Abstract Body (Do not enter title and authors here): INTRODUCTION
In the United States, 3 million children have hypertension (HTN), a cardiovascular disease (CVD) risk factor. However, blood pressure (BP) findings in specific Asian ethnic populations remain understudied. This study examines the prevalence of HTN-range BP among subgroups of Asian and Pacific Islander (API) adolescents.

METHODS
In a cohort of 88,145 API adolescents aged 13-17y with a well child visit in 2013-2019, systolic and diastolic BP and body mass index (BMI) were examined. Those with underweight BMI were excluded. The prevalence of BP ≥130/80 (HTN-range BP) was examined by API ethnicity. Covariates included age, sex, BMI category, and neighborhood deprivation index (NDI). Multivariable logistic regression examined the association of API ethnicity with HTN-range BP, providing adjusted odds ratios (OR) with [95% confidence intervals].

RESULTS
The cohort included 11,694 Chinese, 17,279 Filipino, 5,342 South Asian, 3,495 Southeast Asian, 4,051 Native Hawaiian/Pacific Islander (NHPI) and 46,284 of other/unknown API ethnicity. Mean age was 14.3±1.4y; 50% were female. Prevalence of HTN-range BP was highest for NHPI (11.8%) followed by Filipino (9.6%), and lowest for Southeast Asian (7.0%), Chinese (7.1%), and South Asian (7.6%) adolescents. The proportion with obesity also varied, ranging from 6.5% (Chinese) to 11.3% (South Asian), 12.1% (Southeast Asian), 17.7% (Filipino) and 29.5% (NHPI). Accounting for age, sex, and NDI quartile (Chinese as reference), NHPI (OR 1.54 [1.36-1.74]) and Filipino (OR 1.27 [1.16-1.39]) adolescents had higher odds of HTN-range BP while South Asian (OR 1.10 [0.97-1.24]) and Southeast Asian (OR 0.92 (0.79-1.07]) did not. After adjusting for BMI, the odds of HTN-range BP did not differ for NHPI (OR 1.03 [0.90-1.16]) and Filipino (OR 1.04 [0.95-1.14]) vs Chinese adolescents, but Southeast Asian adolescents had lower odds (OR 0.84 [0.72-0.98]). Sex (OR 1.7 [1.6-1.8]) and BMI (OR ranged from 1.9 [1.8-2.1] to 5.8 [5.3-6.3] in adolescents with overweight and severe obesity) were strongly associated with HTN-range BP.

DISCUSSION
The higher odds of HTN-range BP among Filipino and NHPI compared Chinese adolescents were largely attributable to higher BMI, suggesting that BMI may be an important factor in elevated BP among these high-risk Asian subgroups during adolescence. Efforts focused on pediatric obesity management, including lifestyle intervention, may be integral to reducing HTN and CVD risk prior to adulthood.