Blood pressure, left ventricular structure and cognitive development in young children: a cross-sectional study

As a consequence of hypertension, left ventricular (LV) structural alterations are associated with cognitive decline in the elderly. However, its role in early childhood remains unclear. We examined the relationship between blood pressure (BP), LV structure, and cognitive function in preschool-aged children. This population is free from aging-related comorbidities.

We recruited 1279 4-year-old children from the Shanghai Birth Cohort (2018-2021), excluding those with birth defects or developmental delays. BP and echocardiographic assessment were conducted at follow-up. Cognitive function was evaluated using the Wechsler preschool and primary scales of intelligence-fourth edition.

Elevated BP (107.4 ± 6.2 mmHg) compared to normal BP (96.0 ± 5.9 mmHg) tended towards lower full scale intelligence quotient (IQ) [adjusted mean difference (β) = - 2.95, 95% confidence interval (CI) = - 4.65, - 1.25], processing speed index (β = - 1.77, 95% CI = - 3.41, - 0.14), working memory index (β = - 2.79, 95% CI = - 4.70, - 0.88) and visual spatial index (β = - 2.64, 95% CI = - 4.74, - 0.55). These associations persisted after adjusting for LV mass index (LVMI). Higher systolic BP, analyzed as a continuous variable, was associated with lower full scale IQ (β = - 0.12, 95% CI = - 0.21, - 0.03) and visual spatial index (β = - 0.23, 95% CI = - 0.35, - 0.10); diastolic BP showed the same trend. There was no significant association between cognitive function and LV structure or the mediating effect of LVMI.

Higher BP was associated with poorer cognitive development as early as age four; LV structural alterations were not. This suggests that the relationship between BP and cognitive function was independent of LVMI in early childhood.