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Wang Y, Lin Y, Wang H, Li Y, Shen C, Shi L. The impact of decreased SIRT1 levels on pediatric primary hypertension and left ventricular hypertrophy: a case-control study. BMC Pediatr 2025; 25:340. [PMID: 40307735 PMCID: PMC12042379 DOI: 10.1186/s12887-025-05671-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 04/07/2025] [Indexed: 05/02/2025] Open
Abstract
BACKGROUND Decreased SIRT1 exhibits a correlation with a range of cardiovascular diseases. However, the changes in serum SIRT1 levels in pediatric primary hypertension have not been reported. This study aimed to investigate serum SIRT1 levels in pediatric primary hypertension and explore its association with left ventricular hypertrophy in the context of hypertension. METHODS 126 participants were recruited and categorized into the hypertensive group and the control group. Serum SIRT1 levels were comparatively investigated. Spearman correlation was utilized to establish an association between SIRT1 and blood pressure. Additionally, SIRT1 levels were comparative analyzed between the patients with and without left ventricular hypertrophy. RESULTS The case group had markedly decreased SIRT1 levels than the control group (p < 0.001), and a negative association between SIRT1 levels and blood pressure was revealed (p < 0.01). In subgroup analysis, patients with left ventricular hypertrophy exhibited notably reduced SIRT1 levels (p = 0.011). The multivariate logistic regression analysis showed that lower serum SIRT1 level was an independent risk factor for hypertension (OR = 0.447, 95% CI: 0.269-0.743, p = 0.002) and left ventricular hypertrophy (OR = 0.639, 95% CI: 0.486-0.840, p = 0.001). CONCLUSIONS Serum SIRT1 levels were significantly lower in pediatric primary hypertension patients and were negatively correlated with blood pressure. Patients with left ventricular hypertrophy had significantly lower serum SIRT1 levels, and decreased serum SIRT1 was an independent risk factor for left ventricular hypertrophy.
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Affiliation(s)
- Yuting Wang
- Department of Cardiology, Children's Hospital of Capital Institute of Pediatrics, No. 2, Yabao Road, Chaoyang District, Beijing, China
- Peking Union Medical College Graduate School, Beijing, China
| | - Yao Lin
- Department of Cardiology, Children's Hospital of Capital Institute of Pediatrics, No. 2, Yabao Road, Chaoyang District, Beijing, China
| | - Hui Wang
- Department of Cardiology, Children's Hospital of Capital Institute of Pediatrics, No. 2, Yabao Road, Chaoyang District, Beijing, China
- Peking Union Medical College Graduate School, Beijing, China
| | - Yaqi Li
- Department of Cardiology, Children's Hospital of Capital Institute of Pediatrics, No. 2, Yabao Road, Chaoyang District, Beijing, China
| | - Chen Shen
- Department of Cardiology, Children's Hospital of Capital Institute of Pediatrics, No. 2, Yabao Road, Chaoyang District, Beijing, China
| | - Lin Shi
- Department of Cardiology, Children's Hospital of Capital Institute of Pediatrics, No. 2, Yabao Road, Chaoyang District, Beijing, China.
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2
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Piazza CL, Doyle LW, Pascoe L, Mainzer RM, Takagi M, Cheong JL, Anderson PJ. Twenty four-hour blood pressure and cognitive outcomes in adolescents born extremely preterm and at term. Acta Paediatr 2024; 113:2664-2672. [PMID: 39169648 DOI: 10.1111/apa.17395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/19/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]
Abstract
AIM To explore the impact of blood pressure on cognitive outcomes at 18 years of age in individuals born extremely preterm (<28 weeks' gestation) and at term (≥37 weeks' gestation). METHODS Prospective longitudinal cohort comprising 136 young adults born extremely preterm and 120 matched term controls born in Victoria, Australia in 1991 and 1992. Using linear regression, we analysed the relationships between 24-h mean ambulatory blood pressure, systolic and diastolic hypertension with cognitive outcomes. RESULTS For both birth groups combined, higher 24-h mean ambulatory blood pressure and systolic hypertension were associated with similar or worse cognitive outcomes. The strongest relationships were between higher 24-h mean ambulatory blood pressure and systolic hypertension with poorer general intellect, visual learning and visual memory. We found little evidence that relationships between ambulatory blood pressure and cognitive outcomes differed by birth group. CONCLUSION Higher 24-h mean ambulatory blood pressure and systolic hypertension were associated with poorer cognitive outcomes in individuals born extremely preterm and at term, particularly in general intelligence and visual memory.
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Affiliation(s)
- Chandelle L Piazza
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, Australia
| | - Leona Pascoe
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rheanna M Mainzer
- Clinical Epidemiology and Biostatistics Unit, Department of Paediatrics, Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Takagi
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
- Brain and Mind Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jeanie L Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Anderson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Hooper SR, Lande MB, Flynn JT, Hanevold CD, Meyers KE, Samuels J, Becker RC, Daniels SR, Falkner BE, Ferguson MA, Ingelfinger JR, Martin LJ, Mitsnefes M, Khoury P, Seo J, Urbina EM. Systolic Blood Pressure, Cardiovascular Health, and Neurocognition in Adolescents. Hypertension 2024; 81:2444-2453. [PMID: 39291378 PMCID: PMC11578784 DOI: 10.1161/hypertensionaha.124.22834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 09/03/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND We studied whether increased systolic blood pressure (SBP), as determined by auscultatory SBP, ambulatory SBP, and the number of cardiovascular health risk indicators, are associated with neurocognition in adolescents. METHODS This cross-sectional study included 365 adolescents (mean age, 15.5 years) from 6 academic medical centers in the United States. The sample was 59.5% male, 52.6% White, with 23.9% of the caregivers having less than or equal to a high school degree. Primary exposures included the following: auscultatory SBP, ambulatory SBP, and the number of cardiovascular risk factors. Neurocognitive outcomes comprised nonverbal IQ, attention, and parent ratings of executive functions. RESULTS After examining the models for the effects of targeted covariates (eg, maternal education), higher auscultatory SBP was associated with lower nonverbal IQ (β=-1.39; P<0.001) and verbal attention (β=-2.39; P<0.05); higher ambulatory 24 hours. SBP (β=-21.39; P<0.05) and wake SBP (β=-21.62; P<0.05) were related to verbal attention; and all 3 ambulatory blood pressure measures were related to sustained attention accounting for small to medium amounts of variance (adjusted R2=0.08-0.09). Higher ambulatory blood pressure sleep SBP also was significantly associated with parent ratings of behavior regulation (β=12.61; P<0.05). These associations remained stable after a sensitivity analysis removed cases with hypertension. Number of cardiovascular risk factors performed similarly, with more risk factors being associated with lower nonverbal IQ (β=-1.35; P<0.01), verbal attention (β=-1.23; P<0.01), and all parent ratings of executive functions. CONCLUSIONS Elevated SBP, even below the hypertension range, and general cardiovascular health are associated with neurocognitive outcomes in adolescents. How these findings might guide clinical care is worthy of additional study.
