Abstract
Objective: The majority of elevated blood pressure (BP) in children/adolescents remains undiagnosed. The American Academy of Pediatrics states "there is limited evidence to support school-based measurement of children's BP." We explored the clinical/public health utility of providing BP screening in school health clinics. Methods: A cross-sectional sample of 4096 students ages 6-to-17 from Title 1 Miami-Dade County Public Schools (50% female, 71% non-Hispanic Black, 26% Hispanic, mean age 12.0 [CI 95%: 11.90-12.09]) had their systolic/diastolic BP (SBP/DBP) and body mass index (BMI) collected over the 2016-17 or 2017-18 school years. Relative risks (RRs) were calculated to estimate normal/elevated SBP/DBP by BMI percentile, ethnicity, and sex. Results: Over a quarter (26.4%) of the sample had at least one elevated BP measurement, of which 59% were not obese. Students that were female, Hispanic, and obese showed an increased relative risk of elevated BP. RR for obese status was significant for all categories of elevated BP (all RRs >1.88, all p <.0001). Being female (RR=1.34, p=.009) and Hispanic (RR=1.31, p=.014) were significantly associated with elevated DBP. BMI percentile accounted for <10% of the variation in BP (SBP: F(1,4095)=367.6, adjusted R2=.08, p<.0001; DBP: F(1, 4095)=93.3, adjusted R2=.02, p<.0001). Conclusion: These findings support the public health and clinical significance of providing BP screenings in the school setting. Low-income and minority students often have limited access to primary care and a higher prevalence of obesity and unhealthy lifestyle behaviors. Our findings support universal school-based BP screening regardless of weight status, particularly among ethnically diverse populations.