A comparative study of hypertension and obesity with reference to risk factors in school children aged 6-12 years in urban and rural area

Milind B. Kamble, Sagar G. Chopde


Background: Childhood obesity and hypertension are on the rise and limited data are available regarding the profile of childhood obesity and hypertension from India. We studied the prevalence of childhood obesity and hypertension in a representative sample of school children to find out the relationship between obesity and hypertension in study population.

Methods: This prospective, cross-sectional, observational study was conducted in Department of Pediatrics, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India and data were collected from urban and rural primary schools of Yavatmal from 1489 children between ages 6-12years, selected randomly. Anthropometric measurements were taken to calculate BMI and blood pressure was taken. Data was analyzed using CDC guidelines and statistically using contingency coefficient. Overweight and obesity were defined by body mass index for gender and age. Gender, age and height were considered for determining hypertension. The hypertensive children were followed up at 3 monthly intervals, 3 times, to look for persistent hypertension.

Results: Amongst the 1489 children, prevalence of hypertension was 4.49% and that of pre-hypertension was 1.47% and that of overweight was 1.74% and obese was 0.87%. In girls and boys both, increasing BMI was associated significantly (p<0.0001) with average SBP and average DBP in both pre-hypertension and hypertension groups in rural and urban areas. A higher prevalence of pre-hypertension and hypertension seen in the present study group compared to similar studies in the state. Children with higher BMI were associated with pre-hypertension or hypertension.

Conclusions: Prevalence of sustained hypertension overweight and obesity is on rise in children in this part of world. Possible related factors for this current trend may be the increasing sedentary life style, altered eating habits, and increased fat content of diet. The result suggests the need for more public awareness and prevention programs for childhood obesity and hypertension.


Blood pressure, BMI, Hypertension, Obesity, School children, Urban/rural comparison

Full Text:



World Health Organization. Obesity: preventing and managing the global epidemic. World Health Organization; 2000. Available at

Barlow SE, Dietz WH. Obesity evaluation and treatment: expert committee recommendations. Pediatr. 1998;102(3):e29.

Raj M, Sundaram KR, Paul M, Deepa AS, Kumar RK. Obesity in Indian children: time trends and relationship with hypertension. Nat Med J India. 2007;20(6):288.

Menon PSN, Bajpai A, Ghai K. Obesity. In: Ghai OP, Paul VK, Bagga A editors. Ghai essential pediatrics. 7th edition. CBS publishers and distributers pvt ltd; 2009:494.

Joseph, Skelton, Colin D, Rudolph. Overweight and obesity. In: Kleigman, Behrman, Jenson, Stanton, editors. Nelson Textbook of Pediatrics. 18th edition. Saunders Elsevier; 2008;(1):234-236.

Centers for Disease Control and Prevention, National Center for Health Statistics. 2000 CDC growth charts: United States. Available at Accessed 25 June 2010.

Falkner B, Daniels SR, Flynn JT, Gidding S, Green LA, Ingelfinger JR, et al. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatr. 2004;114(2 III):555-76.

Sorof J, Daniels S. Obesity hypertension in children. Hypertension. 2002;40(4):441-7.

Kollias A, Skliros E, Stergiou G, Leotsakos N, Gikas A, Tolika F, et al. Obesity and high blood pressure among schoolchildren in Greece. J Hypertension. 2010;28:e557.

Raj M, Kumar RK. Obesity in children and adolescents. Indian J Med Res. 2010;132(5):598-607.

Verma M, Chhatwal J, George SM. Obesity and hypertension in children. Indian Pediatr. 1994;31(9):1065-9.

Savitha MR, Krishnamurthy B, Fatthepur SS, Kumar AY, Khan MA. Essential hypertension in early and mid-adolescence. Indian J Pediatr. 2007;74(11):1007.

Sharma A, Grover N, Kaushik S, Bhardwaj R, Sankhyan N. Prevalence of hypertension among schoolchildren in Shimla. Indian Pediatr. 2010;47(10):873-6.

Taksande A, Chaturvedi P, Vilhekar K, Jain M. Distribution of blood pressure in school going children in rural area of Wardha district, Maharashatra, India. Ann Pediatric Cardiol. 2008;1(2):101.

Sundar JS, Parameswari S, Valarmarthi S, Kalpana S, Shantharam D. Prevalence and determinants of hypertension among urban school children in the age group of 13-17 years in, Chennai, Tamilnadu. Epidemiol. 2013;3(3):2161-5.

Sreeramareddy CT, Chew WF, Poulsaeman V, Boo NY, Choo KB, Yap SF. Blood pressure and its associated factors among primary school children in suburban Selangor, Malaysia: a cross-sectional survey. J Fam Comm Med. 2013;20(2):90.

Kaur A, Kaur P, Kaur N, Kumari K, Sidhu S. Variation in blood pressure among school children of Amritsar (Punjab). Anthropologist. 2005;7(3):201-4.

Raj M, Sundaram KR, Paul M, Kumar RK. Blood pressure distribution in Indian children. Indian Pediatrics. 2010;47(6):477-85.

Daniels SR, McMahon RP, Obarzanek E, Waclawiw MA, Similo SL, Biro FM, et al. Longitudinal correlates of change in blood pressure in adolescent girls. Hypertension. 1998;31(1):97-103.

Lakshmanudu M, Mani K, Rao PS. Blood pressure levels in south Indian adolescents. Indian Pediatr. 1992;29(6):715-22.

Monga S. Obesity among school children (7-9 years old) in India: Prevalence and related factors. In The 132nd Annual Meeting (November 6-10, 2004) of American Public Health Association (APHA). 2004. Available at

Mahajan PB, Purty AJ, Singh Z, Cherian J, Natesan M, Arepally S, et al. Study of childhood obesity among school children aged 6 to 12 years in union territory of Puducherry. Indian J Comm Med. 2011;36(1):45.

Chadha SL, Tandon R, Shekhawat S, Gopinath N. An epidemiological study of blood pressure in school children (5-14 years) in Delhi. Indian Heart J. 1999;51(2):178-82.

Mohan B, Kumar N, Aslam N, Rangbulla A, Kumbkarni S, Sood NK, et al. Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart J. 2004;56(4):310-4.

Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A clinical trial of the effects of dietary patterns on blood pressure. New England J Med. 1997;336(16):1117-24.

Margetts BM, Beilin LJ, Vandongen R, Armstrong BK. Vegetarian diet in mild hypertension: a randomised controlled trial. Br Med J. 1986;293(6560):1468-71.

Rouse I, Armstrong B, Beilin L, Vandongen R. Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects. The Lancet. 1983;321:8314-5.

Rao G. Childhood obesity: highlights of AMA Expert Committee recommendations. Am Fam Phy. 2008;78(1).

Boreham C, Savage JM, Primrose D, Cran G, Strain J. Coronary risk factors in schoolchildren. Arch Dis Childhood. 1993;68(2):182-6.

Fava C, Burri P, Almgren P, Groop L, Hulthén UL, Melander O. Heritability of ambulatory and office blood pressure phenotypes in Swedish families. J Hypertension. 2004;22(9):1717-21.

Panja M, Kumar S, Sarkar CN, Sinha DP, Ray S, Chatterjee A, et al. Hypertension in the young in eastern India. Indian Heart J. 1996;48(6):663-6.

Khalil A, Singh TP, Arora R, Puri RK. Pediatric hypertension: clinical profile and etiology. Indian Pediatr. 1991;28:141-6.

Hari P, Bagga A, Srivastava RN. Hypertension in children. Indian Pediatr. 2000;37:268-274.