ABPM is crucial for accurate diagnosis of hypertension in schoolchildren and adolescents, clarifying the relationship between obesity, lifestyle, and elevated BP, and early cardiac remodeling was already present in asymptomatic children.
Key Findings
Results
Obesity prevalence differed markedly between Grade 3 and Grade 9 students, with the older cohort showing substantially higher rates of overweight and obesity.
In Grade 3 (ages 8-9), 45.7% were underweight, 31.9% had normal BMI, and 22% were overweight or obese.
In Grade 9 (approximately age 15), 81.5% were overweight or obese.
The study included 354 students total: 234 primary Grade 3 students and 120 secondary Grade 9 students.
Significant differences were observed in BMI between Grade 3 and Grade 9 cohorts.
Results
Clinic-based hypertension prevalence was higher in younger Grade 3 students compared to older Grade 9 students.
Clinic-based hypertension was identified in 15.4% of Grade 3 students.
Clinic-based hypertension was identified in 12.5% of Grade 9 students.
BP was measured using standardized methods and classified by established percentiles accounting for age, sex, and height.
Sustained hypertension was confirmed by ABPM to rule out white-coat hypertension.
Results
ABPM confirmed sustained hypertension in a subset of students with elevated clinic BP, distinguishing true hypertension from white-coat hypertension.
ABPM was performed for students with elevated BP to analyze 24-hour readings, dipping status, and pulse pressure.
ABPM was used to classify hypertension type after initial clinic-based screening identified elevated BP.
Results of ABPM were correlated with BMI Z scores and lifestyle factors.
The study design used ABPM as the confirmatory standard following clinic-based screening.
Results
Early cardiac remodeling, as measured by interventricular septal thickness, was already present in asymptomatic children and was greater in older students.
Echocardiography was performed on all students with elevated BP.
The mean interventricular septal thickness in diastole (IVSd) was 0.75 cm in Grade 3 students.
The mean IVSd was 1.07 cm in Grade 9 students.
Cardiac changes were observed despite students being asymptomatic.
The findings underscore that early cardiac remodeling was already present in asymptomatic children.
Results
Sustained hypertension findings correlated with BMI Z scores and lifestyle factors in the studied schoolchildren.
ABPM results were correlated with BMI Z scores and lifestyle in both age groups.
The study assessed medical history, physical examination including weight, height, BMI, and BP as part of comprehensive evaluation.
The study emphasizes the relationship between obesity, lifestyle, and elevated BP in the pediatric population.
Schools were identified as an effective environment for identifying at-risk students.
What This Means
This research suggests that high blood pressure (hypertension) is a meaningful concern among school-aged children and teenagers, and that it often goes undetected because it causes no obvious symptoms. The study screened 354 students across two age groups in a school setting, finding that about 15% of younger children (ages 8-9) and 12.5% of older adolescents (around age 15) had elevated blood pressure when measured in a clinic. A more advanced 24-hour monitoring technique called Ambulatory Blood Pressure Monitoring (ABPM) was then used to confirm which students truly had hypertension versus those who only showed elevated readings in a clinical setting — a phenomenon known as 'white-coat hypertension.' The study also found a dramatic difference in obesity rates between age groups, with over 80% of the older students being overweight or obese compared to only 22% of the younger group, and hypertension was correlated with higher BMI and lifestyle factors.
Perhaps most notably, the study found evidence of early heart changes in children and teenagers who had no symptoms at all. Using echocardiography (a heart ultrasound), researchers measured the thickness of the wall between the heart's two lower chambers and found it was already thickening — a sign of the heart working harder than normal due to elevated blood pressure. This structural change was more pronounced in the older adolescent group, suggesting it progresses over time.
This research suggests that routine blood pressure screening in schools, combined with more precise monitoring tools like ABPM, could help catch hypertension early before it causes lasting damage. The findings highlight that obesity and lifestyle factors are closely tied to blood pressure problems even in young people, and that heart changes can begin silently in childhood. Early interventions such as weight management and lifestyle modifications may be important tools for reducing long-term cardiovascular risk.
Kamel M, El-Saiedi S, Shafei A, Salama A, Boles D, Aboudeif M. (2026). Hidden hypertension and early cardiac alterations: insights from ambulatory blood pressure monitoring in children and adolescents.. Italian journal of pediatrics. https://doi.org/10.1186/s13052-026-02319-1