitative and quantitative data of the study participants. The analytical statistics entailed the Chi squared (χ2), student t test, analysis of variance (ANOVA), and the multivariate logistic regression analysis to determine the predictors for having abnormal BP. In all applied analytical statistical tests, p value ≤ 0.05 was considered significant. Results A sum of 856 students equally distributed (50%) among boys and girls, of an average age of 13.3 ± 0.66 years, from the first (34.6%), second (32.6%), and third (32.8%) grades took part in the study. Regarding fathers' educatio, 11.7%, 52.5%, 17.1%, of their fathers were illiterate / read& write, completed secondary school education, or a university graduate respectively. The corresponding values for their mothers were 14.5%, 54.9%, and 17.3% respectively. 59%, 27%, and 14% of them practiced physical activity daily, 2–3 times/ week, and ≤ 1 time/ week, respectively. 40.4% of students reported adding table salt while eating. Based on the developed dietary risk scale, 28.9% were classified having high risk. HTN, DM, obesity, and cardiac diseases were respectively reported by 20.1%, 16%, 15%, and 3.6% of the students. [Table 1 ] Table 1 Socio-demographic characteristics, habits, and family history of some non-communicable diseases, of the students Schoolchildren characteristics Total (n = 856) N (%) Age (years) Min-Max 11–14 Mean ± SD 13.3 ± 0.66 Sex Boys 426 (49.8) Girls 430 (50.2) School grade First grade 296 (34.6) Second grade 279 (32.6) Third grade 281 (32.8) Father’s education Illiterate / read & write 100 (11.7) Primary 49 (5.7) Preparatory 111 (13.0) Secondary 449 (52.5) University 147 (17.1) Mother’s education Illiterate / read & write 124 (14.5) Primary 44 (5.1) Preparatory 70 (8.2) Secondary 470 (54.9) University 148 (17.3) Physical activity ≤ once weekly 120 (14.0) 2–3 times weekly 231 (27.0) Daily (at least 5 days/week) 505 (59.0) Diet risk Low risk 609 (71.1) High risk 247 (28.9) Adding table salt No 510 (59.6) Yes 346 (40.4) Family history Diabetes 137 (16.0) Hypertension 172 (20.1) Cardiac diseases 31 (3.6) Obesity 128 (15.0) Table 2 demonstrated the students’ anthropometric data. These latter recorded a range and an average of 49–112 & 76.78 ± 9.78 cm for waist circumference, 12.7–38.8 & 20.6 ± 4.42 kg/m2 BMI, and 0.29–0.68 & 0.48 ± 0.06 for waist to height ratio with significant higher averages among girls than boys, ( p < 0.001). The BMI status frequency was mostly headed by normal weight (68.3%) followed by obese (13.6%) and overweight (13%). Only 34.2% of the students were diagnosed with abdominal obesity. Girls had higher frequency of Obesity (15.3% vs 11.7%), overweight (15.8% vs 10.1%) and abdominal obesity (40.5% vs 27.9%) than boys, ( p < 0.001). Table 2 Students’ anthropometric data Anthropometric data Total (n = 856) Boys (n = 426) Girls (n = 430) Statistical Test ( p -value) N (%) N (%) N (%) Waist circumference Min-Max 49–112 58–112 49–108 t = -3.944 (< 0.001)** Mean ± SD 76.78 ± 9.78 75.47 ± 9.46 78.08 ± 9.92 Body mass index (BMI) Min-Max 12.7–38.8 12.7–38.2 13.7–38.8 t = -6.034 (< 0.001)** Mean ± SD 20.6 ± 4.42 19.7 ± 3.97 21.49 ± 4.66 BMI status Underweight 44 (5.1) 33 (7.7) 11 (2.6) χ 2 = 19.204 (< 0.001)** Normal 585 (68.3) 300 (70.4) 285 (66.3) Overweight 111 (13.0) 43 (10.1) 68 (15.8) Obese 116 (13.6) 50 (11.7) 66 (15.3) Waist to height ratio Min-Max 0.29–0.68 0.36–0.68 0.29–0.68 t = -4.589 (< 0.001)** Mean ± SD 0.48 ± 0.06 0.47 ± 0.05 0.49 ± 0.06 Abdominal obesity No 563 (65.8) 307 (72.1) 256 (59.5) χ 2 = 14.926 (< 0.001)** Yes 293 (34.2) 119 (27.9) 174 (40.5) **: p ≤ 0.01 is highly statistically significant Table 3 and Fig. 1 displayed the students’ BP status according to the new American normative BP in healthy children and adolescents at the first screening reading and after the third reading. At the first reading, 78.4%, 4.4%, and 17.2% of students were respectively classified to have normal BP, elevated BP and HTN. At the third reading, the corresponding values changed to 84%, 9.1%, and 6.9% respectively. Table 3 Students’ blood pressure status Blood pressure status First reading Second reading Diagnosis after 3 readings N % N % N % Normal 671 78.4 692 80.8 719 84.0 Elevated blood pressure 38 4.4 63 7.4 78 9.1 Hypertension 147 17.2 101 11.8 59 6.9 • Stage 1 hypertension 105 12.3 73 8.5 48 5.6 • Stage 2 hypertension 42 4.9 28 3.3 11 1.3 In Table 4 , among the socio-demographic characteristics, only age and sex owed significant relationship to BP. The average age of the students studied was 13.27 ± 0.66 years for normal BP group, 13.49 ± 0.62 elevated BP group, and 13.46 ± 0.6 for hypertensive group with overall significant difference; F = 5.548 ( p = 0.004). Moreover, salient higher frequency of HTN (10%) and elevated BP (12.6%) among girls in comparison to boys (3.8% & 5.6%) was evident; χ 2 = 27.783 ( p 0.05). There was a significant higher frequency of HTN and elevated BP among students practicing physical activity ≤ once a week (17.5% & 25%) than those practicing physical activity 2–3 times a week (14.7% & 17.3%) and daily (0.8% & 1.6%); χ 2 = 177.358 ( p < 0.001). Further, there was a significant higher frequency of HTN and elevated BP among students classified as having high-risk diet (15% & 16.6%) and those used added table salt (15.6% & 18.5%) compared to those classified as having low risk diet (3.6% & 6.1%) and those did not use added table salt (1% & 2.7%), The corresponding χ 2 values were 64.327 & 142.768 ( p < 0.001) respectively. The recall revealed that the only significant linkage of positive HTN family history was to each of HTN (HTN: 12.8% vs 5.4%) and elevated BP (11.6% vs 8.5); χ 2 = 14.172 ( p < 0.001). None of DM, cardiac diseases, and obesity had either connection to BP status. Waist circumference, BMI, and waist to height ratio were the highest among students with HTN (87.66 ± 11.5 cm, 25.92 ± 5.72 kg/m 2 , & 0.54 ± 0.07), followed by those with elevated BP (84.32 ± 10.64 cm, 24.14 ± 4.84 kg/m 2 , & 0.52 ± 0.06), and lowest with those with normal BP (75.07 ± 8.5 cm, 19.78 ± 3.7 kg/m 2 , & 0.47 ± 0.05). The differences in-between was statistically significant with respective F values of 84.501, 98.687, and 52.393 ( p < 0.001). In exact terms, the frequency of HTN and elevated BP was significantly higher among obese children (24.1% & 21.6%) and overweight children (9.9% & 21.6%) compared to normal weight ones (3.4% & 5.6%), χ 2 = 120.414 ( p < 0.001). Furthermore, the frequency of HTN and elevated BP was significantly higher among children with abdominal obesity (13.7% & 15.4%) compared to those without (3.4% & 5.9%), χ 2 = 57.575 ( p < 0.001). Table 4 Relationship of students’ blood pressure status to socio-demographic characteristics, habits, family history, and anthropometric measurements Schoolchildren characteristics Blood pressure status N (%) Statistical Test ( p -value) Normal Elevated BP Hypertension Age (years) Min-Max 11–14 12–14 12–14 F = 5.548 (0.004)** Mean ± SD 13.27 ± 0.66 13.49 ± 0.62 13.46 ± 0.6 Sex Boys 386 (90.6) 24 (5.6) 16 (3.8) χ 2 = 27.783 (< 0.001)** Girls 333 (77.4) 54 (12.6) 43 (10.0) School grade First grade 259 (87.5) 23 (7.8) 14 (4.7) χ 2 = 6.642 (0.156) Second grade 235 (84.2) 23 (8.3) 21 (7.5) Third grade 225 (80.1) 32 (11.4) 24 (8.5) Father’s education Illiterate / read & write 86 (86.0) 8 (8.0) 6 (6.0) χ 2 = 4.53 (0.806) Primary 43 (87.7) 4 (8.2) 2 (4.1) Preparatory 89 (80.2) 14 (12.6) 8 (7.2) Secondary 381 (84.9) 39 (8.7) 29 (6.4) University 120 (81.6) 13 (8.9) 14 (9.5) Mother’s education Illiterate / read & write 102 (82.3) 12 (9.6) 10 (8.1) χ 2 = 3.717 (0.882) Primary 39 (88.6) 2 (4.6) 3 (6.8) Preparatory 59 (84.3) 8 (11.4) 3 (4.3) Secondary 396 (84.3) 44 (9.3) 30 (6.4) University 123 (83.1) 12 (8.1) 13 (8.8) Physical activity ≤ once weekly 69 (57.5) 30 (25.0) 21 (17.5) χ 2 = 177.358 (< 0.001)** 2–3 times weekly 157 (68.0) 40 (17.3) 37 (14.7) Daily (at least 5 days/week) 493 (97.6) 8 (1.6) 4 (0.8) Diet risk Low risk 550 (90.3) 37 (6.1) 22 (3.6) χ 2 = 64.327 (< 0.001)** High risk 169 (68.4) 41 (16.6) 37 (15.0) Adding table salt No 491 (96.3) 14 (2.7) 5 (1.0) χ 2 = 142.768 (< 0.001)** Yes 228 (65.9) 64 (18.5) 54 (15.6) Diabetes family history No 602 (83.7) 67 (9.3) 50 (7.0) χ 2 = 0.273 (0.872) Yes 117 (85.4) 11 (8.0) 9 (6.6) Hypertension family history No 589 (86.1) 58 (8.5) 37 (5.4) χ 2 = 14.172 (< 0.001)** Yes 130 (75.6) 20 (11.6) 22 (12.8) Cardiac diseases family history No 693 (84.0) 76 (9.2) 56 (6.8) χ 2 = 0.612 (0.736) Yes 26 (83.8) 2 (6.5) 3 (9.7) Obesity family history No 613 (84.2) 66 (9.1) 49 (6.7) χ 2 = 0.221 (0.895) Yes 106 (82.8) 12 (9.4) 10 (7.8) Waist circumference Min-Max 49–105 59–112 60–108 F = 84.501 (< 0.001)** Mean ± SD 75.07 ± 8.5 84.32 ± 10.64 87.66 ± 11.5 Body mass index (BMI) Min-Max 12.7–36.1 14.9–37.4 16.7–38.8 F = 98.687 (< 0.001)** Mean ± SD 19.78 ± 3.7 24.14 ± 4.84 25.92 ± 5.72 BMI status Underweight 43 (97.7) 1 (2.3) 0 (0.0) χ 2 = 120.414 (< 0.001)** Normal 532 (91) 33 (5.6) 20 (3.4) Overweight 81 (73.0) 19 (17.1) 11 (9.9) Obese 63 (54.3) 25 (21.6) 28 (24.1) Waist to height ratio Min-Max 0.29–0.65 0.37–0.68 0.37–0.68 F = 52.393 (< 0.001)** Mean ± SD 0.47 ± 0.05 0.52 ± 0.06 0.54 ± 0.07 Abdominal obesity No 511 (90.7) 33 (5.9) 19 (3.4) χ 2 = 57.575 (< 0.001)** Yes 208 (70.9) 45 (15.4) 40 (13.7) **: p ≤ 0.01 is highly statistically significant Univariate analysis of variables showed prominent association between abnormal BP and age (OR = 1.651), girls (OR = 2.811), third school grade (OR = 1.742), physically activity ≤ once weekly (OR = 30.366) & 2–3 times weekly physical activity (OR = 19.364), high risk diet (OR = 4.302), usage of added table salt (OR = 13.374), positive family history of HTN (OR = 2.003), and being overweight (OR = 3.718) and obese (OR = 8.444), and abdominal obesity (OR = 4.016), ( p < 0.05). While the multivariate analysis including the abovementioned variables revealed that physically activity ≤ once weekly (OR = 15.679) & 2–3 times weekly physical activity (OR = 10.738), usage of added table salt (OR = 5.745), being overweight (OR = 2.735) and obese (OR = 7.463) were the predictors for having abnormal BP level among the students, ( p < 0.05). [Table 5 ] Table 5 Univariate and multivariate logistic regression analysis of students’ abnormal BP predictors Crude OR (95% CI; LL-UL) p value Adjusted OR (95% CI; LL-UL) p value Age 1.651 (1.223–2.229) 0.001** 1.690 (0.971–2.943) 0.064 Sex Boys Reference Girls 2.811 (1.891–4.178) < 0.001** 0.925 (0.516–1.659) 0.794 School Grade First Reference Second 1.311 (0.818-2.100) 0.261 1.433 (0.669–3.070) 0.354 Third 1.742 (1.109–2.738) 0.016* 1.181 (0.534–2.612) 0.681 Father's Education Illiterate/read&write Reference Primary 0.857 (0.308–2.387) 0.768 Preparatory 1.518 (0.730–3.159) 0.264 Secondary 1.096 (0.589–2.040) 0.772 University 1.382 (0.685–2.790) 0.366 Mother's Education Illiterate/read&write Reference Primary 0.594 (0.210–1.680) 0.326 Preparatory 0.864 (0.392–1.908) 0.718 Secondary 0.866 (0.513–1.462) 0.591 University 0.942 (0.502–1.770) 0.853 Physical Activity ≤ once weekly 30.366 (15.424–59.785) < 0.001** 15.679 (6.936–35.443) < 0.001** 2–3 times weekly 19.364 (10.253–36.571) < 0.001** 10.738 (5.247–21.973) < 0.001** Daily Reference High diet risk 4.302 (2.944–6.289) < 0.001** 1.408 (0.845–2.344) 0.189 Adding table salt 13.374 (8.037–22.257) < 0.001** 5.745 (3.108–10.617) < 0.001** Positive family history of DM 0.880 (0.526–1.470) 0.624 Positive family history of HTN 2.003 (1.330–3.018) < 0.001** 1.451 (0.834–2.525) 0.188 Positive family history of cardiac diseases 1.010 (0.381–2.677) 0.985 Positive family history of obesity 1.106 (0.671–1.825) 0.692 BMI status Underweight 0.233 (0.032–1.729) 0.154 0.683 (0.076–5.420) 0.683 Normal Reference Overweight 3.718 (2.243–6.161) < 0.001** 2.735 (1.298–5.765) 0.008** Obese 8.444 (5.322–13.399) < 0.001** 7.463 (3.414–16.314) < 0.001** Abdominal obesity 4.016 (2.744–5.877) < 0.001** 1.221 (0.631–2.360) 0.554 OR: Odds ratio CI: Confidence interval LL: Lower limit UL: Upper limit *: p ≤ 0.05 is statistically significant **: p ≤ 0.01 is highly statistically significant Discussion The analysis of Song et al revealed an overall 4% global pooled prevalence of pediatric HTN with higher prevalence in low- and middle-income countries (LMICs) compared to high-income countries (HIC). Also, the highest HTN prevalence was noticed in the African (6.94%) and East Mediterranean Regions (5.26%). (1) The pooled prevalence of pediatric HTN among African children was almost doubled (7.45%) according to Crouch et al. (2) Country wise, the prevalence of pediatric HTN was quite variable. In Iran, Ebrahimi et al inferred a prevalence of 6.8%. (21) In China, the prevalence 6% in the cross-sectional survey of Lu et al. (22) Similarly, In India, Patel et al reported a 6.8% frequency of HTN. (23) Slightly higher prevalence of pediatric HTN was reported in Egypt (8.6%) and in India (8.9%). (16, 24) Further increased prevalence of pediatric HTN was noticed in Tanzania (10.8%), Jazan, Saudi Arabia (11.6%), and in India (12.4%). (25–27) A much higher prevalence of pediatric HTN was recorded in Turkey (14.8%), Jeddah University Hospital, Saudi Arabia (15.2%), and in Tunisia (15.4%). (28–30) An Extremely higher prevalence of pediatric HTN was reported in India (19.7% and 23%). (31, 32) On the contrary, low prevalence of pediatric HTN was noted in cross-sectional studies in Cameron (1.6%) and in India (2.7%). (33, 34) In line with Ebrahimi et al, (21) Lu et al, (22) and