title: Change in Weight Status and Development of Hypertension.
abstract: OBJECTIVE
  To examine the association of BMI percentile and change in BMI percentile to change in blood pressure (BP) percentile and development of hypertension (HTN).
  
  
  METHODS
  This retrospective cohort included 101 606 subjects age 3 to 17 years from 3 health systems across the United States. Height, weight, and BPs were extracted from electronic health records, and BMI and BP percentiles were computed with the appropriate age, gender, and height charts. Mixed linear regression estimated change in BP percentile, and proportional hazards regression was used to estimate risk of incident HTN associated with BMI percentile and change in BMI percentile.
  
  
  RESULTS
  The largest increases in BP percentile were observed among children and adolescents who became obese or maintained obesity. Over a median 3.1 years of follow-up, 0.3% of subjects developed HTN. Obese children ages 3 to 11 had twofold increased risk of developing HTN compared with healthy weight children. Obese children and adolescents had a twofold increased risk of developing HTN, and severely obese children had a more than fourfold increased risk. Compared with those who maintained a healthy weight, children and adolescents who became obese or maintained obesity had a more than threefold increased risk of incident HTN.
  
  
  CONCLUSIONS
  We observed a strong, statistically significant association between increasing BMI percentile and increases in BP percentile, with risk of incident HTN associated primarily with obesity. The adverse impact of weight gain and obesity in this cohort over a short period underscores the early need for effective strategies for prevention of overweight and obesity.
authors.affiliation: HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota; emily.d.parker@healthpartners.com.
authors.forename: Emily D
authors.initials: ED
authors.lastname: Parker
authors.affiliation: Department of Pediatrics, and.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Sinaiko
authors.affiliation: HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota;
authors.forename: Elyse O
authors.initials: EO
authors.lastname: Kharbanda
authors.affiliation: HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota;
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado;
authors.forename: Matt F
authors.initials: MF
authors.lastname: Daley
authors.affiliation: HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota;
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Trower
authors.affiliation: HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota;
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Sherwood
authors.affiliation: Department of Pediatrics, Kaiser Permanente San Francisco, San Francisco, California; and.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Greenspan
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Joan C
authors.initials: JC
authors.lastname: Lo
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado;
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.affiliation: HealthPartners Institute for Education and Research, HealthPartners, Minneapolis, Minnesota;
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D063766:Pediatric Obesity / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology