Comparison of Trends in Blood Pressure and the Prevalence of Obesity Among Korean and American Adolescents: A 12-Years Cross-sectional Study

  • Heo, Somi (Department of Preventive Medicine, Kyungpook National University School of Medicine) ;
  • Kwon, Seyoung (Department of Public Health, Graduate School of Kyungpook National University) ;
  • Lee, Yu-Mi (Department of Preventive Medicine, Kyungpook National University School of Medicine) ;
  • Shin, Ji-Yeon (Department of Preventive Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Duk-Hee (Department of Preventive Medicine, Kyungpook National University School of Medicine)
  • Received : 2019.07.16
  • Accepted : 2019.11.20
  • Published : 2020.01.31


Objectives: This study was conducted to explore recent trends in the prevalence of pediatric elevated blood pressure and hypertension (HTN) in Korea and the United States, applying the new HTN reference values for adolescents. Methods: This study analyzed 17 339 (8755 Korean and 8584 American) adolescents aged 10 to 17 who participated in the Korea National Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey, respectively, between 2005 and 2016. HTN was defined using percentile-based reference values for non-overweight adolescents from 7 nations, and obesity was defined by body mass index (BMI) based on country-specific growth charts. All analyses were stratified by sex and year-over-year changes were evaluated by calculating the p for trend. Results: Systolic blood pressure showed a statistically meaningful upward trend in Korean boys and girls, while diastolic blood pressure did not show any significant changes. Both systolic and diastolic blood pressure levels declined among United States boys and girls. The prevalence of elevated blood pressure and HTN remained similar in Korean adolescents, but declined in both sexes among United States adolescents. BMI increased in both sexes among Korean adolescents, although the overweight and obesity rates stayed the same. No significant trends were found in any obesity indices among United States adolescents. The prevalence of elevated blood pressure and HTN by obesity level was higher among Korean adolescents than among their United States peers in both sexes, and the gap became higher at more severe levels of obesity. Conclusions: Despite the strong correlation between obesity and HTN, recent trends in the prevalence of HTN and obesity among Korean and United States adolescents were strikingly different. Follow-up studies are necessary to determine why the prevalence of HTN was more than twice as high among Korean adolescents than among their United States counterparts.


