Trends and Inequalities of Co-Occurring Obesity and Elevated Blood Pressure Among Chinese Children and Adolescents Aged 7-18 Years from 1985 to 2019 and Projections to 2030.

: The co-occurrence of obesity and elevated blood pressure (EBP) in childhood represents a critical but underrecognized public health concern, with potential long-term consequences for cardiometabolic health. Understanding its trends and disparities is essential for early prevention strategies. : This study analyzed data from 1,692,660 Han Chinese children and adolescents aged 7-18 years collected across seven waves of the Chinese National Survey on Students' Constitution and Health (CNSSCH) from 1985 to 2019. Joinpoint regression was used to estimate temporal trends, and logistic generalized additive models were fitted to predict prevalence through 2030. : The prevalence of co-occurring obesity and EBP increased from 0.06% in 1985 to 2.36% in 2019 and is projected to reach 5.87% by 2030. A slowdown in the growth rate was observed approximately in 2000. Notably, rural areas experienced a faster and more recent rise, especially among girls, suggesting widening disparities. : The growing dual burden of obesity and EBP in Chinese youth, especially in rural areas, calls for urgent and integrated interventions. Public health efforts must prioritize early prevention, with equitable policies that engage schools, families, and communities, particularly in underserved populations.