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Affiliation(s)
| | | | - Joseph T. Flynn
- Department of Pediatrics, University of Washington School of Medicine, and Division of Nephrology, Seattle Children’s Hospital
| | - Coral D. Hanevold
- Department of Pediatrics, University of Washington School of Medicine, and Division of Nephrology, Seattle Children’s Hospital
| | - Kevin E. Meyers
- Children’s Hospital of Philadelphia and University of Pennsylvania
| | - Joshua Samuels
- McGovern Medical School at University of Texas Health and Children’s Memorial Hermann Hospital, Houston
| | - Richard C. Becker
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine
| | | | | | | | | | - Lisa J. Martin
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine
| | - Mark Mitsnefes
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine
| | - Phillip Khoury
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine
| | - Jangdong Seo
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine
| | - Elaine M. Urbina
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine
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Burke E, Jenkins T, Boles RE, Mitchell JE, Inge T, Gunstad J. Cognitive function 10 years after adolescent bariatric surgery. Surg Obes Relat Dis 2024; 20:614-620. [PMID: 38413319 DOI: 10.1016/j.soard.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/24/2023] [Accepted: 01/13/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Adolescent bariatric surgery produces substantial weight loss and reduction of medical co-morbidities. Research in adult samples shows improved cognitive function postoperatively, although much less is known about the potential cognitive benefits of bariatric surgery in adolescents-especially at extended follow-up. OBJECTIVE Examine cognitive function 10 years after adolescent bariatric surgery. SETTING University hospital. METHODS A total of 99 young adults who underwent bariatric surgery as adolescents completed a computerized cognitive test battery as part of a larger 10-year postoperative assessment. All had been long-term participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. RESULTS Cognitive dysfunction was prevalent on tests of attention and executive function (e.g., Continuous Performance Test - Reaction Time 30%; Maze Errors - Overrun 30%), and 53.5% met research criteria for mild cognitive impairment (MCI). Modified Poisson regression with robust error variance revealed participants with preoperative hypertension and those completing Roux-en-Y gastric bypass were more likely to meet criteria for MCI at 10-year follow-up. CONCLUSIONS The current findings indicate that cognitive deficits are common 10 years after bariatric surgery. Additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up (e.g., 20 yr after surgery), and identify underlying mechanisms and mitigation strategies.
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Affiliation(s)
- Erin Burke
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | - Todd Jenkins
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - James E Mitchell
- Sanford Center for Biobehavioral Research, Fargo, North Dakota; University of North Dakota School of Medicine and Health Science, Fargo, North Dakota
| | - Thomas Inge
- Department of Surgery, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio.
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Azukaitis K, Puteikis K, Kinciniene O, Mikucionyte D, Mameniskiene R, Jankauskiene A. Cognitive performance in children and adolescents with primary hypertension and the role of body mass. Front Pediatr 2024; 12:1369690. [PMID: 38745835 PMCID: PMC11091299 DOI: 10.3389/fped.2024.1369690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Abstract
Objective Primary hypertension has been shown to affect cognitive functions in adults but evidence in the pediatric population remain scarce and equivocal. We aimed to compare cognitive functioning between children diagnosed with primary hypertension and normotensive controls, with a focus on the role of different blood pressure (BP) parameters and body mass. Methods We conducted a single-center, prospective, cross-sectional study of children and adolescents (6-17 years old) with primary hypertension and age- and sex-matched normotensive controls. All participants underwent office BP, ambulatory BP monitoring (ABPM), and central BP measurements using an oscillometric device. Neurocognitive assessment consisted of evaluation of (i) intelligence quotient (IQ), (ii) categorical and phonemic fluency, (iii) verbal memory (verbal-logical story recall), and (iv) non-verbal computerized cognitive assessment. Results The study included a total of 59 patients with primary hypertension (14 ± 3 years) and 37 normotensive controls (14 ± 3 years). Participants in the primary hypertension group had a significantly higher body mass index z-score (BMIz: 2.1 ± 1.4 vs. 0.7 ± 0.9, p < 0.001), and 85% received antihypertensive therapy. Participants with primary hypertension showed worse performance in the domains of reaction speed, attention and processing speed, visual memory, new learning, and phonemic fluency. After adjusting for BMIz, only the differences in the reaction speed tasks remained significant. None of the BP parameters was associated with cognitive outcomes after adjustment for age, sex, and BMIz. BMIz associated with tasks of visual memory, new learning, spatial planning, and working memory, independent of age and sex. Conclusion Children and adolescents diagnosed with primary hypertension exhibit worse performance in the cognitive domains of reaction speed, attention, processing speed, visual memory, and new learning. These differences to healthy controls can be partially attributed to accompanying increase of body mass.
