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Blood pressure, left ventricular structure and cognitive development in young children: a cross-sectional study
Hua-Lin Wang1,2, Bo-Wen Du1,2, Yue Zhou1,2
1Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
Insights
Higher blood pressure (BP) in four-year-olds is linked to lower cognitive function, independent of heart structure. This suggests early BP monitoring is crucial for childhood development.
Area of Science:
- Pediatric Cardiology
- Developmental Neuroscience
- Public Health
Background:
- Hypertension-induced left ventricular (LV) structural changes are linked to cognitive decline in the elderly.
- The association between blood pressure (BP), LV structure, and cognitive function in early childhood is not well understood.
- Preschool-aged children offer a unique population to study these relationships, free from age-related comorbidities.
Purpose of the Study:
- To investigate the relationship between BP, LV structure, and cognitive function in preschool-aged children.
- To determine if LV structure mediates the association between BP and cognitive development in early childhood.
Main Methods:
- Recruited 1279 four-year-old children from the Shanghai Birth Cohort.
- Assessed BP and performed echocardiography.
- Evaluated cognitive function using the Wechsler preschool and primary scales of intelligence-fourth edition.
Main Results:
- Elevated BP was associated with lower full scale intelligence quotient (IQ), processing speed index, working memory index, and visual spatial index.
- These associations persisted after adjusting for LV mass index (LVMI).
- No significant association was found between cognitive function and LV structure, nor a mediating effect of LVMI.
Conclusions:
- Higher BP is associated with poorer cognitive development as early as age four.
- LV structural alterations were not associated with cognitive function in this cohort.
- The relationship between BP and cognitive function in early childhood appears independent of LVMI.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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Monitoring Both Arms:
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.