Patel et al, (23) the current study yielded a prevalence of childhood HTN of 6.9% among the studied students with stage 1 HTN (5.6%) and stage 2 HTN (1.3%). Similar to pediatric HTN, elevated pediatric BP prevalence varied country wise. It was lowest in India (3.2%) (34) and Tanzania (4.4%), (25) modest in Jeddah, Saudi Arabia (6%), (29) China (6.6%), (22) India (6.9%), (23) Iran (7.4%), (21) and in Cameron (8.1%), (33) and highest in Turkey (11.2%), (28) Jazan, Saudi Arabia (12%), (26), Tunisia (12.4%), (30) India (13.4%), (31) and in Egypt (14.7%). (16) An extremely higher prevalence of elevated pediatric BP (21.6%) was seen in India. (24) In line with Song et al, (1) Crouch et al, (2) Ebrahimi et al, (21) Chelo et al, (33) Çam and Ustuner, (28) El-Setouhy et al, (26), and Soua et al, (30) the current study revealed a prevalence of elevated pediatric BP of 9.1% among the studied students. The discrepancy in the prevalence of pediatric HTN and elevated BP could be explained on the basis of variation in the research approach, procedures, and confounders. The influence of adherence to the standardized three separate readings technique of BP measurement for the diagnosis of pediatric HTN was evident. As it helps a lot to achieve accurate diagnosis of pediatric HTN, avoid white coat HTN, and avert other conditions such as child activity and emotional state and the surrounding circumstances that might interfere with BP measurement. (4) The prevalence of HTN dropped by approximately 60% from 17.2% on the first reading to 11.8% on the second reading and reached 6.9% on the third reading. The significance of adherence to the three readings of childhood BP to diagnose HTN was quite evident in Sun et al systematic review and meta-analysis of 21 studies including 179,561 children. (35) Similarly, Marcovecchio et al in their study among 564 Italian school children reported a decline in the prevalence of HTN from 17.2% on the first BP measurement visit to 8.2% on the third visit. (36) Also, Zhang et al in their cross-sectional survey among 7832 Chinese school children revealed a decline from 17.2% on the first visit to approximately 5% on the third one. (37) Deviation from the standardized 3-reading protocol for BP measurement could be the main contributor to the extreme high prevalence of pediatric HTN in the studies of Das et al (31) who considered HTN based on the mean of 3 BP readings in the same visit and Narang et al (32) who diagnosed HTN based on only 2 readings in the same visit separated by 5-minute interval. The role of other confounding factors shared the responsibility for the discrepancy of pediatric HTN prevalence. The influence of age of the study participants was well obvious. Inclusion of younger children by Chelo et al (33) and Sabapathy et al (34) in their studies diluted the prevalence of pediatric HTN, while the inclusion of older children by Ghamri et al (29), Soua et al (30), Çam and Ustuner (28), and Arun & Kavinilavu (27) cumulated it. The impact of the study settings on childhood HTN prevalence was evident by Ghamri et al who conducted their study at health facility in Jaddah. (29) Age is a major contributor to development and progression of HTN. In Egypt, compared to younger children, older ones had higher HTN and elevated BP prevalence. (16) Again, the age correlated positively with both SBP and DBP among children in Jeddah, Saudi Arabia. (29) In Tanzania, abnormal BP possessed statistically significant higher average age than normal BP. (25) Lu et al additionally concluded a prominent significant higher mean age for children with both HTN and elevated BP than normotensive ones. (22) In congruence with the previous studies, the current study showed higher average age among elevated BP children and hypertensive children compared to normotensive ones. The impact of sex on childhood HTN and elevated BP was obvious. Prominent higher frequency of HTN and elevated BP in girls in comparison to boys was evident in the current study. Salient prevalence of HTN among girls in comparison to boys was well evident in Crouch et al meta-analysis, (2) and cross-sectional studies in Jeddah, Saudi Arabia. (29), and India. (27, 32) Meanwhile, higher frequency of both childhood HTN and elevated BP among girls than boys was well seen in the cross-sectional studies in Saudi Arabia, (26) Iran, (21) and India. (31) Conversely, higher prevalences of pediatric HTN and elevated BP were documented among boys than girls in Egypt and Tunisia. (16, 30) The higher frequency of childhood HTN among girls than boys logically coincided with the higher frequency of adulthood HTN among women than men in Egypt as mentioned in the WHO 2023 Report (41% vs 36%) (38) and Fares and Soliman cross-sectional study (21.7% vs 20.1%). (39) Besides, it was evident in the current study that girls had significantly higher frequency of obesity, overweight and abdominal obesity than boys. Hypertension often occurs in familial clusters and seems to be heritable. Remarkable inclination of both childhood HTN and elevated BP towards positive family than the negative one was well seen in the current study. Concomitant to the current results, solid connection between childhood HTN and elevated BP and positive family history was noted in Egypt, (16) Saudi Arabia, (26, 29) and in India. (27) Physical inactivity is an eminent modifiable risk factor for HTN. Compared to physically active Egyptian children, inactive ones showed higher prevalence of HTN and elevated BP. (16) Lu et al concluded higher prevalence of HTN and elevated BP among physically inactive children compared to physically active one. (22) Concomitantly, the current study ascertained the concrete relationship between physical inactivity and childhood HTN and elevated BP. The contribution of dietary habits to development of childhood HTN has been widely studied worldwide. A significant observational connection of consumption of foods poor in vegetables and fruits and rich in fried salty proteins to HTN was exhibited in China. (40) In India, high abnormal BP readings significantly correlated to salted foods consumption. (24) In the same context, the current study found significantly higher frequency of HTN and elevated BP among students classified as high-risk diet and those used added table salt compared to those classified as low risk diet and those did not use added table salt. Worldwide, the sacred union between obesity / overweight and abnormal BP readings has been strongly affirmed. Higher prevalence of HTN among obese / overweight children than normal weight ones was inferred in Africa, (2) Saudi Arabia, (29) and in Tunisia. (30) Higher prevalence of HTN and elevated BP among obese/ overweight children than normal weight ones was detected in Egypt, (16) and in India. (31) Meanwhile, comparatively to normal weight children, obese and overweight ones had a higher frequency of abnormal BP readings in India, (24) and in Tanzania. (25) Likewise, the frequency of HTN was highest, modest, and lowest among obese, overweight, and normal weight children respectively in China, (40) Turkey, (28) and in India. (32) Moreover, the frequency of HTN and elevated BP was highest, modest, and lowest among obese, overweight, and normal weight children globally in Song et al meta-analysis, (1) and in Saudi Arabia. (26) Meanwhile, the average BMI was highest, modest, lowest among hypertensive, elevated BP, and normotensive Chinese children. (22) Additionally, higher prevalence of HTN was noted among children with abdominal obesity than non-obese ones in Turkey. (28) Again, strikingly higher prevalence of HTN and elevated BP was demonstrated among children with abdominal obesity than non-obese ones in Egypt. (16) The SBP and DBP readings positively correlated with each of waist circumference and waist to height ratio in India. (32) Moreover, hypertensive Chinese children owed higher average waist circumference and waist to height ratio in comparison to those with normal BP. (40) Furthermore, the detailed analysis of Lu et al sorted the average waist circumference and waist to height ratio to be highest with HTN, modest with elevated BP, and lowest with normal BP among Chinese children. (22) In congruence, the current study affirmed this prominent association. The multivariate analysis accredited the predictivity of different correlates worldwide. It attested the predictivity of high waist circumference, overweight and obesity, family history of HTN, lack of regular physical activity, and increasing age were the significant predictors for childhood HTN in Egypt; (16) obesity and overweight in Saudi Arabia, (26) and overweight/ obesity and family history of HTN in Saudi Arabi, (29) obesity and overweight in Turkey, (28) and overweight/obesity and high consumption of salted food in India. (24) In concordance with the previous studies, the multivariate analysis in the current study confirmed the predictivity of physically activity ≤ once weekly & 2–3 times weekly physical activity, usage of added table salt, being overweight and obese for having abnormal BP level among the students. The consistency of obesity and overweight predictivity in the current and previous studies could be ascribed to the dependence on the actual objective anthropometric measurements (weight, height, and waist circumference) unlike the subjective family history, physical activity, and dietary habits data that relied on the recall. The study had a limitation of cross-sectional design adoption which cannot establish a definitive causal link between risk factors and high BP; however, this is strongly mitigated by the solid and rigorous methodology employed. By following the AAP 2017 guidelines and requiring three separate BP measurements across three different days for confirmation. The current study also ascertained the association between HTN and studied variables that might need further longitudinal follow up studies to establish this causality. Moreover, the study restricted to only one Egyptian Governorate. To be generalizable to the overall Egyptian situation, the study needs to be replicated to represent all Egyptian Governorates. However, this is offset by the large and representative sample size of 856 students. The use of a multi-stage random sampling technique and a sample size that exceeded the statistical requirement ensured that the data is highly reliable and provided a precise reflection of the pediatric population, offering a strong foundation for future national-scale research. Conclusions Screening of schoolchildren has explicitly unveiled the high frequency of high BP of elevated BP and HTN among preparatory schoolchildren. Strikingly, age, female sex, family history of HTN, physical inactivity, bad dietary habits, overweight, obesity, and abdominal obesity correlated robustly with childhood elevated BP and HTN. The heroic actor played by physical inactivity, added table salt, overweight, and obesity in predicting childhood high BP tipped the scales in favor of the importance of lifestyle modification in rectifying childhood high BP levels. Pursuant to the current study achievements, it is imperative to establish an inextricable academia-practice partnership and enhance the shift from the “quick fix” to “preventive strategy”. This latter emphasizes the awareness, screening, and detection of childhood elevated BP and HTN followed by lifestyle modification intervention to curb the ever-growing childhood high BP. This can be achieved through the conduction of a nationwide multicenter cross-sectional study for early detection of childhood elevated BP and HTN and development of an Egyptian childhood normative BP profile. Abbreviations AAP American Academy of Pediatrics ANOVA Analysis of Variance BMI Body Mass Index BP Blood Pressure CI Confidence Interval cm Centimeter DBP Diastolic Blood Pressure DM Diabetes mellitus HTN Hypertension kg Kilogram LMIC Low- and Middle-Income Countries m Meter NCDs non-communicable diseases OR Odds ratio SBP Systolic blood pressure SD Standard deviation SPSS Statistical Package for Social Sciences SRS Simple Random Sampling WHO World Health Organization X̅ Arithmetic mean χ 2 Chi squared test Declarations Ethics approval and consent to participate The approval of the ethics committee of the High Institute of Public Health for conducting the research was obtained (IRB Number: 00013692). An informed consent was taken from students’ parent / legal guardian in addition to obtaining verbal assent from the students themselves after explanation of the purpose and benefits of the research. Anonymity and confidentiality were assured and maintained and there was no conflict of interest. All methods were performed in accordance with the relevant guidelines and regulations confirm the Declaration of Helsinki. All participants with stage 2 HTN were immediately referred for medical consultation. Consent for publication Not applicable. Availability of data and materials Data is available on reasonable request from the corresponding author. Competing interests None to be declared. Funding Authors declare that no funding has been received related to the manuscript Authors' contributions EE designed the study, collected and analyzed data, and participated in writing the manuscript. HFMF conceived and designed the study, provided methodological guidance and critically revised the manuscript. SOO designed the study, provided methodological guidance and critically revised the manuscript. SBS led data management and interpretation of data analysis and writing the manuscript. DTM assissted in study design, statistical analysis, interpretation of data analysis, and writing the paper. All authors reviewed and approved the final manuscript. Acknowledgements Authors would offer special thanks to all study participants for their tolerance and cooperation Authors' information Ehab Elrewany: Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt. email: [email protected] , ORCID: 0000-0002-8700-0630, EE. Hassan Farag Mohamed Farag: Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt. email: [email protected] , ORCID: 0000-0002-4123-4781, HFMF. Sherif Omar Osman: Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt. email: [email protected] , ORCID: 0000-0002-9808-8412, SOO. Samah Batouta Saleh: Department of Sports Training and Movement Sciences, Faculty of Sports Sciences for Girls, Alexandria University, Alexandria, Egypt. email: [email protected] , SBS Doaa Tawfik Mohamed: Department of Nutrition, High Institute of Public Health, Alexandria University, Alexandria, Egypt. email: [email protected] , DTM. References Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K, et al. Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA pediatrics. 2019;173(12):1154-63. Crouch SH, Soepnel LM, Kolkenbeck-Ruh A, Maposa I, Naidoo S, Davies J, et al. Paediatric hypertension in Africa: a systematic review and meta-analysis. eClinicalMedicine. 2022;43:101229. Dionne JM. Updated guideline may improve the recognition and diagnosis of hypertension in children and adolescents; review of the 2017 AAP blood pressure clinical practice guideline. Current hypertension reports. 2017;19(10):84. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3). Patel N, Walker N. Clinical assessment of hypertension in children. Clinical hypertension. 2016;22:15. Dobson CP, Eide M, Nylund CM. Hypertension prevalence, cardiac complications, and antihypertensive medication use in children. The Journal of Pediatrics. 2015;167(1):92-7.e1. Yang L, Magnussen CG, Yang L, Bovet P, Xi B. Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: a systematic review. Hypertension. 2020;75(4):948-55. Ewald DR, Haldeman Ph DL. Risk factors in adolescent hypertension. Global pediatric health. 2016;3:2333794x15625159. Parker ED, Sinaiko AR, Kharbanda EO, Margolis KL, Daley MF, Trower NK, et al. Change in weight status and development of hypertension. Pediatrics. 2016;137(3):e20151662. Brady TM. Obesity-related hypertension in children. Frontiers in pediatrics. 2017;5:197. World Health Organization. Healthy diet 2024. https://www.who.int/health-topics/healthy-diet#tab=tab_1. Accessed 01 Dec 2025. Chen J, Wang Y, Li W, Zhang Y, Cao R, Peng X, et al. Physical activity and eating behaviors patterns associated with high blood pressure among Chinese children and adolescents. BMC Public Health. 2023;23(1):1516. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. Jama. 2007;298(8):874-9. Moin A, Mohanty N, Tedla YG, Carroll AJ, Padilla R, Langman CB, et al. Under-recognition of pediatric hypertension diagnosis: Examination of 1 year of visits to community health centers. Journal of clinical hypertension (Greenwich, Conn). 2021;23(2):257-64. Theodore RF, Broadbent J, Nagin D, Ambler A, Hogan S, Ramrakha S, et al. Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertension. 2015;66(6):1108-15. Hassan Sk, Abdel Wahed W, Mabrouk SE. Elevated blood pressure and its associated demographic factors among rural school adolescents in Fayoum governorate, Egypt. The Egyptian Journal of Community Medicine. 2023;41(1):18-26. Gibson RS. Principles of nutritional assessment: 3rd edition 2023. https://nutritionalassessment.org/. Accessed 01 Dec 2025. Centers for Disease Control and Prevention. About child & teen BMI 2022. https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html. Accessed 01 Dec 2025. Baioumi AYAA. Chapter 3 - Comparing measures of obesity: waist circumference, waist-hip, and waist-height ratios. In: Watson RR, editor. Nutrition in the Prevention and Treatment of Abdominal Obesity (Second Edition): Academic Press; 2019. p. 29-40. Cheung AK, Whelton PK, Muntner P, Schutte AE, Moran AE, Williams B, et al. International consensus on standardized clinic blood pressure measurement - a call to action. The American journal of medicine. 2023;136(5):438-45.e1. Ebrahimi H, Emamian MH, Hashemi H, Fotouhi A. Prevalence of prehypertension and hypertension and its risk factors in Iranian school children: a population-based study. Journal of Hypertension. 2018;36(9):1816-24. Lu Y, Luo B, Xie J, Zhang X, Zhu H. Prevalence of hypertension and prehypertension and its association with anthropometrics among children: a cross-sectional survey in Tianjin, China. Journal of Human Hypertension. 2018;32(11):789-98. Patel A, Bharani A, Sharma M, Bhagwat A, Ganguli N, Chouhan DS. Prevalence of hypertension and prehypertension in schoolchildren from Central India. Annals of pediatric cardiology. 2019;12(2):90-6. Srirama S, Subramanian M. Prevalence of hypertension and its risk factors among high school children in Bangalore, India. Int J Community Med Public Health. 2020;7:938-45. Muhihi AJ, Njelekela MA, Mpembeni RNM, Muhihi BG, Anaeli A, Chillo O, et al. Elevated blood pressure among primary school children in Dar es salaam, Tanzania: prevalence and risk factors. BMC pediatrics. 2018;18(1):54. El-Setouhy M, Safhi AM, Dallak MY, Ayoub AY, Suwaid OAH, Moafa AK, et al. Prevalence and associated factors of pediatric hypertension in Jazan region, south of the Kingdom of Saudi Arabia. A pilot cross-sectional study. PloS one. 2023;18(7):e0287698. Arun DJ, Kavinilavu R. A study of risk factors associated with hypertension among the school going children in Puducherry. International Journal Of Community Medicine And Public Health. 2018;5(2):764-8. Çam HH, Ustuner Top F. Prevalence of hypertension and its association with body mass index and waist circumference among adolescents in Turkey: A cross-sectional study. Journal of Pediatric Nursing. 2021;57:e29-e33. Ghamri RA, Hegazy AA, Azizkhan AZ, Alsalmi SF, Alharbi NA, Hemedy RA, et al. High blood pressure in children attending pediatric clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Journal of family & community medicine. 2019;26(3):193-8. Soua S, Ghammam R, Maatoug J, Zammit N, Ben Fredj S, Martinez F, et al. The prevalence of high blood pressure and its determinants among Tunisian adolescents. Journal of Human Hypertension. 2024;38(4):371-9. Das MK, Bhatia V, Sibal A. Prevalence of hypertension in urban school children aged 5 to 10 years in North India. International Journal of Contemporary Pediatrics. 2017;4(6):2055-9. Narang R, Saxena A, Desai A, Ramakrishnan S, Thangjam RS, Kulkarni S, et al. Prevalence and determinants of hypertension in apparently healthy schoolchildren in India: A multi-center study. European journal of preventive cardiology. 2018;25(16):1775-84. Chelo D, Mah EM, Chiabi EN, Chiabi A, Koki Ndombo PO, Kingue S, et al. Prevalence and factors associated with hypertension in primary school children, in the centre region of Cameroon. Translational Pediatrics. 2019;8(5):391-7. Sabapathy S, B. A N, C. N B. Prevalence of childhood hypertension and pre-hypertension in school going children of Bangalore rural district: a cross sectional study. International Journal of Contemporary Pediatrics. 2017;4(5):1701-4. Sun J, Steffen LM, Ma C, Liang Y, Xi B. Definition of pediatric hypertension: are blood pressure measurements on three separate occasions necessary? Hypertension research : official journal of the Japanese Society of Hypertension. 2017;40(5):496-503. Marcovecchio ML, Mohn A, Diddi G, Polidori N, Chiarelli F, Fuiano N. Longitudinal assessment of blood pressure in school-aged children: a 3-year follow-up study. Pediatric Cardiology. 2016;37(2):255-61. Zhang Q, Yang L, Zhang Y, Zhao M, Liang Y, Xi B. Hypertension prevalence based on three separate visits and its association with obesity among Chinese children and adolescents. Frontiers in pediatrics. 2019;7. World Health Organization. Hypertension Egypt 2023 country profile 2023. https://www.who.int/publications/m/item/hypertension-egy-2023-country-profile. Accessed 01 Dec 2025. Fares S, Soliman S. Prevalence and determinants of normal, high-normal and high blood pressure and association with cardiovascular risk in Egypt. Eastern Mediterranean Health Journal. 2022;28(6). Lu Z, Teng Y, Wang L, Jia L, Chen Z, Ding S. Analysis of the prevalence and related factors of primary hypertension among adolescents and children in the Taicang area. BMC pediatrics. 2023;23(1):265. Additional Declarations No competing interests reported. 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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-8730799","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589318974,"identity":"aba9d321-3a15-47ed-8dfd-88a3c474cd3a","order_by":0,"name":"Ehab Elrewany","email":"data:image/png;base64,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","orcid":"","institution":"Alexandria University","correspondingAuthor":true,"prefix":"","firstName":"Ehab","middleName":"","lastName":"Elrewany","suffix":""},{"id":589318975,"identity":"2a0b28ac-a747-4d3d-9f00-4313c58dbe1c","order_by":1,"name":"Hassan Farag Mohamed Farag","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Hassan","middleName":"Farag Mohamed","lastName":"Farag","suffix":""},{"id":589318976,"identity":"c2eb6c64-4a60-48c0-a0fa-b67c75d43a33","order_by":2,"name":"Sherif Omar Osman","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Sherif","middleName":"Omar","lastName":"Osman","suffix":""},{"id":589318977,"identity":"b7c66cbd-3e35-44f2-b5de-3ba93842fa7b","order_by":3,"name":"Samah Batouta Saleh","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Samah","middleName":"Batouta","lastName":"Saleh","suffix":""},{"id":589318978,"identity":"c0793bbd-8e08-4873-8fec-f8d8343290d6","order_by":4,"name":"Doaa Tawfik Mohamed","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Doaa","middleName":"Tawfik","lastName":"Mohamed","suffix":""}],"badges":[],"createdAt":"2026-01-29 11:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8730799/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8730799/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-026-27360-x","type":"published","date":"2026-04-23T15:58:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":102491188,"identity":"d3bada98-5982-4d05-9e94-9974dd4b22f7","added_by":"auto","created_at":"2026-02-12 08:42:44","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":108969,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudents’ blood pressure status after 3 measures for diagnosis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8730799/v1/a99027fa5130d99ecb929c8f.jpeg"},{"id":107928971,"identity":"a1bad2f3-d7c5-4b89-a6f4-09c29449ca04","added_by":"auto","created_at":"2026-04-27 16:13:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":741305,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8730799/v1/81761e3e-819a-4025-8c6e-84b85cdcb797.pdf"},{"id":102491136,"identity":"565e52ad-8011-4ad1-bebe-aada02d3efc6","added_by":"auto","created_at":"2026-02-12 08:42:31","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18280,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8730799/v1/84d81d9c4c21a17ba56e5dfa.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and predictors of pediatric high blood pressure: An Egyptian school-based survey","fulltext":[{"header":"Background","content":"\u003cp\u003eOver the past 20 years, there has been a secular escalating tendency of childhood hypertension (HTN). Song et al in their systematic review and meta-analysis of 47 articles to estimate the global prevalence of pediatric HTN noticed a gradual rising trend of 75%-79% between 2000 and 2015. The prevalence of childhood HTN was lowest in the 1990s (1.26%), modest in the 2000s (3.3%), and peaked in the period of 2010\u0026ndash;2014 (6.02%). (1) In line with Song analysis, Crouch et al in their systematic review and meta-analysis of 41 articles from African countries among children aged 3\u0026ndash;19 years deduced duplication of the estimated pooled prevalence of pediatric HTN after 2015 (10%) compared to before 2015 (5.6%). (2) The global meta-analysis of childhood BP profile is alarming; it revealed an overall elevated BP and HTN prevalence of 9.67% and 4% respectively with the highest HTN prevalence in the African and Eastern Mediterranean Regions (6.94% and 5.26% respectively). (1) The meta-analysis of BP among African children yielded an overall elevated BP and HTN prevalence of 11.38% and 7.45% respectively. (2)\u003c/p\u003e \u003cp\u003eUnlike adults, the blood pressure (BP) status in children and adolescents (1\u0026ndash;18 years) is assessed against the normative distribution of BP in healthy children after adjustment to the child sex, age, and height. Several childhood BP distribution norms have been developed. The most recent of which has been developed by the American Academy of Pediatrics (AAP) in the clinical practice guidelines for screening of the childhood BP in 2017. (3) The BP profile in children and adolescents is staged as normal, elevated BP, stage 1, or stage 2 HTN based on readings and classification according to the percentiles. Childhood HTN is considered when the systolic BP (SBP) and/ or diastolic BP (DBP) readings are \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;95th percentile on at least 3 separate occasions. (4)\u003c/p\u003e \u003cp\u003eClinically, high BP in childhood is often asymptomatic and discovered incidentally. The signs and symptoms commonly associated with high BP are headache, vomiting, chest pain, palpitation, shortness of breath, and seizures. (5) Persistence of elevated BP and development of HTN in childhood dramatically damage the blood vessels of the vital organs and prematurely develop long-term complications of the cardiovascular system (left ventricular hypertrophy, coronary artery diseases and strokes), eyes, and kidneys. (6, 7) High BP in younger children is usually secondary to an underlying cause. By time, older children, like adults, are more likely to have primary HTN associated with the same unmodifiable (age, sex, family history, and ethnicity) and modifiable (excess weight, smoking, unhealthy diets, and physical inactivity) risk factors. (8)\u003c/p\u003e \u003cp\u003eObesity has been shown to be the most paramount risk factor for elevated BP during childhood. Several studies have endorsed the strong association between body mass index (BMI) and elevated BP in childhood worldwide. (9, 10) Moreover, childhood BP could be affected by different dietary habits like unhealthy high intake of saturated/trans fats, free sugars, and sodium with low consumption of fruits and vegetables. (11) In addition, strong positive correlation was revealed between sedentary behaviors and high BP levels. (12)\u003c/p\u003e \u003cp\u003eUndetected high childhood BP is so common. Factors contributing to such under-recognition are unawareness of childhood high BP and its significance, work overflow, no measurement of child BP, poor staff training, complexity of the diagnostic technique, need for repeated visits for confirmation, misinterpretation of BP readings, and poor perception of primary HTN and its effects in children. (13, 14) Elevated BP in childhood is an unseen source of HTN in adulthood. BP tracking from childhood through adulthood has shown an eminent correlation between higher BP in childhood through adulthood with onset of HTN in early adulthood. (15)\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe current study aimed to portray the distribution of the blood pressure profile of preparatory schoolchildren in El-Beheira Governorate, Egypt and to identify correlates associated with high blood pressure.\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted in 4 randomly selected governmental preparatory schools in Damanhur district of El Behera Governorate, Egypt. From a previous study, the prevalence of abnormal BP among schoolchildren was 9.7%. (16) Using margin of error of 2.5%, design effect of 1.5, and confidence level of 95%, the minimum required sample size was 807 students. A total of 856 apparently healthy preparatory schoolchildren aged 11\u0026ndash;14 years at the selected schools were eligible and actually participated in the study. The sample size was calculated using Epi-info software.\u003c/p\u003e \u003cp\u003eSampling approach was adopted using simple random sampling (SRS), Damanhur was selected among the 15 districts of El-Behera governorate. Then, Damanhur district was subdivided geographically into four semi-equal divisions (A, B, C, \u0026amp; D). Using SRS, the first division was selected and titled A. Using a toss, division A was randomly assigned to a girls\u0026rsquo; preparatory school. Divisions B, C, and D were alternatively assigned to boys, girls, and boys\u0026rsquo; preparatory schools. According to the division assignment, a list of the public boys or girls\u0026rsquo; preparatory schools was prepared in each division. Four preparatory schools were randomly selected from the prepared lists: two girls\u0026rsquo; schools from divisions A and C and two boys\u0026rsquo; schools from divisions B and D. At each school, 3\u0026ndash;6 classes were randomly selected (1\u0026ndash;2 classes per grade). Within each class, all eligible children were included in the study.\u003c/p\u003e \u003cp\u003eAll participants were interviewed for filling a pre-designed, structured questionnaire \u003cb\u003e(Supplementary file 1)\u003c/b\u003e including the following: (a) Socio-demographic data: age, sex, class grade, parents\u0026rsquo; level of education. (b) Personal habits of cigarettes smoking and physical activity frequency. (c) Dietary habits: adding table salt and ten questions were posted to inquire about the frequency of different food items. Except for adding table salt question, the frequency of the ten different food items [1- vegetables, 2- fruits, 3- salted food, 4- ketchup, mayonnaise, or other sauces, 5- processed meat, 6- fried food, 7- fast food, 8- chocolate and biscuits, 9- soft drinks, and 10- canned juices] was categorized as follows: never, once monthly, once weekly, 2\u0026ndash;3 times weekly, and daily. The frequencies of never, once monthly, and once weekly were scored 1 for intake of vegetables and fruits. While the frequencies of 2\u0026ndash;3 times weekly and daily were scored 0. Conversely the frequency of other remaining food items including were scored as 0 for never, once monthly, once weekly and 1 for 2\u0026ndash;3 times weekly and daily. Scores of 0 and 1 indicate low risk and high risk respectively. The total score of the ten questions ranged from 0 to 10. A cutoff point of 5 was arbitrarily chosen to determine the level of dietary risk as follows: \u0026lt;5: low risk and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;5 high risk. (d) Family history of chronic diseases: HTN, cardiac diseases, diabetes mellitus (DM), and obesity.\u003c/p\u003e \u003cp\u003eThen the following measurements were obtained: (a) Anthropometric measurements: weight in kilogram (kg), height in centimeter (cm), and waist circumference (cm) were measured according to the procedures described by Gibson 2023. (17) BMI was calculated as weight (kg) to height in meter (m) square (kg/ m\u003csup\u003e2\u003c/sup\u003e). Evaluation of BMI based on the score of centile was interpreted as follows: underweight: BMI for age below 5th centile, normal: BMI for age from above or equal to 5th centile to below 85th centile, overweight: BMI for age equal to or above 85th centile but less than 95th centile, and obese: BMI for age equal to or above 95th centile. (18) Waist (cm) to height (cm) ratio was calculated. A cutoff of 0.5 was used to define abdominal obesity for both sexes. (19) (b) Blood pressure measurement: using a mercury sphygmomanometer, in the seated position with supported back, using appropriate cuff for children, exposed right arm, and with at least a 10-min rest period prior to its measurement. Three measurements were taken for each participant with 2-minute interval, and the average was recorded. Students with abnormal BP readings (elevated BP, stage 1 HTN \u0026amp; stage 2 HTN) were rechecked three times on 3 consecutive days to confirm the diagnosis. (20) BP of the studied students was classified according to the new American normative BP in healthy children and adolescents as follows: Children aged 1\u0026ndash;13 years: Normal BP: \u0026lt;90th percentile, elevated BP: \u0026ge;90th - \u0026lt;95th percentile or 120/80 mm Hg - \u0026lt;95th percentile (whichever was lower), stage 1 HTN: \u0026ge;95th - \u0026lt;95th percentile\u0026thinsp;+\u0026thinsp;12 mm Hg or 130/80\u0026ndash;139/89 mm Hg (whichever was lower), and stage 2 HTN: \u0026ge;95th percentile\u0026thinsp;+\u0026thinsp;12 mm Hg or \u0026ge;\u0026thinsp;140/90 mm Hg (whichever was lower). Children aged\u0026thinsp;\u0026gt;\u0026thinsp;13 years: Normal BP: \u0026lt;120/\u0026lt;80 mmHg, elevated BP: 120/\u0026lt;80 mmHg\u0026thinsp;\u0026minus;\u0026thinsp;129/\u0026lt;80 mm Hg, stage 1 HTN: 130/ 80\u0026ndash;139/ 89 mm Hg, and stage 2 HTN: \u0026ge;140/90 mm Hg. (4) All participants with stage 2 HTN were immediately referred for medical consultation.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical analysis\u003c/strong\u003e \u003cp\u003eCollected data were coded, revised, cleaned, tabulated, and analyzed through IBM SPSS Statistics version 27 using the appropriate descriptive and analytical statistics. The descriptive statistics included the percentages (%), arithmetic mean (X̅), and standard deviation (SD) which described various qualitative and quantitative data of the study participants. The analytical statistics entailed the Chi squared (χ2), student t test, analysis of variance (ANOVA), and the multivariate logistic regression analysis to determine the predictors for having abnormal BP. In all applied analytical statistical tests, \u003cem\u003ep\u003c/em\u003e value\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA sum of 856 students equally distributed (50%) among boys and girls, of an average age of 13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66 years, from the first (34.6%), second (32.6%), and third (32.8%) grades took part in the study. Regarding fathers' educatio, 11.7%, 52.5%, 17.1%, of their fathers were illiterate / read\u0026amp; write, completed secondary school education, or a university graduate respectively. The corresponding values for their mothers were 14.5%, 54.9%, and 17.3% respectively. 59%, 27%, and 14% of them practiced physical activity daily, 2\u0026ndash;3 times/ week, and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;1 time/ week, respectively. 40.4% of students reported adding table salt while eating. Based on the developed dietary risk scale, 28.9% were classified having high risk. HTN, DM, obesity, and cardiac diseases were respectively reported by 20.1%, 16%, 15%, and 3.6% of the students. [Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]\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 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics, habits, and family history of some non-communicable diseases, of the students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSchoolchildren characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;856)\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e426 (49.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e430 (50.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSchool grade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e296 (34.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e279 (32.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e281 (32.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFather\u0026rsquo;s education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate / read \u0026amp; write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (11.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (13.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e449 (52.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147 (17.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate / read \u0026amp; write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124 (14.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (5.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (8.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e470 (54.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148 (17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le; once weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (14.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 times weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231 (27.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily (at least 5 days/week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e505 (59.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDiet risk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e609 (71.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247 (28.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAdding table salt\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e510 (59.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e346 (40.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eFamily history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172 (20.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128 (15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrated the students\u0026rsquo; anthropometric data. These latter recorded a range and an average of 49\u0026ndash;112 \u0026amp; 76.78\u0026thinsp;\u0026plusmn;\u0026thinsp;9.78 cm for waist circumference, 12.7\u0026ndash;38.8 \u0026amp; 20.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42 kg/m2 BMI, and 0.29\u0026ndash;0.68 \u0026amp; 0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06 for waist to height ratio with significant higher averages among girls than boys, (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The BMI status frequency was mostly headed by normal weight (68.3%) followed by obese (13.6%) and overweight (13%). Only 34.2% of the students were diagnosed with abdominal obesity. Girls had higher frequency of Obesity (15.3% vs 11.7%), overweight (15.8% vs 10.1%) and abdominal obesity (40.5% vs 27.9%) than boys, (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\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 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudents\u0026rsquo; anthropometric data\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=\"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=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eAnthropometric data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;856)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBoys (n\u0026thinsp;=\u0026thinsp;426)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGirls (n\u0026thinsp;=\u0026thinsp;430)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatistical Test\u003c/p\u003e \u003cp\u003e(\u003cem\u003ep\u003c/em\u003e-value)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWaist circumference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u0026ndash;112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u0026ndash;112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49\u0026ndash;108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et = -3.944\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.78\u0026thinsp;\u0026plusmn;\u0026thinsp;9.