Indian J Pediatr

DOI 10.1007/s12098-014-1573-6

ORIGINAL ARTICLE

The Relationship Between Blood Pressure, Anthropometric

Indices and Metabolic Profile in Adolescents: A Cross
Sectional Study
Setila Dalili & Hamid Mohammadi & Seyed Mahmood Rezvany & Arsalan Dadashi &
Mohammad Hassan Novin & Hajar Gholaminejad & Abdolreza Medghalchi &
Zahra Mohtasham Amiri & Hossein Dalili & Afagh Hassanzadeh Rad

Received: 9 June 2013 / Accepted: 22 August 2014

# Dr. K C Chaudhuri Foundation 2014

Abstract
Objective To investigate the relationship between blood pres-
sure, anthropometric indices and metabolic profile in
adolescents.
Methods The present cross sectional study was conducted in
1005, 12-y-old junior students referred to 15 urban health
centers of Rasht. Samples were recruited randomly and data
were collected in a form which consisted of demographic
characteristics, history of disease in samples and their imme-
diate families, birth weight, physical examination and clinical
examination including height, weight, blood pressure and
body mass index. Also, metabolic profiles including fasting
S. Dalili
Department of Pediatric Endocrinology, Pediatric Growth Disorders
Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan
University of Medical Sciences, Guilan, Iran
H. Mohammadi (*)
Department of Pediatrics, Shiraz University of Medical
Sciences-International Branch, Shiraz, Iran
e-mail: mohammadi219@gmail.com
S. M. Rezvany : A. Dadashi : M. H. Novin : H. Gholaminejad :
A. Medghalchi
Department of Health Center, Guilan University of Medical
Sciences, Guilan, Iran
blood sugar (FBS), blood sugar (BS), cholesterol, and triglyc-
eride (TG), low density lipoprotein (LDL), high-density lipo-
protein (HDL) and insulin levels were measured. Data were
analyzed in SPSS software, by descriptive and analytic statis-
tics and p value 0.05 was considered statistically significant.
Results Eight hundred fifty nine adolescents consisting of 550
(64 %) boys and 309 (34 %) girls participated in this study;
11.4 % (84/739 cases) of the participants had hypertension.
The strongest correlation was seen between systolic blood
pressure and weight, waist or hip circumferences and insulin
levels. Also, FBS had very weak correlation with blood
pressure.
Conclusions Thus, weight, waist and hip circumferences, in-
sulin levels, high TG and low HDL have been indicated as the
strongest correlating factors for high blood pressure.Thus,
these factors should be investigated in high risk children and
followed in hypertensive child to monitor cardiometabolic
risk factors.
Keywords Blood pressure . Anthropometry . Lipoproteins .
Adolescent
Introduction

Z. Mohtasham Amiri Hypertension (HTN) is a global health problem, and it is well-

Department of Social and Preventive Medicine, Guilan University of
Medical Sciences, Guilan, Iran
H. Dalili
Department of Pediatrics, Breastfeeding Research Center, Tehran
University of Medical Sciences, Tehran, Iran
A. Hassanzadeh Rad
Pediatrics Growth Disorders Research Center, School of Medicine,
Guilan University of Medical Sciences, Rasht, Iran
documented that increased blood pressure (BP) becomes
established in childhood [1]. A growing evidence indicate that
not only HTN gradually damages the function of vital organs,
but also pre-HTN has the same harmful effects [2].
Although, the prevalence of hypertension among adoles-
cents is approximately 3.5 % [3] approximately 54 % of stroke
and 47 % of ischemic heart disease which occurs, worldwide
are attributable to high blood pressure [4].

