Association Of Body Mass Index With Hypertension Amongst School-Aged Children

Abstract

Background and Objectives: Childhood obesity and hypertension (HTN) are emerging public health challenges that predispose to early cardiovascular disease. This study aimed to determine the prevalence of HTN and its association with body mass index (BMI) categories among school-aged children in Erbil, Iraq, and to assess related demographic and lifestyle risk factors. 

Methods: A school-based cross-sectional survey was conducted from September 2024 to April 2025 among 200 children aged 6–18 years, selected through multistage cluster sampling. Anthropometric data were collected per WHO protocols, and blood pressure (BP) was measured using validated pediatric guidelines. HTN was defined as systolic and/or diastolic BP ≥95th percentile for age, sex, and height.

Results: Of the participants, 106 (53.0%) were male, and the mean age was 11.97 ± 3.76 years. Based on BMI classification, 6 (3.0%) were underweight, 132 (66.0%) normal, 38 (19.0%) overweight, and 24 (12.0%) obese. Blood pressure profiles showed 131 (65.5%) normal, 40 (20.0%) pre-hypertensive, and 29 (14.5%) hypertensive children. HTN was strongly associated with obesity, affecting 17 (70.8%) of obese children compared to 3 (2.3%) of normal-weight children (p < 0.01). Logistic regression showed that each unit increase in BMI raised the odds of HTN by 83% (OR = 1.831, 95% CI: 1.434–2.339). Physical activity was protective, with highly active children showing only 1 (1.7%) hypertensive case compared to 18 (52.9%) in low activity, corresponding to 77% lower odds (OR = 0.227, 95% CI: 0.092–0.560). No significant associations were found with sex, age, or socioeconomic status.

Conclusion: Childhood overweight and obesity are significantly associated with elevated BP in Erbil. Promoting physical activity and early preventive interventions are crucial to mitigating the growing burden of pediatric HTN in the region.