title: Elevated blood pressure in adolescent girls: correlation to body size and composition.
abstract: BACKGROUND
  To improve understanding of the pathophysiology of hypertension in adolescents and pave the way for risk stratification, studies have sought to determine the correlates of blood pressure (BP). Inconsistencies in dependent and independent variables have resulted in an elusive consensus. The aim of this report is to examine an inclusive array of correlates of BP, as a continuous (systolic and diastolic BP) and a dichotomous variable.
  
  
  METHODS
  Subjects were a school-based sample of 730 urban, mostly African American, non-referred 6th and 7th grade girls. To find independent correlates of SBP/DBP, we used a stepwise model selection method based on the Schwarz Bayesian Information Criterion, enabling selection of a parsimonious model among highly correlated covariates. Candidate variables were: age, stature, heart rate, pubertal development, BMI, BMI z-score, waist circumference, waist-to-height ratio (WHtR), body surface area, fat mass (by bioelectrical impedance analysis), fat-free mass (FFM), percentage of body fat, and presence of overweight/obesity.
  
  
  RESULTS
  The best-fitting models for DBP and SBP (considered separately) included fat-free mass, heart rate and, in the case of SBP, stature. The best-fitting model for high-normal/elevated blood pressure (H-N/EBP) included WHtR with no independent relation of any other variable. The prevalence of H-N/EBP tripled between a WHtR of 0.5 and 0.7.
  
  
  CONCLUSIONS
  The easily obtained and calculated WHtR is the strongest correlate of elevated blood pressure among available variables and is a prime candidate for longitudinal studies of predictors of the development of hypertension.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier, NCT00746083.
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.|Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Devonshire
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Hager
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tilton
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA. ssnitker@medicine.umaryland.edu.|Department of Medicine, University of Maryland School of Medicine, 660 West Lombard Street, Rm. 598-B, 21201, Baltimore, Maryland, USA. ssnitker@medicine.umaryland.edu.
authors.forename: Soren
authors.initials: S
authors.lastname: Snitker
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D001499:Bayes Theorem; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D001827:Body Height; D015992:Body Mass Index; D015984:Causality; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology*; D009765:Obesity / Q000208:ethnology*; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference / Q000502:physiology*; D065927:Waist-Height Ratio
references.citation: Nutrition. 1989 Sep-Oct;5(5):303-11; discussion 312-3
references.pmid: 2520314
references.citation: Paediatr Perinat Epidemiol. 2001 Jan;15(1):88-94
references.pmid: 11237120
references.citation: Pediatr Nephrol. 2003 Apr;18(4):313-8
references.pmid: 12755148
references.citation: J Atheroscler Thromb. 2002;9(3):127-32
references.pmid: 12226553
references.citation: Pediatrics. 2004 Aug;114(2 Suppl 4th Report):555-76
references.pmid: 15286277
references.citation: J Pediatr. 2005 Apr;146(4):482-8
references.pmid: 15812450
references.citation: Nature. 2006 Dec 14;444(7121):881-7
references.pmid: 17167477
references.citation: Hypertension. 1996 Jul;28(1):37-41
references.pmid: 8675261
references.citation: Nutr Metab (Lond). 2010 Dec 09;7:86
references.pmid: 21143876
references.citation: Int J Pediatr Obes. 2011 Jun;6(2-2):e603-10
references.pmid: 21142752
references.citation: Acta Med Scand Suppl. 1988;723:23-36
references.pmid: 3164971
references.citation: Arch Pediatr Adolesc Med. 2009 Sep;163(9):818-25
references.pmid: 19736335
references.citation: Annu Rev Med. 1984;35:535-60
references.pmid: 6372671
references.citation: Int J Obes Relat Metab Disord. 2000 Nov;24(11):1453-8
references.pmid: 11126342
references.citation: NCHS Data Brief. 2010 Dec;(51):1-8
references.pmid: 21211166
references.citation: J Am Coll Cardiol. 2009 Dec 15;54(25):2396-406
references.pmid: 20082930
references.citation: Int J Obes (Lond). 2010 Jun;34(6):949-59
references.pmid: 20065965
references.citation: J Natl Med Assoc. 1982 Jan;74(1):43-6
references.pmid: 7120442
references.citation: Int J Obes Relat Metab Disord. 2002 May;26(5):701-9
references.pmid: 12032756
references.citation: Am J Clin Nutr. 2007 Jul;86(1):33-40
references.pmid: 17616760
references.citation: J Am Coll Cardiol. 2006 Nov 7;48(9):1865-70
references.pmid: 17084264
references.citation: Acta Physiol (Oxf). 2010 Oct;200(2):107-27
references.pmid: 20653609