According to previous investigations, factors such as meth-
odological differences in measurement, socio demographic
factors, adiposity levels and ethnicity appear to influence the
distribution of blood pressure as well as prevalence of
hypertension.
The prevalence and severity of overweight status is clearly
increasing [5] and this increase has also indicated an increase
in the prevalence of type 2 diabetes mellitus and premature
onset of cardiovascular risk factors such as hypertension [6,
7].
The pathophysiology of obesity-related hypertension is
complex, and multiple potential mechanisms contribute to
the development of higher blood pressure in obese children.
These include hyperinsulinemia, activation of the renin-
angiotensin-aldosterone system, stimulation of the sympathet-
ic nervous system, abnormalities in adipokines such as leptin,
direct effects of perinephric fat on the renal parenchyma, and
cytokines acting at the vascular endothelial level [8].
The link between obesity and hypertension which may be
mediated in part by sympathetic nervous system (SNS) hy-
peractivity, includes cardiovascular manifestations such as
increased heart rate and blood pressure variability, neurohu-
moral manifestations such as increased levels of plasma cate-
cholamine, and neural manifestations such as increased pe-
ripheral sympathetic nerve traffic [9].
Consistent with the SNS hyperactivity hypothesis, high
blood pressure in children and adolescents is a growing health
problem that is often overlooked by physicians [10]. Since
early interventions to reduce childhood obesity can reduce
prolonged BP elevation and the future risk of cardiovascular
disease and other complications [11–13], this article aimed to
investigate the relationship between blood pressure with an-
thropometric indices and metabolic profile in adolescents.
Material and Methods
The present descriptive cross sectional study was conducted in
1005, 12-y-old junior students referred to 15 urban health
centers of Rasht. All of these cases were examined by a trained
physician and data were recorded.
Samples were recruited randomly and data were collected
in a form which consisted of demographic characteristics,
history of disease in samples and their immediate families,
birth weight, physical examination and clinical examinations
including height, weight, blood pressure and body mass index.
For each patient with high blood pressure in the first visit, two
additional visits were scheduled and mean blood pressure was
recorded. Blood pressure stages were indicated as normal (a
systolic and/or diastolic BP <90th percentile for age and sex),
pre-hypertension (a systolic and/or diastolic BP ≥90th percen-
tile but <95th percentile for age and sex) and hypertension (a
systolic and/or diastolic BP ≥95th percentile for age and sex)
Indian J Pediatr
and laboratory results’ cutoff point was determined based on
standard references [14].
For anthropometric indices, weight were measured in light
indoor clothing and barefoot or with stockings and partici-
pants were weighed to the nearest 0.1 kg with an electronic
scale (Girmi, Germany) that was calibrated daily at the begin-
ning of each working day. Height was measured to the nearest
0.1 cm with a tape meter in a vertical erect position, with
parallel feet, and with the shoulders and bottom touching the
wall. The height and weight were used to calculate the body
mass index (BMI; kg/m2) using the formula: Weight (kg)
divided by height (m) squared and participants were classified
in Underweight, Normal, Overweight and Obese groups
based on BMI.
Waist circumference was obtained immediately above the
iliac crest and exactly under navel by a tape meter and for hip
circumference, investigators horizontally positioned the tape
meter around the maximum circumference of the buttocks.
Consent letter was obtained and participants were referred
to the reference laboratory and metabolic profiles including
FBS, BS, cholesterol, TG, LDL, HDL and insulin levels (if
necessary) were measured.
Data were collected and analyzed by descriptive (mean,
standard deviation and frequency) and analytic statistics by
one-way ANOVA test and Pearson correlation and p value
<0.05 was considered statistically significant in SPSS v.16.
Results
Eight hundred fifty nine adolescent consisting of 550 (64 %)
boys and 309 (34 %) girls participated in this study. Although,
147 participants had incomplete or missing data form, the
recorded data of these patients was also included in some part
of this study. According to the results, 86.7 % of the partici-
pants had normal blood pressure, 11.4 % had hypertension
and 1.9 % had pre-hypertension.
Table 1 demonstrates mean waist and hip circumference,
BMI, weight, height and biochemistry laboratory results such
as FBS, LDL, HDL, TG and cholesterol concentration which
were categorized based on three hypertension stages (Normal
blood pressure; pre-hypertension and hypertension).
Results showed that 84 students (11.4 %) had hypertension
and there was no significant relation between results based on
gender. Also, there was significant relation between hyperten-
sive and normotensive group based on metabolic indices
except cholesterol and LDL (p<0.05). However, lipid profile
and FBS in pre-hypertensive group showed no significant
difference (P>0.05).
Table 2 categorizes prevalence of pre-hypertension and
hypertension based on BMI which revealed significant differ-
ence between mean blood pressure and hypertension in obese
and normal group (P value <0.01). Also, results showed
Indian J Pediatr