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Affiliation(s)
- Karolis Azukaitis
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Kristijonas Puteikis
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Odeta Kinciniene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Ruta Mameniskiene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Augustina Jankauskiene
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
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Puteikis K, Ažukaitis K, Dadurkevičienė D, Simanauskas K, Šileikienė V, Jankauskienė A, Mameniškienė R. Primary Arterial Hypertension Associated with Cognitive Dysfunction in Young Adults: Results from a Cross-Sectional Controlled Study. Behav Sci (Basel) 2024; 14:321. [PMID: 38667117 PMCID: PMC11047524 DOI: 10.3390/bs14040321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
Despite evidence of primary hypertension (PH)-associated cognitive dysfunction in pediatric, middle-aged, and older adult populations, respective data in young adults remains scarce. We aimed to define differences in cognitive performance between individuals with PH and healthy controls in early adulthood. A convenience sample of young adults (age 18-45 years) with PH and their healthy sex, age, education, and household income matched counterparts were cross-sectionally tested for verbal fluency, verbal memory, general intelligence, reaction speed, attention, visual memory, and executive functioning. Between-group differences were determined using Student's t and Mann-Whitney U tests. Sensitivity analysis was performed by adjusting for body mass index (BMI) in analysis of covariance (ANCOVA) and regression models. Thirty-three adults with PH (22, 66.7% male, median age 38.8, interquartile range (IQR) = 33.2-41.6 years) and twenty-two healthy controls (9, 40.9% male, median age 36.1, IQR = 27.5-39.8 years) completed the neuropsychological assessment. Participants with PH performed worse on computerized tasks of reaction time (median response time (Z = -2.019, p = 0.044), median time for release of response button (Z = -2.509, p = 0.012)) and sustained attention (signal detection measure, RVPA (t = 2.373, p = 0.021), false alarms ÷ (false alarms + correct rejections), RVPPFA (Z = -2.052, p = 0.040)). The group variable was not a statistically significant predictor of performance in these domains after adjustment for BMI (p > 0.05). In regression analyses, high office systolic blood pressure (oSBP) was independently associated with poor sustained attention (βSBP(st.) = -0.283, multiple R2 = 0.252 (RVPA), βSBP(st.) = 0.551, multiple R2 = 0.386 (RVPPFA)). Young adults with PH were found to perform worse in tasks of response speed and sustained attention. While the difference between neuropsychological evaluation results in PH and control groups was confounded by BMI, oSBP measures were independently related to sustained attention. The selectivity of PH-associated cognitive profile in young adults has to be confirmed in larger trials.
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Affiliation(s)
- Kristijonas Puteikis
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Karolis Ažukaitis
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | | | - Kazys Simanauskas
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Vaida Šileikienė
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Augustina Jankauskienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Rūta Mameniškienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
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Ahmmed F, Hossain MJ, Khan MTF, Manik MMR, Shahriar S, Nandi DC, Hussain MP. Mediating effect of BMI on the association of economic status and coexistence of hypertension and diabetes in Bangladesh: A counterfactual framework-based weighting approach. Health Sci Rep 2024; 7:e2063. [PMID: 38660004 PMCID: PMC11039488 DOI: 10.1002/hsr2.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/31/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims Non-communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels. Methods A total of 11,291 complete cases from the Bangladesh demographic and health survey 2017-18 were utilized for this study. Survey-based binary logistic regression or multiple logistic regression was used to find the association among outcome, exposure, and mediator variables, and a counterfactual framework-based weighting approach was utilized for mediation analysis. Results Middle-income (adjusted odds ratio [AOR]: 1.696, 95% confidence interval [CI]: 1.219, 2.360) and rich (AOR: 2.770, CI: 2.054, 3.736) respondents were more likely to have comorbidity of hypertension and diabetes compared to the poor. The odds of comorbidity increased with the increase in BMI. A positive association was observed between ES and BMI. A significant mediating role of BMI in the association between ES and comorbidity was found. We observed that 19.85% (95% CI: 11.50%, 49.6%) and 20.35% (95% CI: 14.9%, 29.3%) of total effect was mediated by BMI for middle and rich respondents, respectively, compared to the poor. Conclusions The mediating role of BMI was greater for female, no or primary educated respondents, and respondents from rural areas. Therefore, the study will facilitate policymakers of Bangladesh and other countries with a similar set-up to decide on health policies regarding hypertension and diabetes.
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Affiliation(s)
- Foyez Ahmmed
- Department of StatisticsComilla UniversityCumillaBangladesh
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Md. Jamal Hossain
- Department of Pharmacy, School of Pharmaceutical SciencesState University of BangladeshDhakaBangladesh
| | | | | | - Saimon Shahriar
- Department of Pharmacy, School of Pharmaceutical SciencesState University of BangladeshDhakaBangladesh
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Lucas I, Puteikis K, Sinha MD, Litwin M, Merkevicius K, Azukaitis K, Rus R, Pac M, Obrycki L, Bårdsen T, Śladowska-Kozłowska J, Sagsak E, Lurbe E, Jiménez-Murcia S, Jankauskiene A, Fernández-Aranda F. Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review. Front Cardiovasc Med 2022; 9:973793. [PMID: 36337900 PMCID: PMC9631488 DOI: 10.3389/fcvm.2022.973793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/04/2022] [Indexed: 01/04/2024] Open
Abstract
Arterial hypertension (AH) among adults is known to be associated with worse cognitive outcomes. Similarly, children and adolescents with AH could be expected to underperform during neuropsychological evaluations when compared with healthy peers. Our aims were to review the existing literature on cognitive functioning among children and adolescents with primary AH and to identify what additional evidence may be needed to substantiate the impact of hypertension on poor cognitive outcomes in this population. We conducted a systematic review of articles in PubMed and Web of Science published before 17 January 2022, reporting on cognitive testing among children and adolescents with primary AH. From 1,316 records, 13 were included in the review-7 used battery-testing while other employed indirect measures of cognitive functions. Most of the studies reported worse results among individuals with AH. Results of two prospective trials suggested that cognitive functioning may improve after starting antihypertensive treatment. Ambulatory blood pressure monitoring was shown to be more strongly related to cognitive testing results than office measures of blood pressure. Significant confounders, namely obesity and sleep apnea, were identified throughout the studies. Our review indicates that evidence relating AH with poor cognitive functioning among youth is usually based on indirect measures of executive functions (e.g., questionnaires) rather than objective neuropsychological tests. Future prospective trials set to test different cognitive domains in children and adolescents undergoing treatment for AH are endorsed and should consider using standardized neuropsychological batteries as well as adjust the assessing results for obesity and sleep disorders.
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Affiliation(s)
- Ignacio Lucas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Karolis Azukaitis
- Faculty of Medicine, Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Rina Rus
- Department of Pediatric Nephrology, Children’s Hospital, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Michał Pac
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Tonje Bårdsen
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Elif Sagsak
- University of Health Sciences Turkey, Clinic of Pediatric Endocrinology, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Empar Lurbe
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pediatric, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Augustina Jankauskiene
- Faculty of Medicine, Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Butler JE, Vincent C, South AM, Chanchlani R. Updates to Pediatric Ambulatory Blood Pressure Monitoring in Clinical Practice: a Review and Strategies for Expanding Access. CURRENT PEDIATRICS REPORTS 2022. [DOI: 10.1007/s40124-022-00273-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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Executive Function-Related Improvements on a Commercial CBT-Based Weight Management Intervention: Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148763. [PMID: 35886615 PMCID: PMC9320503 DOI: 10.3390/ijerph19148763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Executive functioning is a key component involved in many of the processes necessary for effective weight management behavior change (e.g., setting goals). Cognitive behavioral therapy (CBT) and third-wave CBT (e.g., mindfulness) are considered first-line treatments for obesity, but it is unknown to what extent they can improve or sustain executive functioning in a generalized weight management intervention. This pilot randomized controlled trial examined if a CBT-based generalized weight management intervention would affect executive functioning and executive function-related brain activity in individuals with obesity or overweight. Participants were randomized to an intervention condition (N = 24) that received the Noom Weight program or to a control group (N = 26) receiving weekly educational newsletters. EEG measurements were taken during Flanker, Stroop, and N-back tasks at baseline and months 1 through 4. After 4 months, the intervention condition evidenced greater accuracy over time on the Flanker and Stroop tasks and, to a lesser extent, neural markers of executive function compared to the control group. The intervention condition also lost more weight than controls (−7.1 pounds vs. +1.0 pounds). Given mixed evidence on whether weight management interventions, particularly CBT-based weight management interventions, are associated with changes in markers of executive function, this pilot study contributes preliminary evidence that a multicomponent CBT-based weight management intervention (i.e., that which provides both support for weight management and is based on CBT) can help individuals sustain executive function over 4 months compared to controls.
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11
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De Anda-Duran I, Woltz SG, Bell CN, Bazzano LA. Hypertension and cognitive function: a review of life-course factors and disparities. Curr Opin Cardiol 2022; 37:326-333. [PMID: 35731677 PMCID: PMC9354652 DOI: 10.1097/hco.0000000000000975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Dementia is a life-course condition with modifiable risk factors many from cardiovascular (CV) origin, and disproportionally affects some race/ethnic groups and underserved communities in the USA. Hypertension (HTN) is the most common preventable and treatable condition that increases the risk for dementia and exacerbates dementia pathology. Epidemiological studies beginning in midlife provide strong evidence for this association. This study provides an overview of the differences in the associations across the lifespan, and the role of social determinants of health (SDoH). RECENT FINDINGS Clinical trials support HTN management in midlife as an avenue to lower the risk for late-life cognitive decline. However, the association between HTN and cognition differs over the life course. SDoH including higher education modify the association between HTN and cognition which may differ by race and ethnicity. The role of blood pressure (BP) variability, interactions among CV risk factors, and cognitive assessment modalities may provide information to better understand the relationship between HTN and cognition. SUMMARY Adopting a life-course approach that considers SDoH, may help develop tailored interventions to manage HTN and prevent dementia syndromes. Where clinical trials to assess BP management from childhood to late-life are not feasible, observational studies remain the best available evidence.
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Affiliation(s)
- Ileana De Anda-Duran
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Sara G. Woltz
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Caryn N. Bell
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Lydia A. Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Tulane University School of Medicine, New Orleans, LA
- Ochsner Clinic Foundation, New Orleans, LA
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12
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Variation in paediatric 24-h ambulatory blood pressure monitoring interpretation by Canadian and UK physicians. J Hum Hypertens 2022; 37:363-369. [PMID: 35513440 DOI: 10.1038/s41371-022-00702-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 12/18/2022]
Abstract
Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is widely accepted as a more accurate method for measurement of blood pressure (BP) compared to a single office-based measurement of BP. However, it is unclear how physicians interpret ABPM and make management decisions. This study's goal is to investigate variation in ABPM interpretation among paediatric nephrologists (Canada and UK) and paediatric cardiologists (Canada only) via an online survey. The survey content included baseline demographics, questions on the use and indications for ABPM, interpretation of results, and subsequent management decisions in various clinical scenarios. The survey was sent to 196 Canadian physicians, with 69 (35.2%) total responses. Thirty-five UK clinicians also completed the survey. Most respondents were >44 years old, were in practice for at least 11 years, and were university-based. There were substantial differences among clinicians in ABPM interpretation for isolated systolic, diastolic, and night-time hypertension. For example, only 53.1% of physicians would initiate or modify treatment in those with diastolic HTN in CKD. Further, even for the same abnormal ABPM parameter, the decision to start or alter treatment was influenced by the underlying medical condition. There is significant variation in clinical practice among physicians for interpretation and management of hypertension when using ABPM. Differences in guidelines among various jurisdictions, as well as knowledge gaps in the research on which guidelines are based, create ambiguity regarding ABPM interpretation and management decisions. A more protocolized approach and further insight into the reasoning behind the variation in physicians' interpretation may help to standardise practice.
