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

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Abstract

Background

Children with primary hypertension have been reported to have diminished scores in measures of cognition. However, little is known about the relative correlation between office and ambulatory blood pressure (BP) and neurocognitive test performance, and whether short-term BP variability is associated with decreased neurocognitive function. We sought to determine whether ambulatory BP monitoring (ABPM) was more strongly associated with neurocognitive test performance compared with office BP, and whether increased short-term BP variability was associated with lower neurocognitive scores.

Methods

Seventy-five subjects ages 10–18 years, with untreated primary hypertension, and 75 matched normotensive controls completed neurocognitive testing. All subjects had office BP and ABPM prior to neurocognitive testing.

Results

On multivariate analyses, there was no significant association between office BP and neurocognitive tests. However, several ABPM parameters were significantly associated with neurocognitive test scores in the lower quartile, in particular 24 h SBP load and wake systolic blood pressure (SBP) index [Rey Auditory Verbal learning Test (RAVLT) List A Trial 1, 24 h SBP load, odds ratio (OR) = 1.02, wake SBP index, OR = 1.06; List A Total, 24 h SBP load, OR = 1.02, wake SBP index, OR = 1.06; Short Delay Recall, wake SBP index, OR = 1.06; CogState Maze delayed recall, 24 h SBP load, OR = 1.03, wake SBP index, OR = 1.08; Grooved Pegboard, 24 h SBP load, OR = 1.02; all p < 0.05]. In contrast, short-term BP variability measures were not associated with neurocognitive test performance.

Conclusions

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

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Acknowledgements

This work was funded by a grant from the National Heart, Lung, and Blood Institute (R01HL098332, MBL).

We thank the study coordinators at each participating center for all their work in keeping this study going, and the study participants and their parents.

Funding

This work was funded by a grant from the National Heart, Lung, and Blood Institute (R01HL098332, MBL).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA

    Juan C. Kupferman

  2. Department of Pediatrics, Emory University, Atlanta, GA, USA

    Donald L. Batisky

  3. Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA

    Joshua Samuels

  4. Department of Neurology, University of Rochester, Rochester, NY, USA

    Heather R. Adams

  5. Departments of Allied Health Sciences and Psychiatry, University of North Carolina, Chapel Hill, NC, USA

    Stephen R. Hooper

  6. Department of Biostatistics, University of Rochester, Rochester, NY, USA

    Hongyue Wang

  7. Department of Pediatrics, University of Rochester, Rochester, NY, USA

    Marc B. Lande

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  1. Juan C. Kupferman
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Corresponding author

Correspondence to Juan C. Kupferman.

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The Institutional Review Board of each site approved the study. Parental permission was obtained, as well as subject assent.

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Kupferman, J.C., Batisky, D.L., Samuels, J. et al. Ambulatory blood pressure monitoring and neurocognitive function in children with primary hypertension. Pediatr Nephrol 33, 1765–1771 (2018). https://doi.org/10.1007/s00467-018-3954-y

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  • DOI: https://doi.org/10.1007/s00467-018-3954-y

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