Background: Pediatric hypertension is increasing in prevalence with the global childhood obesity epidemic. The burden of paediatric hypertension and prehypertension are poorly understood in areas of the Indian subcontinent.

Methods: Using standardised methods for anthropometry (International Society for the Advancement of Kinanthropometry), and blood pressure (British Hypertension Society guidelines) - paediatric obesity, blood pressure and a marker of arterial stiffness (stiffness index using digital volume pulse analysis PCA Micromedical) were measured within 303 school children (4–14 years) in rural Gujarat, India.

Results: The prevalence of prehypertension was 13.3% in boys and 13.7% in girls, which were markedly higher those reported for the US (3.4%). Many of the Indian children were deemed not have reached their true growth potential, where 82.5% of children were below the 50th percentiles for height, gender and age as advised by consensus US guidelines. On logistic regression, prehypertension was associated with waist to height ratio (P<0.001) and body-mass index (P<0.001). Median stiffness index was comparable in boys 6.89 m/s (IQR: 2.95–7.79) and girls - 6.62 m/s (5.58–7.72). Prehypertension was unrelated to indices of arterial stiffness, which were associated with waist to height ratio (r = −0.34, P<0.001).

Conclusion: Low birth weight and an early manifestation of aberrant endocrine activity are likely to be implicated in higher blood pressure for these children, for which further research is warranted given the impeding threat of over nutrition that looms with the rising epidemic of obesity across the Indian subcontinent. Given the healthcare challenge of cardiovascular morbidity that faces Asia, the assessment of paediatric hypertension and obesity amongst children is an important consideration for prevention strategies.