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13
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Alhamed AA, Toly VB, Hooper SR, Dell KM. The link between executive function, socio-emotional functioning and health-related quality of life in children and adolescents with mild to moderate chronic kidney disease. Child Care Health Dev 2022; 48:455-464. [PMID: 34893999 DOI: 10.1111/cch.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and adolescents with mild to moderate chronic kidney disease (CKD) are at high risk for mild but persistent impairment in executive functions, which have been associated with low health-related quality of life (HRQOL) among children and adolescents with chronic health conditions. However, no similar link has been established among children and adolescents with mild to moderate CKD. Given the essential role executive functions play in the development of adequate cognitive, emotional and social skills, it is essential to gain a clearer understating of the magnitude and attributes of executive functions and its link to HRQOL in order to inform appropriate medical and educational interventions for this patient population. OBJECTIVE The aim of this study is to examine the relationship between executive functions, socio-emotional functioning and HRQOL in children and adolescents with mild to moderate CKD. METHODS A cross-sectional design was used for this secondary data analysis of 199 children and adolescents (ages 6-17) with mild to moderate CKD from the United States and Canada who receive care at hospitals associated with the Chronic Kidney Disease in Children Study (CKiD). RESULTS The presence of impairment in executive functions and socio-emotional functioning (internalizing problems) significantly predicted lower HRQOL after controlling for key covariates (i.e., maternal education, anaemia and hypertension). Further, internalizing problems partially mediated the relationship between executive functions and HRQOL such that impairment in executive functions predicted lower HRQOL directly and indirectly by contributing to higher internalizing problems, which further contributed to low HRQOL. CONCLUSION This study underscores the importance of executive functions and socio-emotional functioning in the manifestation of HRQOL. Given that HRQOL is potentially compromised for many children and adolescents with mild to moderate CKD, it will be important for both clinicians and researchers to examine a range of factors, including executive functions and socio-emotional functioning, in order to optimize HRQOL.
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Affiliation(s)
- Arwa A Alhamed
- Nursing Department, College of Nursing, King Saud bin Abdulaizz University for Health Sciences, Riyadh, Saudi Arabia
| | - Valerie B Toly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stephen R Hooper
- Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine M Dell
- Pediatric Institute, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
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14
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Abstract
The 95th percentile of blood pressure (BP) among healthy children is the currently accepted level used to denote a hypertensive BP reading in pediatric patients. Yet, ample data have emerged showing that the detrimental effects of high BP can be demonstrated at BP levels considered normal by current guidelines. Cardiac, vascular, cognitive, and kidney effects have been shown starting at the 90th percentile in cross-sectional studies, and markers of adult cardiovascular disease appear in longitudinal cohorts whose members had modestly elevated or even normal BP as youth. This review summarizes data that support a lower threshold of concern for children and adolescents, and outlines some of the remaining questions to be answered before a lower threshold BP level could be adopted.
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Affiliation(s)
- Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine. Division of Nephrology, Seattle Children's Hospital, WA
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15
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Abstract
Although a relationship between traditional cardiovascular risk factors and stroke has long been recognized, these risk factors likely play a role in other aspects of brain health. Clinical stroke is only the tip of the iceberg of vascular brain injury that includes covert infarcts, white matter hyperintensities, and microbleeds. Furthermore, an individual's risk for not only stroke but poor brain health includes not only these traditional vascular risk factors but also lifestyle and genetic factors. The purpose of this narrative review is to summarize the state of the evidence on traditional and nontraditional vascular risk factors and their contributions to brain health. Additionally, we will review important modifiers that interact with these risk factors to increase, or, in some cases, reduce risk of adverse brain health outcomes, with an emphasis on genes and biomarkers associated with Alzheimer disease. Finally, we will consider the importance of social determinants of health in brain health outcomes.
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Affiliation(s)
- Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD (R.F.G.)
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UTHSA, San Antonio, TX (S.S.).,Department of Neurology, Boston University School of Medicine, Boston, MA (S.S.)
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16
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Dawson AE, Kallash M, Spencer JD, Wilson CS. The pressure's on: understanding neurocognitive and psychological associations with pediatric hypertension to inform comprehensive care. Pediatr Nephrol 2021; 36:3869-3883. [PMID: 33890179 DOI: 10.1007/s00467-021-05077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The prevalence of hypertension is increasing in pediatric populations. While clinical data and practice guidelines identify the impact of hypertension on organ dysfunction and emphasize the importance for end-organ damage screening, the bidirectional effects of pediatric hypertension on neurocognitive and psychological outcomes are understudied. The objective of this review is to highlight the association between hypertension and cognition, attention, learning, and mental health in children and adolescents. In doing so, this review provides a framework and toolkit to integrate neuropsychology and psychology into the screening and management stages of pediatric hypertension. By recognizing the effects of hypertension on cognition, behavior, and mental health, screenings and interventions can be implemented to proactively and comprehensively improve the health outcomes for children with blood pressure concerns.
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Affiliation(s)
- Anne E Dawson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Mahmoud Kallash
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - John D Spencer
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's, Columbus, OH, USA
| | - Camille S Wilson
- Department of Pediatric Psychology and Neuropsychology, Department of Pediatrics, Nationwide Children's, 700 Children's Drive, Columbus, OH, 43205, USA
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17
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Climie RE, Park C, Avolio A, Mynard JP, Kruger R, Bruno RM. Vascular Ageing in Youth: A Call to Action. Heart Lung Circ 2021; 30:1613-1626. [PMID: 34275753 DOI: 10.1016/j.hlc.2021.06.516] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 12/18/2022]
Abstract
Extensive evidence shows that risk factors for cardiovascular disease (CVD) begin to develop early in life. Childhood obesity and elevated blood pressure (BP) have become overwhelmingly challenging, with 57% of today's children predicted to be obese by the age of 35 years, and global rates of hypertension in children and adolescents increasing by 75% from 2000 to 2015. Thus, there is an urgent need for tools that can assess early CVD risk in youth, which may lead to better risk stratification, preventative intervention, and personalised medicine. Vascular ageing (the deterioration in vascular structure and function) is a pivotal progenitor of health degeneration associated with elevated BP. Exposure to adverse environmental and genetic factors from fetal life promotes the development and accumulation of subclinical vascular changes that direct an individual towards a trajectory of early vascular ageing (EVA)-an independent predictor of target organ damage in the heart, brain, and kidneys. Therefore, characterising vascular ageing from youth may provide a window into cardiovascular risk later in life. However, vascular ageing measurements only have value when techniques are accurate/validated and when reliable thresholds are available for defining normal ranges and ranges that signal increased risk of disease. The aim of this paper is to summarise current evidence on the importance of vascular ageing assessment in youth and the impact of interventions to prevent or delay EVA, to highlight the need for standardisation and validation of measurement techniques in children and adolescents, and the importance of establishing reference values for vascular ageing measures in this population.
