Abstract: Objective To analyze the relationship between different obesity indices and elevated blood pressure (BP) among 12-17-year-old students in Huai'an, Jiangsu Province, and to evaluate the predictive value of different obesity indicators for elevated BP. Methods Utilizing data from the 2022 Jiangsu Provincial Student Common Diseases and Health Risk Factors Surveillance Program, a stratified cluster random sampling method was employed to measure height, weight, waist circumference (WC), and BP in adolescents aged 12-17 in Huai'an. Binary logistic regression was used to analyze the associations between body mass index (BMI), WC, waist-to-height ratio (WHtR), and elevated BP. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of individual and combined obesity indices. Results Among 5 681 adolescents, 995 (17.51%) exhibited elevated BP. Analysis of covariance revealed that obese, high-WC, and abdominal obesity groups had significantly higher systolic and diastolic BP levels (all P<0.05). The prevalence of elevated BP was also significantly higher in these groups (all P<0.01). Binary logistic regression demonstrated positive associations between BMI, WC, WHtR, and elevated BP risk (all P<0.01). ROC analysis showed that BMI, WC, and WHtR all had area under the curve (AUC) values >0.67 (all P<0.001). BMI emerged as the strongest single predictor (AUC: 0.727 in males, 0.684 in females, 0.709 overall; all P<0.05). No statistically significant improvement in AUC was observed when combining BMI with WC, WHtR, or both (all P>0.05). Conclusions Among adolescents in Huai'an, BMI, WC, and WHtR were positively associated with elevated BP. BMI demonstrated superior predictive performance as a single indicator, with no additional benefit from combining it with WC or WHtR. These findings suggest that BMI alone may suffice for BP risk stratification in this population.

Key words: Middle school students, Obesity indices, Body mass index, Waist circumference, Waist-to-height ratio, Elevated blood pressure