title: Trends in Elevated Blood Pressure Among US Children and Adolescents: 1999-2012.
abstract: BACKGROUND
  The prevalence of elevated blood pressure (BP) has been reported to increase significantly among the US children and adolescents from 1988-1994 to 1999-2008. We aimed to examine the recent trends in BP levels and prevalence of elevated BP, as well as related influencing factors among US children and adolescents.
  
  
  METHODS
  Data of National Health and Nutrition Examination Survey (NHANES) 1999-2012 were combined into 3 time periods (1999-2002, 2003-2008, and 2009-2012) for the analysis. A total of 14,270 US children and adolescents aged 8-17 years were included in the current analysis. The sex-, age-, and height-BP standards recommended by the US Fourth Report were used to define high BP and elevated BP (including pre-HBP and HBP).
  
  
  RESULTS
  Mean systolic BP (SBP) and diastolic BP (DBP) decreased by 0.7 and 4.2mm Hg from 1999-2002 to 2009-2012, respectively. In 2009-2012, the prevalence of elevated BP and HBP in children and adolescents were 9.6% and 1.6%, with the absolute reduction of 2.8% and 1.3% from 1999-2002 to 2009-2012, respectively. In addition, daily intakes of total energy, carbohydrate, total saturated fatty acids, and caffeine decreased during the period between 1999-2002 and 2009-2012 (all P < 0.05), whereas daily intake of total polyunsaturated fatty acids and dietary fiber increased (P < 0.05).
  
  
  CONCLUSIONS
  Mean BP levels as well as the prevalence of elevated BP and HBP among US children and adolescents have declined during the past decade. In addition, there might be an associated change in dietary factors.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China;
authors.forename: Bo
authors.initials: B
authors.lastname: Xi
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China;
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China;
authors.forename: Meixian
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Fuwai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China;
authors.forename: Fangchao
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China;
authors.forename: Xinnan
authors.initials: X
authors.lastname: Zong
authors.affiliation: Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China;
authors.forename: Min
authors.initials: M
authors.lastname: Zhao
authors.affiliation: Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA. youfawan@buffalo.edu.
authors.forename: Youfa
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D001794:Blood Pressure; D002648:Child; D004032:Diet; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D009749:Nutrition Surveys; D015995:Prevalence; D014481:United States / Q000453:epidemiology
keywords: blood pressure; children; elevated blood pressure; hypertension; trends.