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Affiliation(s)
- R E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France.
| | - C Park
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, UCL, London, UK
| | - A Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - J P Mynard
- Heart Research, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - R Kruger
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - R-M Bruno
- Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France. https://twitter.com/rosam_bruno
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18
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Rojas M, Chávez-Castillo M, Pirela D, Parra H, Nava M, Chacín M, Angarita L, Añez R, Salazar J, Ortiz R, Durán Agüero S, Gravini-Donado M, Bermúdez V, Díaz-Camargo E. Metabolic Syndrome: Is It Time to Add the Central Nervous System? Nutrients 2021; 13:nu13072254. [PMID: 34208833 PMCID: PMC8308252 DOI: 10.3390/nu13072254] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 12/28/2022] Open
Abstract
Metabolic syndrome (MS) is a set of cardio-metabolic risk factors that includes central obesity, hyperglycemia, hypertension, and dyslipidemias. The syndrome affects 25% of adults worldwide. The definition of MS has evolved over the last 80 years, with various classification systems and criteria, whose limitations and benefits are currently the subject of some controversy. Likewise, hypotheses regarding the etiology of MS add more confusion from clinical and epidemiological points of view. The leading suggestion for the pathophysiology of MS is insulin resistance (IR). IR can affect multiple tissues and organs, from the classic “triumvirate” (myocyte, adipocyte, and hepatocyte) to possible effects on organs considered more recently, such as the central nervous system (CNS). Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) may be clinical expressions of CNS involvement. However, the association between MCI and MS is not understood. The bidirectional relationship that seems to exist between these factors raises the questions of which phenomenon occurs first and whether MCI can be a precursor of MS. This review explores shared pathophysiological mechanisms between MCI and MS and establishes a hypothesis of a possible MCI role in the development of IR and the appearance of MS.
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Affiliation(s)
- Milagros Rojas
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (M.R.); (D.P.); (H.P.); (M.N.); (J.S.)
| | | | - Daniela Pirela
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (M.R.); (D.P.); (H.P.); (M.N.); (J.S.)
| | - Heliana Parra
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (M.R.); (D.P.); (H.P.); (M.N.); (J.S.)
| | - Manuel Nava
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (M.R.); (D.P.); (H.P.); (M.N.); (J.S.)
| | - Maricarmen Chacín
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 08002, Colombia;
| | - Lissé Angarita
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andrés Bello, Sede Concepción 4260000, Chile;
| | - Roberto Añez
- Departamento de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Juan Salazar
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela; (M.R.); (D.P.); (H.P.); (M.N.); (J.S.)
| | - Rina Ortiz
- Posgrado, Carrera de Medicina, Universidad Católica de Cuenca, Cantón de Cuenca 010101, Ecuador;
| | - Samuel Durán Agüero
- Facultad de Ciencias Para el Cuidado de la Salud, Universidad San Sebastián, Los Leones 8420524, Chile;
| | - Marbel Gravini-Donado
- Facultad de Ciencias Jurídicas y Sociales, Universidad Simón Bolívar, Barranquilla 080002, Colombia;
| | - Valmore Bermúdez
- Facultad de Ciencias Jurídicas y Sociales, Universidad Simón Bolívar, Cúcuta 540006, Colombia;
| | - Edgar Díaz-Camargo
- Facultad de Ciencias Jurídicas y Sociales, Universidad Simón Bolívar, Cúcuta 540006, Colombia;
- Correspondence:
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19
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Tyner E, Oropeza M, Figueroa J, Peña ICD. Childhood Hypertension and Effects on Cognitive Functions: Mechanisms and Future Perspectives. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2020; 18:677-686. [PMID: 31749437 DOI: 10.2174/1871527318666191017155442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 12/23/2022]
Abstract
Pediatric hypertension is currently one of the most common health concerns in children, given its effects not only on cardiovascular but also cognitive functions. There is accumulating evidence suggesting neurocognitive dysfunction in hypertensive children that could persist even into adulthood. Identifying the precise mechanism(s) underlying the association between childhood hypertension and cognitive dysfunction is crucial as it could potentially lead to the discovery of "druggable" biological targets facilitating the development of treatments. Here, we discuss some of the proposed pathophysiological mechanisms underlying childhood hypertension and cognitive deficits and suggest strategies to address some of the current challenges in the field. The various research studies involving hypertensive adults indicate that long-term hypertension may produce abnormal cerebrovascular reactivity, chronic inflammation, autonomic dysfunction, or hyperinsulinemia and hypercholesterolemia, which could lead to alterations in the brain's structure and functions, resulting in cognitive dysfunction. In light of the current literature, we propose that dysregulation of the hypothalamus-pituitaryadrenal axis, modifications in endothelial brain-derived neurotrophic factor and the gut microbiome may also modulate cognitive functions in hypertensive individuals. Moreover, the above-mentioned pathological states may further intensify the detrimental effects of hypertension on cognitive functions. Thus, treatments that target not only hypertension but also its downstream effects may prove useful in ameliorating hypertension-induced cognitive deficits. Much remains to be clarified about the mechanisms and treatments of hypertension-induced cognitive outcomes in pediatric populations. Addressing the knowledge gaps in this field entails conducting not only clinical research but also rigorous basic and translational studies.
