Abstract P484: The Role of Excessive Body Weight in Hypertension Risk Among Youth

Abstract

Objective: To determine the hypertension risk associated with elevated body mass index (BMI) for age in children. Study design: In a retrospective cohort of 706,903 children ages 3-18 years in an integrated health care system in Southern California between 2008 and 2017, Cox proportional hazard models with age as time scale were fitted to assess the risk of hypertension (based on 2017 Blood Pressure Guidelines by the American Academy of Pediatrics using 3 blood pressures of independent consecutive visits), by baseline BMI-for-age category (starting at their first available BMI) and BMI change over time, adjusted for sex, race, socioeconomic status and baseline year. Children were followed up until end of membership, onset of hypertension, death, or end of study period. Results: During 3,121,299 person-years, we identified 19,158 youth with incident hypertension. The adjusted hazard ratio (HR) for hypertension was 0.842 (95%CI 0.755, 0.938) for children with a baseline BMI-for-age <5th percentile, 0.864 (95%CI 0.814, 0.917) for 5-39th percentile, 1.00 (reference) for 40-59th percentile, 1.216 (95%CI 1.153, 1.282) for 60-84th percentile, 1.721 (95%CI 1.629, 1.817) for 85-94th percentile, 2.418 (95%CI 2.261, 2.586) for 95-96th percentile, and 3.816 (95%CI 3.624, 4.019) for ≥97th percentile. The adjusted HR for change in BMI over time was 1.095 (95%CI 1.090, 1.100) per kg/m2. Conclusions: In this large cohort study, we found that even moderate elevations in BMI-for age percentile conferred an increased risk of hypertension in children. Results also indicate an escalation of hypertension risk as BMI increased over time. Our results suggest that normal body weight in children ranging from the 5th to the 85th percentile of BMI-for-age and modest increases in BMI over time may increase the risk for hypertension.