Evidence to Support Universal Blood Pressure Screening in School-Based Clinical Settings

Juliet Silberstein, Lisa Gwynn, M. Sunil Mathew, Kristopher Arheart, Sarah E. Messiah

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


BACKGROUND: Most pediatric elevated blood pressure (BP) remains undiagnosed. The American Academy of Pediatrics states “there is limited evidence to support school-based measurement of children's BP.” We explored the utility school-based BP screening. METHODS: A cross-sectional sample of 4096 students ages 6 to 17 from Title 1 Miami-Dade Public Schools (50% female, 71% non-Hispanic black, 26% Hispanic) had their systolic/diastolic BP (SBP/DBP) and body mass index (BMI) collected over the 2016 to 2017 or 2017 to 2018 school years. Relative risks (RRs) ratios were calculated to estimate normal/elevated SBP/DBP by BMI percentile, ethnicity, and sex. RESULTS: Overall, 26.4% had at least one elevated BP measurement, of which 59% were not obese. RR for obese status was significant for all categories of elevated BP (RRs > 1.88, p <.0001). Being either female (RR = 1.34, p =.009) or Hispanic (RR = 1.31, p =.014) was significantly associated with elevated DBP. BMI 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 providing BP screenings in school settings. Low-income and minority students often have limited access to health care, higher obesity rates, and unhealthy behaviors. Our findings support universal school-based BP screening regardless of weight status, particularly among ethnically diverse populations.

Original languageEnglish (US)
Pages (from-to)474-481
Number of pages8
JournalJournal of School Health
Issue number6
StatePublished - Jun 1 2020


  • blood pressure
  • child and adolescent health
  • obesity
  • pediatric hypertension
  • school health policy
  • school-based clinics

ASJC Scopus subject areas

  • Education
  • Philosophy
  • Public Health, Environmental and Occupational Health


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