Changes in behavior as an early symptom of renovascular hypertension in children

Abstract

Renovascular hypertension in children is usually asymptomatic and diagnosed incidentally. Behavioral changes have not yet been well recognized as a part of the clinical spectrum of renovascular disease in children. We surveyed all children diagnosed with renovascular hypertension in our institute over a 15-year period. Eleven children were identified, of whom five (45%) had abnormal behavior, which had preceded the diagnosis of hypertension by 3-12 months. The symptoms included restlessness, sleep disturbances, temper tantrums, hyperactivity, aggressive behavior and attention deficit. In three children all behavioral symptoms disappeared following blood pressure normalization, and, in the other two a significant improvement was noted. It was concluded that behavioral symptoms may be a common and early manifestation of renovascular hypertension. Awareness of this association may bring about earlier diagnosis of the disease and prevent end-organ damage as well as unnecessary investigations for behavioral abnormalities.

Antagonism of L-type Cav channels with nifedipine differentially affects performance of wildtype and NK1R−/− mice in the 5-Choice Serial Reaction-Time Task

“…Cholinergic interneurons and striatal projection neurons are the likely sites for this functional interaction between L-type channels and NK1R. The evidence described here complements reports that L-type channel antagonists can ameliorate impaired motor and cognitive performance in rats (Meneses and Hong, 1998), adult humans (Schwartz et al, 1997;Hanyu et al, 2007) and hypertensive children expressing behavioral disturbances similar to those associated with ADHD (Krause et al, 2009).…”

“…It has recently been reported that behavioral abnormalities seen in ADHD (restlessness, sleep disturbances, temper-tantrums, hyperactivity, aggressive behavior and attention-deficit) are also evident in some children with renal hypertension and can be ameliorated by the dihydropyridine, nifedipine (Krause et al, 2009). This is one of a family of compounds that block L-type, voltage-gated Ca v channels, which are prevalent throughout the brain (Hetzenauer et al, 2006), especially in the striatum and cerebral cortex (Hirota and Lambert, 1997).…”

Attention-deficit/hyperactivity disorder and adverse health outcomes

“…Whereas an association between ADHD and obesity is beginning to be documented, there is a paucity of data examining whether ADHD is directly associated with obesity-related medical complications including type 2 diabetes mellitus (T2DM) and hypertension (Krause, Cleper, Kovalski, Sinai, & Davidovits, 2009; Levitt Katz et al, 2005). A retrospective chart review that examined the incidence of neuropsychiatric disorders in children with T2DM found that 46 of the 237 subjects (19.4%) had a neuropsychiatric disorder and 10 (4.2%) had a diagnosis of ADHD (Levitt Katz et al, 2005).…”

Renovascular hypertension: a case with atypical neurological signs

“…Children with severe hypertension can present with severe neurological signs such as headache, facial palsy, acute hypertensive encephalopathy or cerebrovascular incidents 5 9 15. In this case, there were behavioural changes (irritability), spastic paraparesis and neurogenic bladder.…”