BackgroundThe aim of this study was to systemically examine the concomitant impact of adiposity indices on hypertension in children and adolescents.MethodsA community-based cohort study conducted by the China Health and Nutrition Survey (CHNS) 2009-2011 included 262 children and adolescents aged 7-17 years. Anthropometric and lipid profiles were analyzed for hypertension risk using logistic and cross-lagged models.ResultsAmong the 227 participants (mean age, 16.5 years), 147 (53.9%) were boys. Over 2 years, 26.4% of patients developed hypertension, 5.3% had elevated systolic blood pressure (SBP), and 25.6% had elevated diastolic blood pressure (DBP). After adjusting for covariates, higher body mass index (BMI), waist circumference (WC), hip circumference (HC), triceps skinfold thickness (TST), and body roundness index (BRI) were associated with an increased risk of hypertension. Incorporating these measures into a BP-based model improved the area under the curve (AUC) for hypertension prediction from 0.551 to 0.670. A longitudinal relationship was observed between adiposity indices and hypertension symptoms.ConclusionsThis study suggests that anthropometric parameters are superior to blood lipid indicators in predicting the occurrence of hypertension in children. Abdominal obesity, as indicated by WC, HC, and BRI, accounts for a significant proportion of the risk of hypertension, particularly in children aged 7-12 years.ImpactAnthropometric parameters are superior to blood lipid indicators in predicting the occurrence of hypertension in children.Abdominal obesity, as indicated by WC, and HC, accounts for a significant proportion of the risk of hypertension, particularly in children aged 7-12 years.The indices of BMI-WC-HC or BRI-HC appear to be the most promising indices for prevention and risk stratification for pediatric hypertension.