The prevalence of primary (essential) hypertension in children has increased significantly, especially in minority youth;a public health phenomenon that parallels the current childhood obesity epidemic. Hypertensive children often manifest evidence of target organ damage such as left ventricular hypertrophy. Studies show that young adults with hypertension have decreased performance on neurocognitive testing compared with normotensive control subjects. Moreover, the deficits in neurocognitive function in young hypertensive adults improve with effective antihypertensive therapy, suggesting that these neurocognitive deficits represent early, potentially reversible, hypertensive target organ damage of the brain. Unlike studies in adults, data on the potential negative effects of hypertension on neurocognitive processes in children are limited. We for the first time demonstrated, by analyzing a large nationally representative database, that children with elevated blood pressure had decreased neurocognitive function. We subsequently showed by a prospective study that children with sustained primary hypertension have decreased parental ratings of executive function compared with normotensive controls. Furthermore, we have preliminary evidence that antihypertensive therapy improves parental ratings of executive function. These findings are significant since executive functions represent higher neurocognitive activities involving skills needed for goal- directed behavior. The goal of this proposal is to investigate the relationship between primary hypertension and executive function as a novel, emerging target of hypertensive damage in children. We propose to define the impact of childhood primary hypertension on executive function by comparing performance of hypertensive subjects on a comprehensive battery of tests of executive function with that of normotensive controls. We will evaluate the association between hypertension severity and executive function test performance, and determine the reversibility of executive function deficits with antihypertensive therapy. Findings will provide critical information for clinical interventions for children with hypertension and may increase the urgency to successfully diagnose and treat hypertension in children.

Public Health Relevance

High blood pressure in childhood has become a common problem, in large part due to the obesity epidemic in children. This project investigates a newly recognized way that high blood pressure can adversely affect children's health, namely causing problems with the brain's ability to process information. Given the growing number of children with high blood pressure, this project will have a significant impact on public health by defining the impact of high blood pressure on brain function in these children and by determining to what extent these problems are reversible with medication to lower blood pressure.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZRG1-BBBP-N (05))
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Einhorn, Paula
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University of Rochester
Schools of Dentistry
United States
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Taasoobshirazi, Katayun; Batisky, Donald L (2015) When listening for hoofbeats, sometimes there are zebras-an interesting case of a teenager with edema and high blood pressure: Answers. Pediatr Nephrol 30:927-9
Lande, Marc B; Kupferman, Juan C (2014) Pediatric hypertension: the year in review. Clin Pediatr (Phila) 53:315-9
Batisky, Donald L (2014) Neonatal hypertension. Clin Perinatol 41:529-42
Lande, Marc B; Kupferman, Juan C; Hooper, Stephen R et al. (2014) Blood pressure and school performance. Psychosom Med 76:163-6
Kupferman, Juan C; Lande, Marc B; Adams, Heather R et al. (2013) Primary hypertension and neurocognitive and executive functioning in school-age children. Pediatr Nephrol 28:401-8
Lande, Marc B; Adams, Heather R; Kupferman, Juan C et al. (2013) A multicenter study of neurocognition in children with hypertension: methods, challenges, and solutions. J Am Soc Hypertens 7:353-62