Single-Visit Screening-Positive Blood Pressure Among School-Going Adolescents in Coimbatore, South India: A Cross-Sectional Study

Abstract

Background Pediatric hypertension is an increasingly recognized cardiovascular risk factor, yet Indian prevalence data using current diagnostic criteria remain scarce outside single-city surveys. This study examined the prevalence and correlates of screening-positive hypertensive-range blood pressure, per the 2017 American Academy of Pediatrics (AAP) criteria, among school-going adolescents in Coimbatore, Tamil Nadu. Methods In this cross-sectional, school-based study (July 2024-November 2025), blood pressure was measured (triplicate, bilateral-arm readings) in adolescents aged 12-18 years across private, urban government, and aided schools. Multivariable logistic regression identified independent correlates of combined (Stage 1 plus Stage 2) screening-positive hypertensive-range blood pressure. Results Among 3,160 adolescents analyzed (mean age 15.79 years; 1,769/3,160, 55.98% male), most were enrolled in private schools (n = 2,579; 81.61%), followed by government urban (n = 301; 9.53%) and aided (n = 280; 8.86%) schools. Most belonged to lower-middle and upper-lower socioeconomic strata (n = 2,421; 76.62% combined). A non-vegetarian diet was reported by 2,830 (89.56%); 408 (12.91%) were overweight and 179 (5.66%) obese. In total, 1,213 (38.39%; 95% CI 36.68-40.11%) had screening-positive hypertensive-range blood pressure meeting combined (Stage 1 plus Stage 2) criteria, and 438 (13.86%) had elevated blood pressure, most asymptomatic. Confirmation on repeated visits is required before clinical diagnosis. Prevalence rose from 317/1,142 (27.76%) in underweight to 124/179 (69.27%) in obese adolescents, peaking at 41.72% at age 17. Obesity (aOR 3.16), overweight (aOR 1.43), male sex (aOR 1.59), and age (aOR 1.09/year) independently associated with screening-positive hypertensive-range BP; underweight was protective (aOR 0.59). Conclusion More than one in three adolescents (1,213/3,160, 38.39%) in this South Indian cohort had screening-positive hypertensive-range blood pressure by the AAP 2017 criteria, mostly asymptomatic, with obesity as the strongest modifiable correlate. Confirmation on repeated visits is required; findings support routine school-based blood pressure screening for identification of high-risk youth requiring further evaluation and obesity-focused prevention.