Objective: The majority of elevated blood pressure (BP) in children/adolescents remains undiagnosed. The American Academy of Pediatrics states "there is limited evidence to support school-based measurement of children's BP." We explored the clinical/public health utility of providing BP screening in school health clinics. Methods: A cross-sectional sample of 4096 students ages 6-to-17 from Title 1 Miami-Dade County Public Schools (50% female, 71% non-Hispanic Black, 26% Hispanic, mean age 12.0 [CI 95%: 11.90-12.09]) had their systolic/diastolic BP (SBP/DBP) and body mass index (BMI) collected over the 2016-17 or 2017-18 school years. Relative risks (RRs) were calculated to estimate normal/elevated SBP/DBP by BMI percentile, ethnicity, and sex. Results: Over a quarter (26.4%) of the sample had at least one elevated BP measurement, of which 59% were not obese. Students that were female, Hispanic, and obese showed an increased relative risk of elevated BP. RR for obese status was significant for all categories of elevated BP (all RRs >1.88, all p <.0001). Being female (RR=1.34, p=.009) and Hispanic (RR=1.31, p=.014) were significantly associated with elevated DBP. BMI percentile accounted for <10% of the variation in BP (SBP: F(1,4095)=367.6, adjusted R2=.08, p<.0001; DBP: F(1, 4095)=93.3, adjusted R2=.02, p<.0001). Conclusion: These findings support the public health and clinical significance of providing BP screenings in the school setting. Low-income and minority students often have limited access to primary care and a higher prevalence of obesity and unhealthy lifestyle behaviors. Our findings support universal school-based BP screening regardless of weight status, particularly among ethnically diverse populations.

a: Elevated SBP/DBP as ≥90th percentile; greatly elevated SBP/DBP as ≥95th percentile b: normal weight (BMI<85th percentile), overweight (BMI 85-94th percentile), obese (BMI ≥95th percentile) and super obese (BMI ≥99th percentile) (Barlow, 2007) c: BMI percentiles were adjusted for age and sex based on CDC z-scores (Cole, 1990; Cole 1992) d: Blood pressures (SBP/DBP) were adjusted for height, age, and sex by the NHLBI Fourth Report Guidelines ("The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents," 2004)

a: Elevated SBP/DBP as ≥90th percentile; greatly elevated SBP/DBP as ≥95th percentile b: normal weight (BMI<85th percentile), overweight (BMI 85-94th percentile), obese (BMI ≥95th percentile) and super obese (BMI ≥99th percentile) (Barlow, 2007) c: BMI percentiles were adjusted for age and sex based on CDC z-scores (Cole, 1990; Cole 1992) d: Blood pressures (SBP/DBP) were adjusted for height, age, and sex by the NHLBI Fourth Report Guidelines ("The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents," 2004)

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a: Obese Status: Not Obese: BMI <95th Percentile; Obese: BMI ≥95th Percentile (Barlow, 2007) b: RRs were controlled for age groups (</>12 y.o.) and school-screening year (2016-17/ 2017-18) c: *** p<.0001; ** p<.01; *p<.05

a: Obese Status: Not Obese: BMI <95th Percentile; Obese: BMI ≥95th Percentile (Barlow, 2007) b: RRs were controlled for age groups (</>12 y.o.) and school-screening year (2016-17/ 2017-18) c: *** p<.0001; ** p<.01; *p<.05

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