Primary hypertension affects up to 10% of minority school-aged children. Although such morbid events as stroke and myocardial infarction are uncommon in childhood, it is clear that hypertensive end-organ damage may occur at a young age. Studies in young adults indicate that mild-to-moderate hypertension is associated with neurocognitive deficits and that these deficits are reversible consequences of the effects of elevated blood pressure on the central nervous system. We have for the first time demonstrated decreased neurocognitive function in children with elevated BP in a large national database. Confirmation of neurocognitive deficits in children with hypertension would represent the finding of a newly recognized complication of childhood primary hypertension. Candidate: This K23 award will facilitate Dr. Marc Lande's development as a patient-oriented scientist with the long-term goal of becoming a high-quality, independent academic investigator in the area of childhood hypertension. Dr. Lande will obtain advanced training in biostatistics, epidemiology, clinical trial design, research methods, data management, and ethics through coursework from the Rochester Clinical Research Curriculum (K30 grant funded) and the Masters in Public Health. He will participate in courses, seminars, and meetings in the areas of both hypertension and neuropsychology. He will receive extensive group and one-on-one mentoring from a number of senior clinical investigators. Research Plan: The pattern and severity of hypertension in children referred for primary hypertension will be assessed by 24-hour ambulatory blood pressure monitoring. Hypertensive children and matched normotensive controls will then undergo a battery of neuropsychological testing and behavior measures. Neurocognitive function and behavior will be reassessed after a 12-month period, during which the hypertensive children will receive antihypertensive therapy. Performance on neuropsychological testing of hypertensive subjects will be compared with that of normotensive controls both initially and after antihypertensive therapy. The effect of antihypertensive therapy on neurocognitive function will be determined.
