Ambulatory blood pressure monitoring and neurocognitive function in children with primary hypertension

Kupferman, Juan C.; Batisky, Donald L.; Samuels, Joshua; Adams, Heather; Hooper, Stephen R.; Wang, Hongyue; Lande, Marc B.

doi:10.1007/s00467-018-3954-y

Cited by 15 publications

(3 citation statements)

References 32 publications

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“…The observation that the influence of higher BP on executive functions may be better detected through testing of central hemodynamics is in line with current pathophysiological theories suggesting that the latter are more relevant for AH mediated organ damage ( 45 ). Furthermore, the reviewed literature emphasizes that ABPM is the best method for detecting AH associated with possible cognitive deficits, and should therefore be the preferred measure to use in this clinical domain dysfunctions ( 37 , 40 ). In this line, the measure of systolic AH was also more related to cognitive deficits than diastolic hypertension ( 30 ).…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

“…Two studies used solely office BP measures to define AH and control groups, others sought confirmation by performing 24h ambulatory blood pressure monitoring (ABPM). ABPM was found to be more precise in distinguishing hypertensive children with executive dysfunctions (37,40). Ten of the studies excluded the participants with secondary hypertension from the study, only two studies did not make the distinction between primary and secondary hypertension and one study compared a group of children with primary AH to children with renal AH.…”

Section: Arterial Hypertension Etiology and Measurementsmentioning

confidence: 99%

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Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review

Lucas

Puteikis

Sinha

et al. 2022

Front. Cardiovasc. Med.

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Arterial hypertension (AH) among adults is known to be associated with worse cognitive outcomes. Similarly, children and adolescents with AH could be expected to underperform during neuropsychological evaluations when compared with healthy peers. Our aims were to review the existing literature on cognitive functioning among children and adolescents with primary AH and to identify what additional evidence may be needed to substantiate the impact of hypertension on poor cognitive outcomes in this population. We conducted a systematic review of articles in PubMed and Web of Science published before 17 January 2022, reporting on cognitive testing among children and adolescents with primary AH. From 1,316 records, 13 were included in the review—7 used battery-testing while other employed indirect measures of cognitive functions. Most of the studies reported worse results among individuals with AH. Results of two prospective trials suggested that cognitive functioning may improve after starting antihypertensive treatment. Ambulatory blood pressure monitoring was shown to be more strongly related to cognitive testing results than office measures of blood pressure. Significant confounders, namely obesity and sleep apnea, were identified throughout the studies. Our review indicates that evidence relating AH with poor cognitive functioning among youth is usually based on indirect measures of executive functions (e.g., questionnaires) rather than objective neuropsychological tests. Future prospective trials set to test different cognitive domains in children and adolescents undergoing treatment for AH are endorsed and should consider using standardized neuropsychological batteries as well as adjust the assessing results for obesity and sleep disorders.

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Section: Discussion and Future Directionsmentioning

confidence: 99%

Section: Arterial Hypertension Etiology and Measurementsmentioning

confidence: 99%

Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review

Lucas

Puteikis

Sinha

et al. 2022

Front. Cardiovasc. Med.

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“…Finally, we analyzed different measures of BP, including office BP, ABPM and central BP but were unable to find associations with cognitive performance domains after adjusting for age and sex. Dose-dependent association of BP level and cognitive functions has been reported in populational studies (30) and the hypertensive population (14,15,41) and it has been shown that ABPM may be superior to office BP in discriminating those with worse cognitive performance (15,41). Considering the direct exposure of brain circulation to central BP and known disparities between brachial and central BP, particularly in young subjects, central hemodynamics could be a superior risk factor for cognitive dysfunction (18).…”

Section: Discussionmentioning

confidence: 96%

Cognitive performance in children and adolescents with primary hypertension and the role of body mass

Azukaitis,

Puteikis,

Kinciniene

et al. 2024

Front. Pediatr.

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ObjectivePrimary hypertension has been shown to affect cognitive functions in adults but evidence in the pediatric population remain scarce and equivocal. We aimed to compare cognitive functioning between children diagnosed with primary hypertension and normotensive controls, with a focus on the role of different blood pressure (BP) parameters and body mass.MethodsWe conducted a single-center, prospective, cross-sectional study of children and adolescents (6–17 years old) with primary hypertension and age- and sex-matched normotensive controls. All participants underwent office BP, ambulatory BP monitoring (ABPM), and central BP measurements using an oscillometric device. Neurocognitive assessment consisted of evaluation of (i) intelligence quotient (IQ), (ii) categorical and phonemic fluency, (iii) verbal memory (verbal-logical story recall), and (iv) non-verbal computerized cognitive assessment.ResultsThe study included a total of 59 patients with primary hypertension (14 ± 3 years) and 37 normotensive controls (14 ± 3 years). Participants in the primary hypertension group had a significantly higher body mass index z-score (BMIz: 2.1 ± 1.4 vs. 0.7 ± 0.9, p < 0.001), and 85% received antihypertensive therapy. Participants with primary hypertension showed worse performance in the domains of reaction speed, attention and processing speed, visual memory, new learning, and phonemic fluency. After adjusting for BMIz, only the differences in the reaction speed tasks remained significant. None of the BP parameters was associated with cognitive outcomes after adjustment for age, sex, and BMIz. BMIz associated with tasks of visual memory, new learning, spatial planning, and working memory, independent of age and sex.ConclusionChildren and adolescents diagnosed with primary hypertension exhibit worse performance in the cognitive domains of reaction speed, attention, processing speed, visual memory, and new learning. These differences to healthy controls can be partially attributed to accompanying increase of body mass.

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Sequelae of Hypertension in Children and Adolescents

Weaver

Mitsnefes

2023

Pediatric Hypertension

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Ambulatory blood pressure monitoring and neurocognitive function in children with primary hypertension

Abstract: ABPM is superior to office BP in distinguishing hypertensive youth with lower neurocognitive test performance.

Cited by 15 publications

References 32 publications

Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review

Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review

Cognitive performance in children and adolescents with primary hypertension and the role of body mass

Sequelae of Hypertension in Children and Adolescents

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