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Affiliation(s)
- Emma Tyner
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, California, 92350, United States
| | - Marie Oropeza
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, California, 92350, United States
| | - Johnny Figueroa
- Center for Health Disparities and Molecular Medicine, and Physiology Division, Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, California 92350, United States
| | - Ike C Dela Peña
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, California, 92350, United States
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20
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Central SBP and executive function in children and adolescents with primary and secondary hypertension. J Hypertens 2020; 38:2176-2184. [DOI: 10.1097/hjh.0000000000002551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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A longitudinal examination of parent-reported emotional-behavioral functioning of children with mild to moderate chronic kidney disease. Pediatr Nephrol 2020; 35:1287-1295. [PMID: 32157444 PMCID: PMC8210580 DOI: 10.1007/s00467-020-04511-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Children with mild to moderate chronic kidney disease (CKD) are at increased risk for deficits in neurocognition. Less is known about how CKD affects emotional-behavioral functioning in this population. METHODS Parent ratings of emotional-behavioral functioning at baseline and over time were examined for 845 children with mild to moderate CKD using the Behavior Assessment System for Children, Second Edition Parent Rating Scales (BASC-2 PRS). Associations with demographic and disease-related predictors were also examined. RESULTS Children with mild to moderate CKD had parent-reported emotional-behavioral functioning largely within normal limits, at baseline and over time. The proportion with T-scores at least 1 SD above the mean was 24% for Internalizing Problems and 28% for Attention Problems. A greater proportion of participants scored lower than expected (worse) on scales measuring adaptive skills (25%). Persistent hypertension predicted attention problems (β = 1.59, 95% CI = 0.24 to 2.94, p < 0.02) and suggested worse behavioral symptoms (β = 1.36, 95% CI = - 0.01 to 2.73, p = 0.05). Participants with proteinuria at baseline, but not at follow-up, had fewer attention problems than participants whose proteinuria had not resolved (β = - 3.48, CI = - 6.79 to - 0.17, p < 0.04). Glomerular diagnosis was related to fewer (β = - 2.68, 95% CI = - 4.93 to - 0.42, p < 0.02) internalizing problems. CONCLUSIONS Although children with CKD generally have average emotional-behavioral parent ratings, a notable percentage of the population may be at risk for problems with attention and adaptive behavior. Providers working with this population should facilitate psychosocial referrals when indicated.
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22
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Impact of ambulatory SBP and overweight on executive function performance in children and adolescents. J Hypertens 2020; 38:1123-1130. [DOI: 10.1097/hjh.0000000000002371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jennings JR, Muldoon MF, Sved AF. Is the Brain an Early or Late Component of Essential Hypertension? Am J Hypertens 2020; 33:482-490. [PMID: 32170317 DOI: 10.1093/ajh/hpaa038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 11/13/2022] Open
Abstract
The brain's relationship to essential hypertension is primarily understood to be that of an end-organ, damaged late in life by stroke or dementia. Emerging evidence, however, shows that heightened blood pressure (BP) early in life and prior to traditionally defined hypertension, relates to altered brain structure, cerebrovascular function, and cognitive processing. Deficits in cognitive function, cerebral blood flow responsivity, volumes of brain areas, and white matter integrity all relate to increased but prehypertensive levels of BP. Such relationships may be observed as early as childhood. In this review, we consider the basis of these relationships by examining the emergence of putative causative factors for hypertension that would impact or involve brain function/structure, e.g., sympathetic nervous system activation and related endocrine and inflammatory activation. Currently, however, available evidence is not sufficient to fully explain the specific pattern of brain deficits related to heightened BP. Despite this uncertainty, the evidence reviewed suggests the value that early intervention may have, not only for reducing BP, but also for maintaining brain function.
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Affiliation(s)
- John Richard Jennings
- Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew F Muldoon
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Heart and Vascular Institute, Hypertension Center, UPMC Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alan F Sved
- Center for Neuroscience, University of Pittsburgh, Pennsylvania, USA
- Department of Neuroscience, University of Pittsburgh, Pennsylvania, USA
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Baradaran H, Demissie S, Himali JJ, Beiser A, Gupta A, Polak JF, DeCarli C, Seshadri S, Romero JR. The progression of carotid atherosclerosis and imaging markers of dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12015. [PMID: 32296732 PMCID: PMC7154591 DOI: 10.1002/trc2.12015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We studied the association of carotid intima-media thickness (CIMT) with hippocampal volume (HV) in community dwelling individuals, testing the hypothesis that persons with carotid atherosclerosis progression would have lower HV. METHODS We studied 1376 Framingham Offspring participants with two carotid ultrasounds and brain magnetic resonance imaging (MRIs). We used multivariable linear regression analyses to relate CIMT progression and HV and total brain volume. Regression models were adjusted for demographics and vascular risk factors, time interval between imaging examinations, and baseline CIMT. We assessed effect modification by hypertension treatment (HRx). RESULTS Participants with higher ICA IMT progression had significantly lower HV after adjustment for vascular risk factors and baseline IMT (standardized beta ± standard error: -0.067 ± 0.027, P = .01). We observed weaker association between ICA IMT change and HV among subjects treated for hypertension (β = -0.047, P = .19 vs β = -0.096, P = .026). DISCUSSION Cumulative vascular risk factor exposure, reflected by CIMT progression, may increase the risk of neurodegeneration.
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Affiliation(s)
| | - Serkalem Demissie
- Department of BiostatisticsBoston University School of MedicineBostonMassachusettsUSA
| | - Jayandra J. Himali
- Department of BiostatisticsBoston University School of MedicineBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- NHLBI's Framingham Heart StudyFraminghamMassachusettsUSA
| | - Alexa Beiser
- Department of BiostatisticsBoston University School of MedicineBostonMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- NHLBI's Framingham Heart StudyFraminghamMassachusettsUSA
| | - Ajay Gupta
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Joseph F. Polak
- Department of RadiologyTufts University School of MedicineBostonMassachusettsUSA
| | - Charles DeCarli
- Department of NeurologyUniversity of California‐DavisSacramentoCaliforniaUSA
| | - Sudha Seshadri
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- NHLBI's Framingham Heart StudyFraminghamMassachusettsUSA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative DiseasesUniversity of Texas Health San AntonioSan AntonioTexasUSA
| | - Jose R. Romero
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- NHLBI's Framingham Heart StudyFraminghamMassachusettsUSA
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25
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Lande MB, Kupferman JC. Blood Pressure and Cognitive Function in Children and Adolescents. Hypertension 2019; 73:532-540. [PMID: 30686086 DOI: 10.1161/hypertensionaha.118.11686] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marc B Lande
- From the Department of Pediatrics, University of Rochester, NY (M.B.L.)
| | - Juan C Kupferman
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY (J.C.K.)
