Central SBP and executive function in children and adolescents with primary and secondary hypertension
Stella Stabouli1, Katerina Chrysaidou1, Vasilios Kotsis2
11st Pediatric Department, Aristotle University Thessaloniki, Hippocratio Hospital.
Insights
Children with secondary hypertension show distinct executive function patterns, particularly in metacognition, compared to those with primary hypertension. Central systolic blood pressure (SBP) is linked to cognitive performance in hypertensive youth.
Area of Science:
- Pediatric Cardiology
- Neuropsychology
- Hypertension Research
Background:
- Hypertension in children and adolescents is a growing concern.
- Executive function deficits are increasingly recognized in pediatric hypertension.
- Understanding the relationship between blood pressure and cognitive function is crucial for early intervention.
Purpose of the Study:
- To evaluate executive function in pediatric patients with primary and secondary hypertension.
- To explore associations between central systolic blood pressure (SBP) and executive function.
- To investigate the role of ambulatory blood pressure monitoring in assessing cognitive outcomes.
Main Methods:
- Ambulatory blood pressure monitoring and pulse wave analysis were conducted on 92 pediatric patients (46 primary, 46 secondary hypertension).
- Executive function was assessed using the Behavior Rating Inventory of Executive Function (BRIEF).
- Analysis of covariance examined the impact of blood pressure parameters and hypertension etiology on cognitive performance.
Main Results:
- Patients with secondary hypertension exhibited higher parent and self-reported Metacognition Index T scores than those with primary hypertension.
- Secondary hypertension group showed higher central SBP z-scores.
- Central SBP was independently associated with Metacognition and Behavior Regulation Indices, regardless of other factors.
Conclusions:
- Central SBP is a significant correlate of executive function in youth with hypertension.
- Central SBP may complement ambulatory blood pressure monitoring in identifying at-risk children.
- These findings highlight the importance of assessing cognitive function in pediatric hypertension management.
Objectives:
The aims of the study were to assess executive function performance in children and adolescents with primary and secondary hypertension, and to investigate for associations with central SBP and ambulatory blood pressure.
Methods:
Forty-six pediatric patients with secondary hypertension because of kidney diseases and 46 patients with primary hypertension underwent ambulatory blood pressure monitoring, pulse wave analysis, and assessment of executive function using Behavior Rating Inventory of Executive Function. Results for comparisons are presented as mean (SD). Analysis of covariance was performed to examine the effect of blood pressure parameters and hypertension cause.
Results:
Patients with secondary hypertension had higher T scores in parent and self-reported Metacognition Indices compared with those with primary hypertension (51.2 ± 8.9 vs. 47.6 ± 7.5, P = 0.05 and 49.6 ± 9.1 vs. 42.1 ± 7.9, P = 0.001, respectively), but did not differ in Behavior Regulation Index T scores, as well as in mean arterial pressure z-score. Patients with secondary hypertension had higher central SBP z-scores (P = 0.05). Adjustment for central SBP attenuated differences in parent Metacognition Index between groups. Central SBP z-score associated with parent Metacognition (B = 0.95, 95% CI 0.02-1.87), Behavior Regulation (B = 1.14, 95% CI 0.07-2.21), and self-reported Metacognition Indices T scores (B = 1.48, 95% CI 0.39-2.56), independent of mean arterial pressure z-score, age, sex, socioeconomic status, hypertension cause, and antihypertensive treatment.
Conclusion:
Central SBP associates with executive function performance in youth with hypertension and could have complementary role to ambulatory blood pressure for identifying children at risk for adverse cognitive outcomes.
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Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.