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.47\u0026thinsp;\u0026plusmn;\u0026thinsp;9.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.08\u0026thinsp;\u0026plusmn;\u0026thinsp;9.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBody mass index (BMI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.7\u0026ndash;38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7\u0026ndash;38.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.7\u0026ndash;38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et = -6.034\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.49\u0026thinsp;\u0026plusmn;\u0026thinsp;4.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;19.204\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e585 (68.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e300 (70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e285 (66.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (15.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWaist to height ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.29\u0026ndash;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u0026ndash;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.29\u0026ndash;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et = -4.589\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAbdominal obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e563 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e307 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e256 (59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;14.926\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e293 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e119 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e174 (40.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e**: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.01 is highly statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displayed the students\u0026rsquo; BP status according to the new American normative BP in healthy children and adolescents at the first screening reading and after the third reading. At the first reading, 78.4%, 4.4%, and 17.2% of students were respectively classified to have normal BP, elevated BP and HTN. At the third reading, the corresponding values changed to 84%, 9.1%, and 6.9% respectively.\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 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudents\u0026rsquo; blood pressure status\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\u003eBlood pressure status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFirst reading\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSecond reading\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDiagnosis after 3 readings\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\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\u003e671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e719\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated blood pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Stage 1 hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026bull; Stage 2 hypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, among the socio-demographic characteristics, only age and sex owed significant relationship to BP. The average age of the students studied was 13.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66 years for normal BP group, 13.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 elevated BP group, and 13.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 for hypertensive group with overall significant difference; F\u0026thinsp;=\u0026thinsp;5.548 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004). Moreover, salient higher frequency of HTN (10%) and elevated BP (12.6%) among girls in comparison to boys (3.8% \u0026amp; 5.6%) was evident; χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;27.783 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). None of the school grades, and parents' educational level, had either relation to the BP status (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). There was a significant higher frequency of HTN and elevated BP among students practicing physical activity \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003eonce a week (17.5% \u0026amp; 25%) than those practicing physical activity 2\u0026ndash;3 times a week (14.7% \u0026amp; 17.3%) and daily (0.8% \u0026amp; 1.6%); χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;177.358 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Further, there was a significant higher frequency of HTN and elevated BP among students classified as having high-risk diet (15% \u0026amp; 16.6%) and those used added table salt (15.6% \u0026amp; 18.5%) compared to those classified as having low risk diet (3.6% \u0026amp; 6.1%) and those did not use added table salt (1% \u0026amp; 2.7%), The corresponding χ\u003csup\u003e2\u003c/sup\u003e values were 64.327 \u0026amp; 142.768 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) respectively. The recall revealed that the only significant linkage of positive HTN family history was to each of HTN (HTN: 12.8% vs 5.4%) and elevated BP (11.6% vs 8.5); χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;14.172 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). None of DM, cardiac diseases, and obesity had either connection to BP status. Waist circumference, BMI, and waist to height ratio were the highest among students with HTN (87.66\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5 cm, 25.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.72 kg/m\u003csup\u003e2\u003c/sup\u003e, \u0026amp; 0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07), followed by those with elevated BP (84.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64 cm, 24.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84 kg/m\u003csup\u003e2\u003c/sup\u003e, \u0026amp; 0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06), and lowest with those with normal BP (75.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5 cm, 19.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7 kg/m\u003csup\u003e2\u003c/sup\u003e, \u0026amp; 0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05). The differences in-between was statistically significant with respective F values of 84.501, 98.687, and 52.393 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In exact terms, the frequency of HTN and elevated BP was significantly higher among obese children (24.1% \u0026amp; 21.6%) and overweight children (9.9% \u0026amp; 21.6%) compared to normal weight ones (3.4% \u0026amp; 5.6%), χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;120.414 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the frequency of HTN and elevated BP was significantly higher among children with abdominal obesity (13.7% \u0026amp; 15.4%) compared to those without (3.4% \u0026amp; 5.9%), χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;57.575 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship of students\u0026rsquo; blood pressure status to socio-demographic characteristics, habits, family history, and anthropometric measurements\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=\"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=\"left\" 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\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eSchoolchildren characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eBlood pressure status N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatistical Test\u003c/p\u003e \u003cp\u003e(\u003cem\u003ep\u003c/em\u003e-value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eElevated BP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u0026ndash;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;5.548\u003c/p\u003e \u003cp\u003e(0.004)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e386 (90.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;27.783\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e333 (77.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSchool grade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;6.642\u003c/p\u003e \u003cp\u003e(0.156)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235 (84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (7.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225 (80.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (8.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFather\u0026rsquo;s education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate / read \u0026amp; write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;4.53\u003c/p\u003e \u003cp\u003e(0.806)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (80.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e381 (84.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMother\u0026rsquo;s education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate / read \u0026amp; write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (82.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;3.717\u003c/p\u003e \u003cp\u003e(0.882)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (6.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e396 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (83.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le; once weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;177.358\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 times weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157 (68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (14.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily (at least 5 days/week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e493 (97.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (0.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDiet risk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e550 (90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;64.327\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh risk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e169 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAdding table salt\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e491 (96.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;142.768\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e228 (65.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54 (15.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDiabetes family history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e602 (83.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;0.273\u003c/p\u003e \u003cp\u003e(0.872)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (6.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHypertension family history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e589 (86.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;14.172\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (75.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (12.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCardiac diseases family history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e693 (84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;0.612\u003c/p\u003e \u003cp\u003e(0.736)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (83.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eObesity family history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e613 (84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;0.221\u003c/p\u003e \u003cp\u003e(0.895)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (7.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWaist circumference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u0026ndash;105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u0026ndash;112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60\u0026ndash;108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;84.501\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.07\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.32\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.66\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBody mass index (BMI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.7\u0026ndash;36.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u0026ndash;37.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.7\u0026ndash;38.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;98.687\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.78\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (97.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;120.414\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e532 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (9.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (24.