Table 1 Distribution of demographic characteristics, anthropometric indices and metabolic profiles based on hypertension′s stage

Hypertension Stage (based on SBP & DBP)

Normal blood pressure Pre-hypertension (0≤BPI<95) Hypertension (95≤BPI) Total cases

Sex Male Count (%) 423 (87.4) 11 (2.3) 50 (10.3) 484 (100)
Female Count (%) 218 (85.5) 3 (1.2) 34 (13.3) 255 (100)
Total Count (%) 641 (86.7) 14 (1.9) 84 (11.4) 739 (100)
Waist circumference (cm) Mean (+/−SD) 69.6 (11.2) 80.5 (16.9) 78.7 (15.1) * 70.9 (12.3)
Hip circumference (cm) Mean (+/−SD) 84 (10) 93 (13) 91 (12) * 85 (11)
Weight (kg) Mean (+/−SD) 42.9 (12.1) 59.5 (20.5) 54.1 (17.9) * 44.5 (13.7)
Height (cm) Mean (+/−SD) 147.8 (8.5) 148.6 (5.7) 152.9 (8.9) * 148.4 (8.7)
BMI Mean (+/−SD) 19.5 (5.9) 27.1 (10.1) 22.9 (6) * 20.1 (6.2)
Birth weight (g) Mean (+/− SD) 3,274 (604) 3,175 (491) 3,467 (647) 3,297 (604)
FBS (mg/dl) Mean (+/−SD) 92 (7) 92 (5) 95 (8) * 93 (7)
Total cholesterol (mg/dl) Mean (+/−SD) 156 (28) 171(35) 166 (25) 157 (28)
Triglyceride (mg/dl) Mean (+/−SD) 103 (64) 136 (75) 179 (91) * 107 (67)
HDL(mg/dl) Mean (+/−SD) 44 (9) 42(9) 36 (8) * 43 (9)
LDL (mg/dl) Mean (+/−SD) 92 (24) 102 (27) 96 (20) 92 (24)
*
The mean difference was statistically significant (p<0.05)

significant relation between raised BMI and elevated systolic
blood pressure.
Figure 1 clearly shows crescendo pattern of hypertension
prevalence in higher BMI categories.
Pearson correlation coefficient showed strong correlation
between systolic blood pressure with weight, waist and hip
circumferences and insulin level (Table 3). FBS had a very
weak correlation with blood pressure; in addition significant
difference between mean FBS in normotensive and hyperten-
sive groups was noted (92 ± 7 and 95 ± 8 respectively).
Furthermore, lipid abnormality showed weak and HDL neg-
ative weak correlation with blood pressure.
Discussion
Systemic hypertension in infants and young children is
uncommon (<1 %), but is often indicative of an under-
lying disease process such as secondary hypertension. In
contrast, the prevalence of primary essential hypertension,

Table 2 Prevalence of blood pressure abnormalities based on BMI classification

BMI Percentile

Underweight Normal Overweight Obesity Total

(BMI<5) (5<BMI ≤85) (85<BMI≤95) (BMI>95)

Systolic blood pressure* Mean (+/−SD) 93 (10) 96 (10) 100 (11) 106 (15) 98 (12)
Diastolic blood pressure $ Mean (+/−SD) 60 (7) 62 (8) 62 (9) 67 (9) 63 (8)
Blood pressure Normal blood pressure 91 (95) 362 (91) 92 (85) 84 (68) 629 (87)
[Count (Percent)]
Pre-hypertension 1 (1) 3 (1) 2 (2) 8 (7) 14 (2)
(90 %≤BPI <95 %)
[Count (Percent)]
Hypertension $ (95 %≤BPI) 4 (4) 34 (9) 14 (13) 31 (25) 83 (11)
[Count (Percent)]
*
Significant statistical difference between all BMI categories with P value <0.01
$
Significant statistical difference between obese group and other BMI classification with P value <0.01. Non-obese group had no significant statistical
differences
 Indian J Pediatr

