Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States

Lande, Marc B.; Kaczorowski, Jeffrey M.; Auinger, Peggy; Schwartz, George J.; Weitzman, Michael

doi:10.1067/s0022-3476(03)00412-8

Cited by 174 publications

(132 citation statements)

References 16 publications

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“…It is known that young adults with primary hypertension demonstrate decreased performance on neurocognitive testing compared with normotensive controls (8). There is emerging evidence that children with primary hypertension also have decreased performance on neurocognitive testing (9). However, data on the potential contribution of hypertension to CKD-associated neurocognitive deficits in children are limited, particularly in those with mildto-moderate CKD.…”

Section: Introductionmentioning

confidence: 92%

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Casual Blood Pressure and Neurocognitive Function in Children with Chronic Kidney Disease

Lande

Gerson

Hooper

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Children with chronic kidney disease (CKD) are at risk for cognitive dysfunction, and over half have hypertension. Data on the potential contribution of hypertension to CKD-associated neurocognitive deficits in children are limited. Our objective was to determine whether children with CKD and elevated BP (EBP) had decreased performance on neurocognitive testing compared with children with CKD and normal BP.Design, setting, participants, & measurements This was a cross-sectional analysis of the relation between auscultatory BP and neurocognitive test performance in children 6 to 17 years enrolled in the Chronic Kidney Disease in Children (CKiD) project.Results Of 383 subjects, 132 (34%) had EBP (systolic BP and/or diastolic BP Ն90 th percentile). Subjects with EBP had lower mean (SD) scores on Wechsler Abbreviated Scales of Intelligence (WASI) Performance IQ than those with normal BP (normal BP versus EBP, 96.1 (16.7) versus 92.4 (14.9), P ϭ 0.03) and WASI Full Scale IQ (97.0 (16.2) versus 93.4 (16.5), P ϭ 0.04). BP index (subject's BP/95 th percentile BP) correlated inversely with Performance IQ score (systolic, r ϭ Ϫ0.13, P ϭ 0.01; diastolic, r ϭ Ϫ0.19, P Ͻ 0.001). On multivariate analysis, the association between lower Performance IQ score and increased BP remained significant after controlling for demographic and disease-related variables (EBP, ␤ ϭ Ϫ3.7, 95% confidence interval [CI]: Ϫ7.3 to Ϫ0.06; systolic BP index, ␤ ϭ Ϫ1.16 to 95% CI: Ϫ2.1, Ϫ0.21; diastolic BP index, ␤ ϭ Ϫ1.17, 95% CI: Ϫ1.8 to Ϫ0.55). ConclusionsHigher BP was independently associated with decreased WASI Performance IQ scores in children with mild-to-moderate CKD.

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Section: Introductionmentioning

confidence: 92%

“…Recent studies suggest that children with high BP have deficits in neurocognitive function, similar to young adults with hypertension (8,9,18,19). Children with CKD are at risk for neurocognitive dysfunction, and they are frequently hypertensive.…”

Section: Discussionmentioning

confidence: 99%

Casual Blood Pressure and Neurocognitive Function in Children with Chronic Kidney Disease

Lande

Gerson

Hooper

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…The effects of CKD on neurodevelopment and cognitive function of children remain largely unknown, but age of CKD onset (42,43), duration of kidney failure (44,45), hypertension (46), anemia (47)(48)(49)(50), and depression (51-53) have been associated with impairments in cognition and neurodevelopment. Furthermore, systematic assessment of nutritional status by measurement of growth parameters (height, weight, mid-upper arm circumference, pubertal development, and nutritional intake via 3 d diet history) and food frequency questionnaire will be collected to define further the influence of CKD on these parameters and the influence of these parameters on cognition and development.…”

Section: Discussionmentioning

confidence: 99%

Design and Methods of the Chronic Kidney Disease in Children (CKiD) Prospective Cohort Study

Furth

Cole

Moxey-Mims

et al. 2006

Clinical Journal of the American Society of Nephrology

362

316

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An estimated 650,000 Americans will have ESRD by 2010. Young adults with kidney failure often develop progressive chronic kidney disease (CKD) in childhood and adolescence. The Chronic Kidney Disease in Children (CKiD) prospective cohort study of 540 children aged 1 to 16 yr and have estimated GFR between 30 and 75 ml/min per 1.73 m 2 was established to identify novel risk factors for CKD progression; the impact of kidney function decline on growth, cognition, and behavior; and the evolution of cardiovascular disease risk factors. Annually, a physical examination documenting height, weight, Tanner stage, and standardized BP is conducted, and cognitive function, quality of life, nutritional, and behavioral questionnaires are completed by the parent or the child. Samples of serum, plasma, urine, hair, and fingernail clippings are stored in biosamples and genetics repositories. GFR is measured annually for 2 yr, then every other year using iohexol, HPLC creatinine, and cystatin C. Using age, gender, and serial measurements of Tanner stage, height, and creatinine, compared with iohexol GFR, a formula to estimate GFR that will improve on traditional pediatric GFR estimating equations when applied longitudinally is expected to be developed. Every other year, echocardiography and ambulatory BP monitoring will assess risk for cardiovascular disease. The primary outcome is the rate of decline of GFR. The CKiD study will be the largest North American multicenter study of pediatric CKD.

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“…This differs from the bulk of the existing literature that focused on either children but mostly on the elderly. Studies in children are limited by the relatively few children showing hypertension, which is then often complicated in those children by comorbid disorders and congenital disease (Cha et al, 2012;Lande et al, 2003;Lyngdoh et al, 2013). Studies in the elderly are complicated by comorbidity of high BP with other atherosclerotic risk factors like cholesterol, diabetes, body mass index (BMI), immune parameters, and medical or psychiatric disorders, which can all assert an influence on cognitive functioning (Spauwen et al, 2015;van Vliet et al, 2010;Waldstein, 2003;Walther et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

No Evidence of Causal Effects of Blood Pressure on Cognition in the Population at Large

et al. 2016

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The large body of literature on the association between blood pressure (BP) and cognitive functioning has yielded mixed results, possibly due to the presence of non-linear effects across age, or because BP affects specific brain areas differently, impacting more on some cognitive skills than on others. If a robust association was detected among BP and specific cognitive tasks, the causal nature of reported associations between BP and cognition could be investigated in twin data, which allow a test of alternative explanations, including genetic pleiotropy. The present study first examines the association between BP and cognition in a sample of 1,140 participants with an age range between 10 and 86 years. Linear and quadratic effects of systolic BP (SBP) and diastolic BP (DBP) on cognitive functioning were examined for 17 tests across five functions. Associations were corrected for effects of sex and linear and quadratic effects of age. Second, to test a causal model, data from 123 monozygotic (MZ) twin pairs were analyzed to test whether cognitive functioning of the twins with the higher BP was different from that of the co-twins with lower BP. Associations between BP and cognitive functioning were absent for the majority of the cognitive tests, with the exception of a lower speed of emotion identification and verbal reasoning in subjects with high diastolic BP. In the MZ twin pair analyses, no effects of BP on cognition were found. We conclude that in the population at large, BP level is not associated with cognitive functioning in a clinically meaningful way.

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Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States

Cited by 174 publications

References 16 publications

Casual Blood Pressure and Neurocognitive Function in Children with Chronic Kidney Disease

Casual Blood Pressure and Neurocognitive Function in Children with Chronic Kidney Disease

Design and Methods of the Chronic Kidney Disease in Children (CKiD) Prospective Cohort Study

No Evidence of Causal Effects of Blood Pressure on Cognition in the Population at Large

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