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eWaist to height ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.29\u0026ndash;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u0026ndash;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.37\u0026ndash;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;52.393\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAbdominal obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e511 (90.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e \u0026thinsp;=\u0026thinsp;57.575\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;0.001)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e208 (70.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (13.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e**: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.01 is highly statistically significant\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eUnivariate analysis of variables showed prominent association between abnormal BP and age (OR\u0026thinsp;=\u0026thinsp;1.651), girls (OR\u0026thinsp;=\u0026thinsp;2.811), third school grade (OR\u0026thinsp;=\u0026thinsp;1.742), physically activity\u0026thinsp;\u0026le;\u0026thinsp;once weekly (OR\u0026thinsp;=\u0026thinsp;30.366) \u0026amp; 2\u0026ndash;3 times weekly physical activity (OR\u0026thinsp;=\u0026thinsp;19.364), high risk diet (OR\u0026thinsp;=\u0026thinsp;4.302), usage of added table salt (OR\u0026thinsp;=\u0026thinsp;13.374), positive family history of HTN (OR\u0026thinsp;=\u0026thinsp;2.003), and being overweight (OR\u0026thinsp;=\u0026thinsp;3.718) and obese (OR\u0026thinsp;=\u0026thinsp;8.444), and abdominal obesity (OR\u0026thinsp;=\u0026thinsp;4.016), (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). While the multivariate analysis including the abovementioned variables revealed that physically activity\u0026thinsp;\u0026le;\u0026thinsp;once weekly (OR\u0026thinsp;=\u0026thinsp;15.679) \u0026amp; 2\u0026ndash;3 times weekly physical activity (OR\u0026thinsp;=\u0026thinsp;10.738), usage of added table salt (OR\u0026thinsp;=\u0026thinsp;5.745), being overweight (OR\u0026thinsp;=\u0026thinsp;2.735) and obese (OR\u0026thinsp;=\u0026thinsp;7.463) were the predictors for having abnormal BP level among the students, (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). [Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e]\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate logistic regression analysis of students\u0026rsquo; abnormal BP predictors\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=\"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=\"left\" 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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrude OR\u003c/p\u003e \u003cp\u003e(95% CI; LL-UL)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR\u003c/p\u003e \u003cp\u003e(95% CI; LL-UL)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.651 (1.223\u0026ndash;2.229)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.690 (0.971\u0026ndash;2.943)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGirls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.811 (1.891\u0026ndash;4.178)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.925 (0.516\u0026ndash;1.659)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSchool\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eGrade\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \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=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.311 (0.818-2.100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.433 (0.669\u0026ndash;3.070)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.742 (1.109\u0026ndash;2.738)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.016*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.181 (0.534\u0026ndash;2.612)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFather's\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate/read\u0026amp;write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \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=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.857 (0.308\u0026ndash;2.387)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.768\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.518 (0.730\u0026ndash;3.159)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.264\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.096 (0.589\u0026ndash;2.040)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.772\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.382 (0.685\u0026ndash;2.790)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMother's\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate/read\u0026amp;write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \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=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.594 (0.210\u0026ndash;1.680)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.326\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreparatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.864 (0.392\u0026ndash;1.908)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.718\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.866 (0.513\u0026ndash;1.462)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.591\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.942 (0.502\u0026ndash;1.770)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.853\u003c/p\u003e \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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePhysical\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eActivity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le; once weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.366 (15.424\u0026ndash;59.785)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.679 (6.936\u0026ndash;35.443)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 times weekly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.364 (10.253\u0026ndash;36.571)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.738 (5.247\u0026ndash;21.973)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigh diet risk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.302 (2.944\u0026ndash;6.289)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.408 (0.845\u0026ndash;2.344)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdding table salt\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.374 (8.037\u0026ndash;22.257)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.745 (3.108\u0026ndash;10.617)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePositive family history of DM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.880 (0.526\u0026ndash;1.470)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.624\u003c/p\u003e \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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePositive family history of HTN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.003 (1.330\u0026ndash;3.018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.451 (0.834\u0026ndash;2.525)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePositive family history of cardiac diseases\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.010 (0.381\u0026ndash;2.677)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.985\u003c/p\u003e \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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePositive family history of obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.106 (0.671\u0026ndash;1.825)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.692\u003c/p\u003e \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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBMI status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.233 (0.032\u0026ndash;1.729)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.683 (0.076\u0026ndash;5.420)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReference\u003c/p\u003e \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\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.718 (2.243\u0026ndash;6.161)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.735 (1.298\u0026ndash;5.765)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.008**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.444 (5.322\u0026ndash;13.399)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.463 (3.414\u0026ndash;16.314)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbdominal obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.016 (2.744\u0026ndash;5.877)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.221 (0.631\u0026ndash;2.360)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.554\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOR: Odds ratio CI: Confidence interval LL: Lower limit UL: Upper limit\u003c/p\u003e \u003cp\u003e*: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05 is statistically significant **: \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.01 is highly statistically significant\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe analysis of Song et al revealed an overall 4% global pooled prevalence of pediatric HTN with higher prevalence in low- and middle-income countries (LMICs) compared to high-income countries (HIC). Also, the highest HTN prevalence was noticed in the African (6.94%) and East Mediterranean Regions (5.26%). (1) The pooled prevalence of pediatric HTN among African children was almost doubled (7.45%) according to Crouch et al. (2)\u003c/p\u003e \u003cp\u003eCountry wise, the prevalence of pediatric HTN was quite variable. In Iran, Ebrahimi et al inferred a prevalence of 6.8%. (21) In China, the prevalence 6% in the cross-sectional survey of Lu et al. (22) Similarly, In India, Patel et al reported a 6.8% frequency of HTN. (23) Slightly higher prevalence of pediatric HTN was reported in Egypt (8.6%) and in India (8.9%). (16, 24) Further increased prevalence of pediatric HTN was noticed in Tanzania (10.8%), Jazan, Saudi Arabia (11.6%), and in India (12.4%). (25\u0026ndash;27) A much higher prevalence of pediatric HTN was recorded in Turkey (14.8%), Jeddah University Hospital, Saudi Arabia (15.2%), and in Tunisia (15.4%). (28\u0026ndash;30) An Extremely higher prevalence of pediatric HTN was reported in India (19.7% and 23%). (31, 32) On the contrary, low prevalence of pediatric HTN was noted in cross-sectional studies in Cameron (1.6%) and in India (2.7%). (33, 34) In line with Ebrahimi et al, (21) Lu et al, (22) and Patel et al, (23) the current study yielded a prevalence of childhood HTN of 6.9% among the studied students with stage 1 HTN (5.6%) and stage 2 HTN (1.3%).\u003c/p\u003e \u003cp\u003eSimilar to pediatric HTN, elevated pediatric BP prevalence varied country wise. It was lowest in India (3.2%) (34) and Tanzania (4.4%), (25) modest in Jeddah, Saudi Arabia (6%), (29) China (6.6%), (22) India (6.9%), (23) Iran (7.4%), (21) and in Cameron (8.1%), (33) and highest in Turkey (11.2%), (28) Jazan, Saudi Arabia (12%), (26), Tunisia (12.4%), (30) India (13.4%), (31) and in Egypt (14.7%). (16) An extremely higher prevalence of elevated pediatric BP (21.6%) was seen in India. (24) In line with Song et al, (1) Crouch et al, (2) Ebrahimi et al, (21) Chelo et al, (33) \u0026Ccedil;am and Ustuner, (28) El-Setouhy et al, (26), and Soua et al, (30) the current study revealed a prevalence of elevated pediatric BP of 9.1% among the studied students.\u003c/p\u003e \u003cp\u003eThe discrepancy in the prevalence of pediatric HTN and elevated BP could be explained on the basis of variation in the research approach, procedures, and confounders. The influence of adherence to the standardized three separate readings technique of BP measurement for the diagnosis of pediatric HTN was evident. As it helps a lot to achieve accurate diagnosis of pediatric HTN, avoid white coat HTN, and avert other conditions such as child activity and emotional state and the surrounding circumstances that might interfere with BP measurement. (4)\u003c/p\u003e \u003cp\u003eThe prevalence of HTN dropped by approximately 60% from 17.2% on the first reading to 11.8% on the second reading and reached 6.9% on the third reading. The significance of adherence to the three readings of childhood BP to diagnose HTN was quite evident in Sun et al systematic review and meta-analysis of 21 studies including 179,561 children. (35) Similarly, Marcovecchio et al in their study among 564 Italian school children reported a decline in the prevalence of HTN from 17.2% on the first BP measurement visit to 8.2% on the third visit. (36) Also, Zhang et al in their cross-sectional survey among 7832 Chinese school children revealed a decline from 17.2% on the first visit to approximately 5% on the third one. (37) Deviation from the standardized 3-reading protocol for BP measurement could be the main contributor to the extreme high prevalence of pediatric HTN in the studies of Das et al (31) who considered HTN based on the mean of 3 BP readings in the same visit and Narang et al (32) who diagnosed HTN based on only 2 readings in the same visit separated by 5-minute interval.