THE RELATIONSHIP OF BODY MASS INDEX AND BLOOD PRESSURE IN PRIMARY CARE PEDIATRIC PATIENTS BONITA FALKNER, MD, SAMUEL S. GIDDING, MD, GABRIELA RAMIREZ-GARNICA,PHD, MPH,STACEY ARMATTI WILTROUT, MA, MS, DAVID WEST, MD, AND ELIZABETH B. RAPPAPORT, MD Objective To determine whether an association of overweight, or risk of overweight, and blood pressure can be detected in children in the pediatric primary care practice setting. Study design We examined electronic medical record (EMR) data from primary care practices on 18,618 children age 2 to 19 years. Each child was classified on the basis of age- and sex-specific body mass index (BMI) percentile as normal weight (BMI < 85th percentile), at risk for overweight (BMI > 85th and < 95th percentile), or overweight (BMI > 95th percentile). BMI Z-score and height Z-score were computed. Systolic and diastolic blood pressures were compared among age-sex-BMI groups. Results Among children in primary care pediatric practices, 16.7% were at risk of overweight and 20.2% were overweight. With increasing BMI status there was a significant increase in both systolic blood pressure (P < .001) and diastolic blood pressure (P < .001). The association of higher blood pressure with increasing BMI status was present in all age groups. Conclusions Clinical data from pediatric primary care practices verify the high prevalence of childhood overweight. The effect of overweight on blood pressure is present in childhood and can be detected even in children as young as 2 to 5 years. (J Pediatr 2006;148:195-200) E levated blood pressure is a major risk factor for cardiovascular disease and is linked to cardiovascular morbidity. 1 Among US adults, the prevalence of hypertension has increased from 25.0% in 1988 to 28.7% in 2000, an increase related to the parallel increase in obesity. 2 Higher blood pressure in childhood is predictive of sustained hypertension in young adulthood. 3 New evidence indicates that high blood pressure at a young age is not benign. Recent findings demonstrate that higher blood pressure during adolescence is associated with an increase in left ventricular mass 4 and significant thickening of carotid arterial walls in healthy young adults. 5 Recently, Muntner et al 6 examined trends in systolic and diastolic blood pressure in children and adolescents using the National Health and Nutrition Examination Survey (NHANES) data from 2 serially conducted cross-sectional studies. They reported that, following age, race/ethnicity, and sex standardization, systolic blood pressure was 1.4 mm Hg higher and diastolic blood pressure was 3.3 mmHg higher in 1999-2000 than in 1988-1994. This population increase in blood pressure among children and adolescents was statistically significant and was largely (but not entirely) due to the increased prevalence of overweight in children. The marked increase in adiposity among children and adolescents over the past few decades is well established. Health statistics show that the prevalence of overweight in US children age 6 to 11 years rose from 4% to 15.3% between 1963 and 2000. During the most recent decade, the prevalence of overweight also increased among very young children (age 2 to 5 years), from 7.2% to 10.4%. 7,8 The purpose of this study was to determine whether an association between overweight, or risk of overweight, and blood pressure could be detected in children in the pediatric primary care practice setting. It was of particular interest to determine whether this association could be detected in children under age 6 years. Growth and blood pressure measurements obtained during scheduled health assessment visits to pediatric primary care practices were examined. This information was systematically recorded in an electronic medical record (EMR). Sex and insurance status were also examined as correlates of blood pressure in children. BMI Body mass index EMR Electronic medical record NHANES National Health and Nutrition Examination Survey SES Socioeconomic status From the Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania; the Alfred I. du- Pont Hospital for Children, Wilmington, Delaware; and the Nemours Foundation, Orlando, Florida. Submitted for publication Apr 14, 2005; last revision received Sep 2, 2005; accepted Oct 11, 2005. Reprint requests: Bonita Falkner, MD, 833 Chestnut St., Suite 700, Philadelphia, PA 19107. E-mail: Bonita.Falkner@jefferson.edu. 0022-3476/$ - see front matter Copyright © 2006 Elsevier Inc. All rights reserved. 10.1016/j.jpeds.2005.10.030 195