Hypertension associated with cognitive issues in children

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Hypertension is associated with cognitive issues in children and adolescents, found a small US study.

Hypertension, more commonly known as high blood pressure, has increased significantly in children, paralleling the current childhood obesity epidemic. Although we know that adult hypertension can affect the brain, little research has been done on the cognitive effects of childhood hypertension.

Dr Marc B Lande and researchers from the University of Rochester, Emory University, Maimonides Medical Centre, University of Texas at Houston, University of North Carolina, Thomas Jefferson University, University of Maryland, and the University of California – Los Angeles, compared different tests of cognitive skills between 75 10-18-year-old children with newly-diagnosed hypertension and 75 matched children without hypertension.

Children who had other factors that are known to affect cognitive skills were excluded from the study (ADHD, learning disabilities, sleep disorders). According to Lande, “We wanted to make sure that if we found differences between children with and without hypertension, it was likely associated with the hypertension itself, not any of these other factors.”

The researchers found that the children with hypertension performed worse on the cognitive tests that measured visual and verbal memory, processing speed, and verbal skills. Additionally, more children with sleep issues had hypertension, which intensified the effect of poor sleep on cognition and executive function. It is important to note that the differences between groups were small and that the average cognitive test scores of both groups were largely within normal ranges. The children with hypertension were not cognitively impaired, but rather performing less well than children without hypertension.

Overall, this study provides evidence that hypertension in children is associated with a subtle pattern of decreased performance on cognitive testing.

Notes Lande, “In the future, we want to better understand if there are physical changes to the brain in children who have hypertension that could explain these cognitive test results.” Knowing how these physical changes might affect cognitive skills could be important in future studies that assess whether anti-hypertensive treatments could improve cognitive performance in children with hypertension and reverse or prevent future adult hypertension-related problems.

Abstract
Objective: To compare neurocognitive test performance of children with primary hypertension with that of normotensive controls.
Study design: Seventy-five children (10-18 years of age) with newly diagnosed, untreated hypertension and 75 frequency-matched normotensive controls had baseline neurocognitive testing as part of a prospective multicenter study of cognition in primary hypertension. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed. Parents completed rating scales of executive function and the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD).
Results: Hypertension and control groups did not differ significantly in age, sex, maternal education, income, race, ethnicity, obesity, anxiety, depression, cholesterol, glucose, insulin, and C-reactive protein. Subjects with hypertension had greater PSQ-SRBD scores (P = .04) and triglycerides (P = .037). Multivariate analyses showed that hypertension was independently associated with worse performance on the Rey Auditory Verbal Learning Test (List A Trial 1, P = .034; List A Total, P = .009; Short delay recall, P = .013), CogState Groton Maze Learning Test delayed recall (P = .002), Grooved Pegboard dominant hand (P = .045), and Wechsler Abbreviated Scales of Intelligence Vocabulary (P = .016). Results indicated a significant interaction between disordered sleep (PSQ-SRBD score) and hypertension on ratings of executive function (P = .04), such that hypertension heightened the association between increased disordered sleep and worse executive function.
Conclusions: Youth with primary hypertension demonstrated significantly lower performance on neurocognitive testing compared with normotensive controls, in particular, on measures of memory, attention, and executive functions.

Authors
Marc B Lande, Donald L Batisky, Juan C Kupferman, Joshua Samuels, Stephen R Hooper, Bonita Falkner, Shari R Waldstein, Peter G Szilagyi, Hongyue Wang, Jennifer Staskiewicz, Heather R Adams

University of Rochester material
Journal of Pediatrics abstract


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