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.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL080068-05
Application #
7482216
Study Section
Special Emphasis Panel (ZHL1-SRC (99))
Program Officer
Riley, William T
Project Start
2004-09-10
Project End
2010-06-30
Budget Start
2008-07-01
Budget End
2010-06-30
Support Year
5
Fiscal Year
2008
Total Cost
$126,948
Indirect Cost
Name
University of Rochester
Department
Pediatrics
Type
Schools of Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Adams, Heather R; Szilagyi, Peter G; Gebhardt, Laura et al. (2010) Learning and attention problems among children with pediatric primary hypertension. Pediatrics 126:e1425-9
Lande, Marc B; Adams, Heather; Falkner, Bonita et al. (2010) Parental assessment of executive function and internalizing and externalizing behavior in primary hypertension after anti-hypertensive therapy. J Pediatr 157:114-9
Lande, Marc B; Flynn, Joseph T (2009) Treatment of hypertension in children and adolescents. Pediatr Nephrol 24:1939-49
Lande, Marc B; Adams, Heather; Falkner, Bonita et al. (2009) Parental assessments of internalizing and externalizing behavior and executive function in children with primary hypertension. J Pediatr 154:207-12
Lande, Marc B; Pearson, Thomas A; Vermilion, Roger P et al. (2008) Elevated blood pressure, race/ethnicity, and C-reactive protein levels in children and adolescents. Pediatrics 122:1252-7
Lande, Marc B; Meagher, Cecilia C; Fisher, Susan Gross et al. (2008) Left ventricular mass index in children with white coat hypertension. J Pediatr 153:50-4
Nicoletta, Julie A; Lande, Marc B (2006) Medical evaluation and treatment of urolithiasis. Pediatr Clin North Am 53:479-91, vii
Lande, Marc B; Carson, Nancy L; Roy, Jason et al. (2006) Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study. Hypertension 48:40-4