100% HDL. This finding is similar with the results mentioned by

90%
Pinhas-Hamiel et al. They showed that blood pressure is
80%
70% positively related to plasma triglyceride level and negatively
60% with high density lipoprotein cholesterol [6]. The association
50% between blood pressure with hypercholesterolemia and LDL
40%
was weak and no significant difference was detected in blood
30%
20% pressure groups. Therefore, it seems that hyper-
10% triglyceridemia has a considerable effect on blood pressure
0%
Underweight Normal Overweight Obese
in children and adolescents.
NBP 95% 91% 85% 68% The relation between birth weight and blood pressure
PRE-HTN 1% 1% 2% 7%
showed controversial results. Seidman, Daniel S., et al. had
HTN 4% 9% 13% 25%
previously demonstrated that intrauterine environment, as
Fig. 1 Prevalence of hypertension [systolic blood pressure (SBP) and/or reflected by birth weight, had little effect on blood pressure
diastolic blood pressure (DBP) that is ≥95th percentile for age, sex, and
height] in different BMI groups in young men and women. On the other hand, Vasylyeva et al.
indicate that the development of obesity and HTN had been
mostly in older school aged children and adolescents has been related to preterm/LBW [20]. However, the present results
increased parallel to obesity. According to previous investiga- indicate no significant difference between birth weights in 3
tions, approximately 10 % of American youths have pre- hypertension stages and only weak correlation with birth
hypertension and 4 % have hypertension [15, 16]. weight and measured blood pressure.
The present results show significant relation between obe- Among anthropometric indices, the strongest correlation
sity and hypertension. Significant correlation between BMI was detected between hip circumference and systolic hyper-
and systolic and diastolic BP has been observed (R=0.3 and tension. Systolic blood pressure indicated higher correlation
0.21 with p value of <0.05) which is consistent with previous with weight, height and BMI rather than diastolic BP, which is
investigations which report higher chance for hypertension in similar with previous studies which showed stronger correla-
obese children [7, 17]. tion between systolic blood pressure and anthropometric in-
In this study, there was no significant difference between dices rather than diastolic pressure [21, 22].
mean FBS and blood pressure stages and weak correlation
between FBS and BP was found. Blood pressure in patients
with normal and impaired FBS did not show significant
difference. However, Williams et al. has previously demon- Conclusions
strated a positive association between FPG and BP in children
with impaired fasting glucose (IFG) [18]. Furthermore, Di According to the mentioned results, weight, waist and hip
Bonito et al. reported that this relation also presents at FPG circumferences, insulin level, high TG and low HDL have
within the normal range [19]. It seems that this difference has been indicated as the strongest correlated factors for high
been observed as a result of higher age group in these studies. blood pressure. Thus, these factors should be investigated
Regarding the association of hyperlipidemia and blood in high risk children and followed in hypertensive child to
pressure, hypertensive group had higher TG and lower monitor cardiometabolic risk factors.

Table 3 Correlation of blood pressure with anthropometric indices and metabolic profile

Height Weight Birth weight AC GC BMI FBS TC TG HDL LDL Insulin

Systolic BP Pearson correlation 0.211* 0.402* 0.146* 0.399* 0.405* 0.319 0.081 0.097* 0.209* −0.155* 0.069 0.343*
P value <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 .028 <0.01 <0.01 <0.01 NS 0.001
Number 734 730 539 664 656 726 738 735 738 738 738 88
Diastolic BP Pearson correlation 0.171* 0.275* 0.123* 0.246* 0.241* 0.217 0.093 0.063 0.143* −0.088 0.039 0.353*
P value <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 .013 NS <0.01 0.020 NS <0.01
Number 703 699 525 633 625 697 705 703 705 705 705 83

N/S Not significant; BP Blood pressure; AC Abdominal circumference; GC Grid circumference; TC Total cholesterol; TG Triglyceride; HDL High-
density lipoprotein; LDL: Low density lipoprotein; FBS: Fasting blood sugar; BMI Body mass index
* Statistically significant at p value <0.01
Indian J Pediatr
Acknowledgments The authors would like to thank participants and
colleagues in Guilan University of Medical Sciences.
Conflict of Interest None.
Source of Funding Department of Health Center, Guilan University of
Medical Sciences, Guilan, Iran.
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