\u003c/p\u003e \u003cp\u003eThe role of other confounding factors shared the responsibility for the discrepancy of pediatric HTN prevalence. The influence of age of the study participants was well obvious. Inclusion of younger children by Chelo et al (33) and Sabapathy et al (34) in their studies diluted the prevalence of pediatric HTN, while the inclusion of older children by Ghamri et al (29), Soua et al (30), \u0026Ccedil;am and Ustuner (28), and Arun \u0026amp; Kavinilavu (27) cumulated it. The impact of the study settings on childhood HTN prevalence was evident by Ghamri et al who conducted their study at health facility in Jaddah. (29)\u003c/p\u003e \u003cp\u003eAge is a major contributor to development and progression of HTN. In Egypt, compared to younger children, older ones had higher HTN and elevated BP prevalence. (16) Again, the age correlated positively with both SBP and DBP among children in Jeddah, Saudi Arabia. (29) In Tanzania, abnormal BP possessed statistically significant higher average age than normal BP. (25) Lu et al additionally concluded a prominent significant higher mean age for children with both HTN and elevated BP than normotensive ones. (22) In congruence with the previous studies, the current study showed higher average age among elevated BP children and hypertensive children compared to normotensive ones.\u003c/p\u003e \u003cp\u003eThe impact of sex on childhood HTN and elevated BP was obvious. Prominent higher frequency of HTN and elevated BP in girls in comparison to boys was evident in the current study. Salient prevalence of HTN among girls in comparison to boys was well evident in Crouch et al meta-analysis, (2) and cross-sectional studies in Jeddah, Saudi Arabia. (29), and India. (27, 32) Meanwhile, higher frequency of both childhood HTN and elevated BP among girls than boys was well seen in the cross-sectional studies in Saudi Arabia, (26) Iran, (21) and India. (31) Conversely, higher prevalences of pediatric HTN and elevated BP were documented among boys than girls in Egypt and Tunisia. (16, 30) The higher frequency of childhood HTN among girls than boys logically coincided with the higher frequency of adulthood HTN among women than men in Egypt as mentioned in the WHO 2023 Report (41% vs 36%) (38) and Fares and Soliman cross-sectional study (21.7% vs 20.1%). (39) Besides, it was evident in the current study that girls had significantly higher frequency of obesity, overweight and abdominal obesity than boys.\u003c/p\u003e \u003cp\u003eHypertension often occurs in familial clusters and seems to be heritable. Remarkable inclination of both childhood HTN and elevated BP towards positive family than the negative one was well seen in the current study. Concomitant to the current results, solid connection between childhood HTN and elevated BP and positive family history was noted in Egypt, (16) Saudi Arabia, (26, 29) and in India. (27)\u003c/p\u003e \u003cp\u003ePhysical inactivity is an eminent modifiable risk factor for HTN. Compared to physically active Egyptian children, inactive ones showed higher prevalence of HTN and elevated BP. (16) Lu et al concluded higher prevalence of HTN and elevated BP among physically inactive children compared to physically active one. (22) Concomitantly, the current study ascertained the concrete relationship between physical inactivity and childhood HTN and elevated BP.\u003c/p\u003e \u003cp\u003eThe contribution of dietary habits to development of childhood HTN has been widely studied worldwide. A significant observational connection of consumption of foods poor in vegetables and fruits and rich in fried salty proteins to HTN was exhibited in China. (40) In India, high abnormal BP readings significantly correlated to salted foods consumption. (24) In the same context, the current study found significantly higher frequency of HTN and elevated BP among students classified as high-risk diet and those used added table salt compared to those classified as low risk diet and those did not use added table salt.\u003c/p\u003e \u003cp\u003eWorldwide, the sacred union between obesity / overweight and abnormal BP readings has been strongly affirmed. Higher prevalence of HTN among obese / overweight children than normal weight ones was inferred in Africa, (2) Saudi Arabia, (29) and in Tunisia. (30) Higher prevalence of HTN and elevated BP among obese/ overweight children than normal weight ones was detected in Egypt, (16) and in India. (31) Meanwhile, comparatively to normal weight children, obese and overweight ones had a higher frequency of abnormal BP readings in India, (24) and in Tanzania. (25) Likewise, the frequency of HTN was highest, modest, and lowest among obese, overweight, and normal weight children respectively in China, (40) Turkey, (28) and in India. (32) Moreover, the frequency of HTN and elevated BP was highest, modest, and lowest among obese, overweight, and normal weight children globally in Song et al meta-analysis, (1) and in Saudi Arabia. (26) Meanwhile, the average BMI was highest, modest, lowest among hypertensive, elevated BP, and normotensive Chinese children. (22)\u003c/p\u003e \u003cp\u003eAdditionally, higher prevalence of HTN was noted among children with abdominal obesity than non-obese ones in Turkey. (28) Again, strikingly higher prevalence of HTN and elevated BP was demonstrated among children with abdominal obesity than non-obese ones in Egypt. (16) The SBP and DBP readings positively correlated with each of waist circumference and waist to height ratio in India. (32) Moreover, hypertensive Chinese children owed higher average waist circumference and waist to height ratio in comparison to those with normal BP. (40) Furthermore, the detailed analysis of Lu et al sorted the average waist circumference and waist to height ratio to be highest with HTN, modest with elevated BP, and lowest with normal BP among Chinese children. (22) In congruence, the current study affirmed this prominent association.\u003c/p\u003e \u003cp\u003eThe multivariate analysis accredited the predictivity of different correlates worldwide. It attested the predictivity of high waist circumference, overweight and obesity, family history of HTN, lack of regular physical activity, and increasing age were the significant predictors for childhood HTN in Egypt; (16) obesity and overweight in Saudi Arabia, (26) and overweight/ obesity and family history of HTN in Saudi Arabi, (29) obesity and overweight in Turkey, (28) and overweight/obesity and high consumption of salted food in India. (24) In concordance with the previous studies, the multivariate analysis in the current study confirmed the predictivity of physically activity\u0026thinsp;\u0026le;\u0026thinsp;once weekly \u0026amp; 2\u0026ndash;3 times weekly physical activity, usage of added table salt, being overweight and obese for having abnormal BP level among the students. The consistency of obesity and overweight predictivity in the current and previous studies could be ascribed to the dependence on the actual objective anthropometric measurements (weight, height, and waist circumference) unlike the subjective family history, physical activity, and dietary habits data that relied on the recall.\u003c/p\u003e \u003cp\u003eThe study had a limitation of cross-sectional design adoption which cannot establish a definitive causal link between risk factors and high BP; however, this is strongly mitigated by the solid and rigorous methodology employed. By following the AAP 2017 guidelines and requiring three separate BP measurements across three different days for confirmation. The current study also ascertained the association between HTN and studied variables that might need further longitudinal follow up studies to establish this causality. Moreover, the study restricted to only one Egyptian Governorate. To be generalizable to the overall Egyptian situation, the study needs to be replicated to represent all Egyptian Governorates. However, this is offset by the large and representative sample size of 856 students. The use of a multi-stage random sampling technique and a sample size that exceeded the statistical requirement ensured that the data is highly reliable and provided a precise reflection of the pediatric population, offering a strong foundation for future national-scale research.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eScreening of schoolchildren has explicitly unveiled the high frequency of high BP of elevated BP and HTN among preparatory schoolchildren. Strikingly, age, female sex, family history of HTN, physical inactivity, bad dietary habits, overweight, obesity, and abdominal obesity correlated robustly with childhood elevated BP and HTN. The heroic actor played by physical inactivity, added table salt, overweight, and obesity in predicting childhood high BP tipped the scales in favor of the importance of lifestyle modification in rectifying childhood high BP levels. Pursuant to the current study achievements, it is imperative to establish an inextricable academia-practice partnership and enhance the shift from the \u0026ldquo;quick fix\u0026rdquo; to \u0026ldquo;preventive strategy\u0026rdquo;. This latter emphasizes the awareness, screening, and detection of childhood elevated BP and HTN followed by lifestyle modification intervention to curb the ever-growing childhood high BP. This can be achieved through the conduction of a nationwide multicenter cross-sectional study for early detection of childhood elevated BP and HTN and development of an Egyptian childhood normative BP profile.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Academy of Pediatrics\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ecm\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCentimeter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiastolic Blood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHTN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ekg\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKilogram\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMIC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003em\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMeter\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNCDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003enon-communicable diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSystolic blood pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSimple Random Sampling\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eX̅\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArithmetic mean\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChi squared test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe approval of the ethics committee of the High Institute of Public Health for conducting the research was obtained (IRB Number: 00013692). An informed consent was taken from students\u0026rsquo; parent / legal guardian in addition to obtaining verbal assent from the students themselves after explanation of the purpose and benefits of the research. Anonymity and confidentiality were assured and maintained and there was no conflict of interest. All methods were performed in accordance with the relevant guidelines and regulations confirm the Declaration of Helsinki.\u0026nbsp;All participants with stage 2 HTN were immediately referred for medical consultation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is available on reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to be declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare that no funding has been received related to the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEE\u003c/strong\u003e designed the study, collected and analyzed data, and participated in writing the manuscript. \u003cstrong\u003eHFMF\u003c/strong\u003e conceived and designed the study, provided methodological guidance and critically revised the manuscript.\u0026nbsp;\u003cstrong\u003eSOO\u003c/strong\u003e designed the study, provided methodological guidance and critically revised the manuscript.\u0026nbsp;\u003cstrong\u003eSBS\u003c/strong\u003e led data management and\u0026nbsp;interpretation of data analysis and writing the manuscript.\u0026nbsp;\u003cstrong\u003eDTM\u0026nbsp;\u003c/strong\u003eassissted in study design, statistical analysis, interpretation of data analysis, and writing the paper. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors would offer special thanks to all study participants for their tolerance and cooperation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eEhab Elrewany:\u003c/strong\u003e Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt. email: [email protected], ORCID: 0000-0002-8700-0630, EE.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eHassan Farag Mohamed Farag:\u003c/strong\u003e Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt. email: [email protected], ORCID: 0000-0002-4123-4781, HFMF.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSherif Omar Osman:\u003c/strong\u003e Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt. email: [email protected], ORCID: 0000-0002-9808-8412, SOO.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSamah Batouta Saleh:\u003c/strong\u003e Department of Sports Training and Movement Sciences, Faculty of Sports Sciences for Girls, Alexandria University, Alexandria, Egypt. email: [email protected], SBS\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDoaa Tawfik Mohamed:\u003c/strong\u003e Department of Nutrition, High Institute of Public Health, Alexandria University, Alexandria, Egypt. email: [email protected], DTM.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSong P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K, et al. Global prevalence of hypertension in children: a systematic review and meta-analysis. JAMA pediatrics. 2019;173(12):1154-63.