Association of obesity, ACE I/D, and AT1R A1166C polymorphisms with elevated blood pressure in Indonesian adolescents

Hypertension is a major non-communicable disease in Indonesia, affecting not only adults but also children and adolescents. Obesity is a key risk factor, with overweight adolescents facing an increased likelihood of developing hypertension, which can persist into adulthood, impacting quality of life and elevating morbidity and mortality risks. Hypertension is a multifactorial condition influenced by genetic and environmental factors, including dietary intake, stress, and obesity. Genetic predisposition plays a crucial role, with variations in the angiotensin II type 1 receptor (AT1R) and angiotensin-converting enzyme (ACE) genes implicated in blood pressure regulation and obesity. To determine the association between overweight/obesity, genetic variation of AT1R and ACE with blood pressure in adolescents in Indonesia. This was an observational study with a cross-sectional design conducted among high school students in Yogyakarta, Indonesia. Inclusion criteria were: (a) willingness to participate demonstrated by signing informed consent; (b) enrollment in grades X and XI at selected high schools in Yogyakarta City; (c) aged 15–18 years; (d) in healthy condition as confirmed by a medical professional. Exclusion criteria included absence from school, unwillingness to participate, and adherence to a specific diet regimen. Participants were selected using purposive sampling. Variables measured included AT1R and ACE gene variations, nutritional status, anthropometric indices, lipid profile, and blood pressure. Data were analyzed using the chi-square test and bivariate associations between potential risk factors and elevated blood pressure were examined using univariable logistic regression with 95% confidence interval and significance p < 0.05. Male and overweight/obesity were significantly associated with higher odds of elevated blood pressure. Anthropometric indicators of adiposity, including waist and neck circumference, were positively associated with elevated blood pressure, while elevated LDL-cholesterol was significantly associated with elevated blood pressure risk in univariable analysis, an association that remained robust to correction for multiple comparisons but was attenuated after adjustment for obesity; the total cholesterol association did not survive correction for multiple comparisons; triglycerides showed no significant association. No significant associations were observed between elevated blood pressure and ACE I/D or AT1R A1166C gene variations, either individually or in interaction with sex. In multivariable analysis, male sex and obesity remained independently associated with elevated blood pressure after adjustment for genetic variations, which did not improve model fit (Δχ²(2) = 1.89; p = 0.388). Combined ACE–AT1R genotype analyses similarly did not demonstrate significant effects on elevated blood pressure risk. Elevated blood pressure in adolescents appears to be more strongly associated with sex and overweight/obesity rather than genetic variations in ACE or AT1R, although the modest sample size limits definitive conclusions about the absence of genetic effects. This indicates that adiposity and related risk factors play a critical role in elevated blood pressure at this stage. Thus, prevention efforts should focus on reducing obesity.