  1. Beaglehole R, Horton R. Chronic diseases: global action must match global evidence. Lancet 2010;376(9753):1619-1621.
  2. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360(9349):1903-1913.
  3. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens 2009;23(6): 385-390.
  4. Yan W, Li X, Zhang Y, Niu D, Mu K, Ye Y, et al. Reevaluate secular trends of body size measurements and prevalence of hypertension among Chinese children and adolescents in past two decades. J Hypertens 2016;34(12):2337-2343.
  5. Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 2003;290(17): 2277-2283.
  6. Barker DJ, Bagby SP, Hanson MA. Mechanisms of disease: in utero programming in the pathogenesis of hypertension. Nat Clin Pract Nephrol 2006;2(12):700-707.
  7. Ewald DR, Haldeman LA. Risk factors in adolescent hypertension. Glob Pediatr Health 2016; 3:2333794X15625159.
  8. Willig AL, Casazza K, Dulin-Keita A, Franklin FA, Amaya M, Fernandez JR. Adjusting adiposity and body weight measurements for height alters the relationship with blood pressure in children. Am J Hypertens 2010;23(8):904-910.
  9. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017;390(10113):2627-2642.
  10. Kouda K, Nakamura H, Nishio N, Fujita Y., Takeuchi H, Iki M. Trends in body mass index, blood pressure, and serum lipids in Japanese children: Iwata population-based annual screening (1993-2008). J Epidemiol 2010:20(3):212-218.
  11. Watkins D, McCarron P, Murray L, Cran G, Boreham C, Robson P, et al. Trends in blood pressure over 10 years in adolescents: analyses of cross sectional surveys in the Northern Ireland Young Hearts project. BMJ 2004;329(7458):139.
  12. Xi B, Bovet P, Hong YM, Zong X, Chiolero A, Kim HS, et al. Recent blood pressure trends in adolescents from China, Korea, Seychelles and the United States of America, 1997-2012. J Hypertens 2016;34(10):1948-1958.
  13. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140(3):e20171904.
  14. Xi B, Zong X, Kelishadi R, Hong YM, Khadilkar A, Steffen LM, et al. Establishing international blood pressure references among nonoverweight children and adolescents aged 6 to 17 years. Circulation 2016;133(4):398-408.
  15. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr 2008;51(1):1-25 (Korean).
  16. Centers for Disease Control and Prevention. CDC growth charts [cited 2019 Dec 5]. Available from:
  17. Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, et al. Human blood pressure determination by sphygmomanometry. Circulation 1993;88(5 Pt 1):2460-2470.
  18. Park J, Hilmers DC, Mendoza JA, Stuff JE, Liu Y, Nicklas TA. Prevalence of metabolic syndrome and obesity in adolescents aged 12 to 19 years: comparison between the United States and Korea. J Korean Med Sci 2010;25(1):75-82.
  19. Park J, Mendoza JA, O'Neil CE, Hilmers DC, Liu Y, Nicklas TA. A comparison of the prevalence of the metabolic syndrome in the United States (US) and Korea in young adults aged 20 to 39 years. Asia Pac J Clin Nutr 2008;17(3):471-482.
  20. Ha K, Kim K, Chun OK, Joung H, Song Y. Differential association of dietary carbohydrate intake with metabolic syndrome in the US and Korean adults: data from the 2007-2012 NHANES and KNHANES. Eur J Clin Nutr 2018;72(6):848-860.
  21. Shirasawa T, Ochiai H, Nishimura R, Morimoto A, Shimada N, Ohtsu T, et al. Secular trends in blood pressure among Japanese schoolchildren: a population-based annual survey from 1994 to 2010. J Epidemiol 2012;22(5):448-453.
  22. Xi B, Zhang T, Zhang M, Liu F, Zong X, Zhao M, et al. Trends in elevated blood pressure among US children and adolescents: 1999-2012. Am J Hypertens 2016;29(2):217-225.
  23. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(Suppl 2):555-576.
  24. Mi J, Wang TY, Meng LH, Zhu GJ, Han SM, Zhong Y, et al. Development of blood pressure reference standards for Chinese children and adolescents. Chin J Evid Based Pediatr 2010;5(1): 4-14.
  25. Jackson LV, Thalange NK, Cole TJ. Blood pressure centiles for Great Britain. Arch Dis Child 2007;92(4):298-303.
  26. Lee CG, Moon JS, Choi JM, Nam CM, Lee SY, Oh K, et al. Normative blood pressure references for Korean children and adolescents. Korean J Pediatr 2008;51(1):33-41 (Korean).
  27. Khang YH, Lynch JW. Exploring determinants of secular decreases in childhood blood pressure and hypertension. Circulation 2011;124(4):397-405.
  28. Jackson SL, Zhang Z, Wiltz JL, Loustalot F, Ritchey MD, Goodman AB, et al. Hypertension among youths - United States, 2001-2016. Am J Transplant 2018;18(9):2356-2360.
  29. Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatr 2014;168(6):561-566.
  30. Gu X, Tucker KL. Dietary quality of the US child and adolescent population: trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs. Am J Clin Nutr 2017;105(1):194-202.
  31. Livingstone KM, Givens DI, Cockcroft JR, Pickering JE, Lovegrove JA. Is fatty acid intake a predictor of arterial stiffness and blood pressure in men? Evidence from the Caerphilly Prospective Study. Nutr Metab Cardiovasc Dis 2013;23(11):1079-1085.
  32. Iannotti RJ, Wang J. Trends in physical activity, sedentary behavior, diet, and BMI among US adolescents, 2001-2009. Pediatrics 2013;132(4):606-614.
  33. Kirkendall WM, Burton AC, Epstein FH, Freis ED. Recommendations for human blood pressure determination by sphygmomanometers. Circulation 1967;36(6):980-988.