\u003c/li\u003e\n\u003cli\u003eCrouch SH, Soepnel LM, Kolkenbeck-Ruh A, Maposa I, Naidoo S, Davies J, et al. Paediatric hypertension in Africa: a systematic review and meta-analysis. eClinicalMedicine. 2022;43:101229.\u003c/li\u003e\n\u003cli\u003eDionne JM. Updated guideline may improve the recognition and diagnosis of hypertension in children and adolescents; review of the 2017 AAP blood pressure clinical practice guideline. Current hypertension reports. 2017;19(10):84.\u003c/li\u003e\n\u003cli\u003eFlynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3).\u003c/li\u003e\n\u003cli\u003ePatel N, Walker N. Clinical assessment of hypertension in children. Clinical hypertension. 2016;22:15.\u003c/li\u003e\n\u003cli\u003eDobson CP, Eide M, Nylund CM. Hypertension prevalence, cardiac complications, and antihypertensive medication use in children. The Journal of Pediatrics. 2015;167(1):92-7.e1.\u003c/li\u003e\n\u003cli\u003eYang L, Magnussen CG, Yang L, Bovet P, Xi B. Elevated blood pressure in childhood or adolescence and cardiovascular outcomes in adulthood: a systematic review. Hypertension. 2020;75(4):948-55.\u003c/li\u003e\n\u003cli\u003eEwald DR, Haldeman Ph DL. Risk factors in adolescent hypertension. Global pediatric health. 2016;3:2333794x15625159.\u003c/li\u003e\n\u003cli\u003eParker ED, Sinaiko AR, Kharbanda EO, Margolis KL, Daley MF, Trower NK, et al. Change in weight status and development of hypertension. Pediatrics. 2016;137(3):e20151662.\u003c/li\u003e\n\u003cli\u003eBrady TM. Obesity-related hypertension in children. Frontiers in pediatrics. 2017;5:197.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Healthy diet 2024. https://www.who.int/health-topics/healthy-diet#tab=tab_1. Accessed 01 Dec 2025.\u003c/li\u003e\n\u003cli\u003eChen J, Wang Y, Li W, Zhang Y, Cao R, Peng X, et al. Physical activity and eating behaviors patterns associated with high blood pressure among Chinese children and adolescents. BMC Public Health. 2023;23(1):1516.\u003c/li\u003e\n\u003cli\u003eHansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. Jama. 2007;298(8):874-9.\u003c/li\u003e\n\u003cli\u003eMoin A, Mohanty N, Tedla YG, Carroll AJ, Padilla R, Langman CB, et al. Under-recognition of pediatric hypertension diagnosis: Examination of 1 year of visits to community health centers. Journal of clinical hypertension (Greenwich, Conn). 2021;23(2):257-64.\u003c/li\u003e\n\u003cli\u003eTheodore RF, Broadbent J, Nagin D, Ambler A, Hogan S, Ramrakha S, et al. Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertension. 2015;66(6):1108-15.\u003c/li\u003e\n\u003cli\u003eHassan Sk, Abdel Wahed W, Mabrouk SE. Elevated blood pressure and its associated demographic factors among rural school adolescents in Fayoum governorate, Egypt. The Egyptian Journal of Community Medicine. 2023;41(1):18-26.\u003c/li\u003e\n\u003cli\u003eGibson RS. Principles of nutritional assessment: 3rd edition 2023. https://nutritionalassessment.org/. Accessed 01 Dec 2025.\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. About child \u0026amp; teen BMI 2022. https://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html. Accessed 01 Dec 2025.\u003c/li\u003e\n\u003cli\u003eBaioumi AYAA. Chapter 3 - Comparing measures of obesity: waist circumference, waist-hip, and waist-height ratios. In: Watson RR, editor. Nutrition in the Prevention and Treatment of Abdominal Obesity (Second Edition): Academic Press; 2019. p. 29-40.\u003c/li\u003e\n\u003cli\u003eCheung AK, Whelton PK, Muntner P, Schutte AE, Moran AE, Williams B, et al. International consensus on standardized clinic blood pressure measurement - a call to action. The American journal of medicine. 2023;136(5):438-45.e1.\u003c/li\u003e\n\u003cli\u003eEbrahimi H, Emamian MH, Hashemi H, Fotouhi A. Prevalence of prehypertension and hypertension and its risk factors in Iranian school children: a population-based study. Journal of Hypertension. 2018;36(9):1816-24.\u003c/li\u003e\n\u003cli\u003eLu Y, Luo B, Xie J, Zhang X, Zhu H. Prevalence of hypertension and prehypertension and its association with anthropometrics among children: a cross-sectional survey in Tianjin, China. Journal of Human Hypertension. 2018;32(11):789-98.\u003c/li\u003e\n\u003cli\u003ePatel A, Bharani A, Sharma M, Bhagwat A, Ganguli N, Chouhan DS. Prevalence of hypertension and prehypertension in schoolchildren from Central India. Annals of pediatric cardiology. 2019;12(2):90-6.\u003c/li\u003e\n\u003cli\u003eSrirama S, Subramanian M. Prevalence of hypertension and its risk factors among high school children in Bangalore, India. Int J Community Med Public Health. 2020;7:938-45.\u003c/li\u003e\n\u003cli\u003eMuhihi AJ, Njelekela MA, Mpembeni RNM, Muhihi BG, Anaeli A, Chillo O, et al. Elevated blood pressure among primary school children in Dar es salaam, Tanzania: prevalence and risk factors. BMC pediatrics. 2018;18(1):54.\u003c/li\u003e\n\u003cli\u003eEl-Setouhy M, Safhi AM, Dallak MY, Ayoub AY, Suwaid OAH, Moafa AK, et al. Prevalence and associated factors of pediatric hypertension in Jazan region, south of the Kingdom of Saudi Arabia. A pilot cross-sectional study. PloS one. 2023;18(7):e0287698.\u003c/li\u003e\n\u003cli\u003eArun DJ, Kavinilavu R. A study of risk factors associated with hypertension among the school going children in Puducherry. International Journal Of Community Medicine And Public Health. 2018;5(2):764-8.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;am HH, Ustuner Top F. Prevalence of hypertension and its association with body mass index and waist circumference among adolescents in Turkey: A cross-sectional study. Journal of Pediatric Nursing. 2021;57:e29-e33.\u003c/li\u003e\n\u003cli\u003eGhamri RA, Hegazy AA, Azizkhan AZ, Alsalmi SF, Alharbi NA, Hemedy RA, et al. High blood pressure in children attending pediatric clinic at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Journal of family \u0026amp; community medicine. 2019;26(3):193-8.\u003c/li\u003e\n\u003cli\u003eSoua S, Ghammam R, Maatoug J, Zammit N, Ben Fredj S, Martinez F, et al. The prevalence of high blood pressure and its determinants among Tunisian adolescents. Journal of Human Hypertension. 2024;38(4):371-9.\u003c/li\u003e\n\u003cli\u003eDas MK, Bhatia V, Sibal A. Prevalence of hypertension in urban school children aged 5 to 10 years in North India. International Journal of Contemporary Pediatrics. 2017;4(6):2055-9.\u003c/li\u003e\n\u003cli\u003eNarang R, Saxena A, Desai A, Ramakrishnan S, Thangjam RS, Kulkarni S, et al. Prevalence and determinants of hypertension in apparently healthy schoolchildren in India: A multi-center study. European journal of preventive cardiology. 2018;25(16):1775-84.\u003c/li\u003e\n\u003cli\u003eChelo D, Mah EM, Chiabi EN, Chiabi A, Koki Ndombo PO, Kingue S, et al. Prevalence and factors associated with hypertension in primary school children, in the centre region of Cameroon. Translational Pediatrics. 2019;8(5):391-7.\u003c/li\u003e\n\u003cli\u003eSabapathy S, B. A N, C. N B. Prevalence of childhood hypertension and pre-hypertension in school going children of Bangalore rural district: a cross sectional study. International Journal of Contemporary Pediatrics. 2017;4(5):1701-4.\u003c/li\u003e\n\u003cli\u003eSun J, Steffen LM, Ma C, Liang Y, Xi B. Definition of pediatric hypertension: are blood pressure measurements on three separate occasions necessary? Hypertension research : official journal of the Japanese Society of Hypertension. 2017;40(5):496-503.\u003c/li\u003e\n\u003cli\u003eMarcovecchio ML, Mohn A, Diddi G, Polidori N, Chiarelli F, Fuiano N. Longitudinal assessment of blood pressure in school-aged children: a 3-year follow-up study. Pediatric Cardiology. 2016;37(2):255-61.\u003c/li\u003e\n\u003cli\u003eZhang Q, Yang L, Zhang Y, Zhao M, Liang Y, Xi B. Hypertension prevalence based on three separate visits and its association with obesity among Chinese children and adolescents. Frontiers in pediatrics. 2019;7.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Hypertension Egypt 2023 country profile 2023. https://www.who.int/publications/m/item/hypertension-egy-2023-country-profile. Accessed 01 Dec 2025.\u003c/li\u003e\n\u003cli\u003eFares S, Soliman S. Prevalence and determinants of normal, high-normal and high blood pressure and association with cardiovascular risk in Egypt. Eastern Mediterranean Health Journal. 2022;28(6).\u003c/li\u003e\n\u003cli\u003eLu Z, Teng Y, Wang L, Jia L, Chen Z, Ding S. Analysis of the prevalence and related factors of primary hypertension among adolescents and children in the Taicang area. BMC pediatrics. 2023;23(1):265.\u003c/li\u003e\n\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":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Children, hypertension, elevated blood pressure, school-based survey","lastPublishedDoi":"10.21203/rs.3.rs-8730799/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8730799/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChildhood hypertension (HTN) is a substantial public health problem due to its rising trend and strong correlation with adulthood HTN with its long-term sequelae. It has notable unmodifiable and modifiable risk factors. The current study aimed to portray blood pressure (BP) profile and identify the correlates associated with abnormal BP readings among preparatory schoolchildren in El-Beheira Governorate, Egypt.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eusing a multistage random sampling, from El Beheira governorate 15 districts, Damanhur was chosen where 4 preparatory schools (two for boys\u0026thinsp;+\u0026thinsp;two for girls) and 856 students aged 11\u0026ndash;14 years were recruited for a cross-sectional study. A pre-designed structured interview questionnaire having socio-demographic information; habitual and family history data; besides anthropometric and three BP measurements were obtained for each student. BP was classified according to the new American normative BP in healthy children and adolescents.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eStudents boys and girls were equally distributed (50%), with an average age of 13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66 years. Among the students, 27% were obese/overweight and 40% didn\u0026rsquo;t exercise regularly. The frequency of elevated BP and HTN was 9.1% and 6.9%, respectively. High BP predominated with girls (odds ratio (OR)\u0026thinsp;=\u0026thinsp;2.811), physical inactivity (\u0026le;\u0026thinsp;once weekly: OR\u0026thinsp;=\u0026thinsp;30.366, \u0026amp; 2\u0026ndash;3 times weekly: OR\u0026thinsp;=\u0026thinsp;19.364), high risk diet (OR\u0026thinsp;=\u0026thinsp;4.302), added table salt (OR\u0026thinsp;=\u0026thinsp;13.374), family history of HTN (OR\u0026thinsp;=\u0026thinsp;2.003), overweight (OR\u0026thinsp;=\u0026thinsp;3.718), obesity (OR\u0026thinsp;=\u0026thinsp;8.444), and abdominal obesity (OR\u0026thinsp;=\u0026thinsp;4.016), (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe bottom line is that childhood high BP represents an alarming public health problem that should be seriously considered. Screening of schoolchildren has explicitly unveiled the high frequency of high BP (elevated BP and HTN) among preparatory schoolchildren tipped the scales in favor of the importance of lifestyle modification in rectifying childhood high BP levels.\u003c/p\u003e","manuscriptTitle":"Prevalence and predictors of pediatric high blood pressure: An Egyptian school-based survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-12 08:40:00","doi":"10.21203/rs.3.rs-8730799/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-23T04:14:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T12:06:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T14:23:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T09:07:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217818631153139459285025189432129527082","date":"2026-02-16T07:35:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311304074777539664301430326373584642217","date":"2026-02-14T17:11:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"326376156618138208913691334925900995142","date":"2026-02-12T13:05:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107936757225735415288162321420991420175","date":"2026-02-10T15:22:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287245134317889530208049197160335873754","date":"2026-02-09T22:46:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128347868312687171476886179234736479959","date":"2026-02-08T14:18:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-08T14:13:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-08T14:08:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-06T05:16:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T19:16:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-03T19:08:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f7b360f8-bdf1-4c47-8989-4964965c988a","owner":[],"postedDate":"February 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:07:53+00:00","versionOfRecord":{"articleIdentity":"rs-8730799","link":"https://doi.org/10.1186/s12889-026-27360-x","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-04-23 15:58:50","publishedOnDateReadable":"April 23rd, 2026"},"versionCreatedAt":"2026-02-12 08:40:00","video":"","vorDoi":"10.1186/s12889-026-27360-x","vorDoiUrl":"https://doi.org/10.1186/s12889-026-27360-x","workflowStages":[]},"version":"v1","identity":"rs-8730799","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8730799","identity":"rs-8730799","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}