Early BMI-associated increases in central and peripheral blood pressure in primary school children: evidence of a continuous, nonlinear relationship below the overweight threshold.

Blood pressure increased progressively with rising BMI percentile in primary school children, with the largest elevations in children with overweight or obesity.

• Cohort of 1,183 primary school children with mean age 7.9 years.
• Peripheral and central BP were measured using standardized protocols.
• Associations were evaluated using spline and linear regression models adjusted for age, sex, and height.

Significant increases in peripheral and central systolic BP were observed at BMI percentiles below the WHO-defined cutoff for overweight.

• BMIp categories were compared against children with BMIp < 50 to identify thresholds at which BP became significantly higher.
• The authors conclude BMI-associated BP increases are detectable at substantially lower BMIp than commonly considered.
• Both peripheral and central BP increased within the high-normal BMI range.

Central systolic BP increased at lower BMI percentiles than peripheral systolic BP.

• Central BP was suggested to provide additional insight into early hemodynamic changes.
• Central BP identified early, distinct BP alterations compared with peripheral BP.

Peripheral diastolic BP was not associated with BMIp, whereas central diastolic BP increased significantly across higher BMIp ranges.

• Central BP detected significant diastolic changes that were not detected with peripheral BP.
• Central diastolic increases appeared at higher BMIp ranges.

The relationship between BMI percentile and BP is continuous and nonlinear, suggesting body weight-related cardiovascular risk arises along a continuum.

• Spline regression models were used to characterize the nonlinear association.
• Children with high-normal body weight are highlighted as a group at early cardiovascular risk.
• The authors suggest this supports potential value of early BP monitoring in children with increasing BMI.