An estimated 18% of US youth with obesity have elevated BP. This study aims to assess predictors of elevated BP (defined using the 2017 BP clinical practice guideline) for youth receiving obesity management care at 35 Pediatric Obesity Weight Evaluation Registry (POWER) sites.


Data from first visits of subjects aged 3-18 years (y), with valid BP, height and weight measures, and body mass index (BMI) for age ≥95th percentile were evaluated. Data were used to compute % of the 95th BMI percentile (BMIp95) and height z-score (HtZ) based on CDC 2000 references. BP interpretation used 2017 guideline strategies (SAS macro). A generalized linear multivariable model, with site as a random effect to account for multi-site sampling, was used to evaluate factors associated with having a BP reading above normal (elevated BP group).


Among 7,943 subjects, 49% were in the elevated BP group (19% elevated BP, 24% stage 1 hypertension, 6% stage 2). Subjects were 54% female, mean BMIp95 137% (SD 25), mean HtZ 0.8 (1.1) with 53% aged 3-11y and 47% 12-18y; race/ethnicity 40% white, 19% black/African American, 32% Hispanic, 5% other/mixed, 5% unknown. Elevated BP group subjects were less often female (odds ratio (OR) 0.72, 95% confidence interval (CI) 0.65-0.79), had higher BMIp95 (increase per 10 point increase, OR 1.17, CI 1.15-1.20) and were older (OR 0.6 for all age groups compared to 15-18y, all p<0.0001). As compared to white race, elevated BP group subjects were less often black/African American (OR 0.8, CI 0.7-0.9); other race/ethnicity groups were not different than the white race group. HtZ was not significant in the model.


In obesity care settings, substantial numbers of youth have elevated BP. In this sample, males, older teens, youth with severe obesity and of white race more often had elevated BP.Further work is needed to identify reasons for these findings.