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26
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Affiliation(s)
- Pamela S Singer
- Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-01 76th Avenue, New Hyde Park, NY 11040, USA.
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Abstract
PURPOSE OF REVIEW This is a review of ambulatory blood pressure monitoring (ABPM) use in pediatrics, summarizing current knowledge and uses of ABPM. RECENT FINDINGS Updated guidelines from the American Academy of Pediatrics have emphasized the value of ABPM. ABPM is necessary to diagnose white coat hypertension, masked hypertension, and nocturnal hypertension associated with specific conditions. There is growing evidence that ABPM may be useful in these populations. ABPM has been demonstrated to be more predictive of end-organ damage in pediatric hypertension compared to office blood pressure. ABPM is an important tool in the diagnosis and management of pediatric hypertension. Routine use of ABPM could potentially prevent early cardiovascular morbidity and mortality in a wide variety of populations.
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Affiliation(s)
- Sonali S Patel
- Department of Pediatrics, Section of Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, USA.
| | - Stephen R Daniels
- Department of Pediatrics, Section of Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, USA
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28
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Nehus E, Mitsnefes MM. When to Initiate Dialysis in Children and Adolescents: Is Waiting Worthwhile? Am J Kidney Dis 2019; 73:762-764. [DOI: 10.1053/j.ajkd.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/09/2019] [Indexed: 11/11/2022]
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Taylor-Zapata P, Baker-Smith CM, Burckart G, Daniels SR, Flynn JT, Giacoia G, Green D, Kelly AS, Khurana M, Li JS, Pratt C, Urbina EM, Zajicek A. Research Gaps in Primary Pediatric Hypertension. Pediatrics 2019; 143:e20183517. [PMID: 31023830 PMCID: PMC6564054 DOI: 10.1542/peds.2018-3517] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
Hypertension affects >40% of the US population and is a major contributor to cardiovascular-related morbidity and mortality. Although less common among children and adolescents, hypertension affects 1% to 5% of all youth. The 2017 Clinical Practice Guideline for the Diagnosis and Management of High Blood Pressure in Children and Adolescents provided updates and strategies regarding the diagnosis and management of hypertension in youth. Despite this important information, many gaps in knowledge remain, such as the etiology, prevalence, and trends of hypertension; the utility and practicality of ambulatory blood pressure monitoring; practical goals for lifestyle modification that are generalizable; the long-term end-organ impacts of hypertension in youth; and the long-term safety and efficacy of antihypertensive therapy in youth. The Eunice Kennedy Shriver National Institute of Child Health and Human Development, in collaboration with the National Heart, Lung, and Blood Institute and the US Food and Drug Administration, sponsored a workshop of experts to discuss the current state of childhood primary hypertension. We highlight the results of that workshop and aim to (1) provide an overview of current practices related to the diagnosis, management, and treatment of primary pediatric hypertension; (2) identify related research gaps; and (3) propose ways to address existing research gaps.
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Affiliation(s)
- Perdita Taylor-Zapata
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development,
| | | | - Gilbert Burckart
- Office of Clinical Pharmacology, Immediate Office of the Commissioner, and
| | - Stephen R Daniels
- Department of Pediatrics, Section of Cardiology, School of Medicine, University of Colorado, Aurora, Colorado
| | - Joseph T Flynn
- School of Medicine, University of Washington, Seattle, Washington
| | - George Giacoia
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Dionna Green
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mona Khurana
- Division of Pediatric and Maternal Health, Office of New Drugs
| | - Jennifer S Li
- Department of Pediatrics, Duke University, Durham, North Carolina; and
| | - Charlotte Pratt
- Clinical Applications and Prevention Branch, National Heart, Lung, and Blood Institute, and
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne Zajicek
- Office of Clinical Research Training and Medical Education, National Institutes of Health, Bethesda, Maryland
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30
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Elias MF, Torres RV, Davey A. Diastolic Blood Pressure, Not Just Systolic Blood Pressure, Is Related to Cerebral Measures in Middle Age: Implications for Prospective Studies. Am J Hypertens 2018; 31:1263-1265. [PMID: 30113618 DOI: 10.1093/ajh/hpy125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Merrill F Elias
- Department of Psychology, Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, Maine, USA
| | - Rachael V Torres
- Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Adam Davey
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, Delaware, USA
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31
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Lamballais S, Sajjad A, Leening MJG, Gaillard R, Franco OH, Mattace‐Raso FUS, Jaddoe VWV, Roza SJ, Tiemeier H, Ikram MA. Association of Blood Pressure and Arterial Stiffness With Cognition in 2 Population-Based Child and Adult Cohorts. J Am Heart Assoc 2018; 7:e009847. [PMID: 30608188 PMCID: PMC6404174 DOI: 10.1161/jaha.118.009847] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/07/2018] [Indexed: 12/27/2022]
Abstract
Background High blood pressure levels and higher arterial stiffness have been shown to be associated with lower cognition during adulthood, possibly by accumulative changes over time. However, vascular factors may already affect the brain during early life. Methods and Results We examined the relation between cognition and vascular factors within 5853 children from the Generation R Study (mean age 6.2 years) and 5187 adults from the Rotterdam Study (mean age 61.8 years). Diastolic and systolic blood pressure and arterial stiffness were assessed, the latter by measuring pulse-wave velocity and pulse pressure. For cognition, the Generation R Study relied on nonverbal intelligence, whereas the Rotterdam Study relied on a cognitive test battery to calculate the g-factor, a measure of global cognition. In the Generation R Study, standardized diastolic blood pressure showed a significant association with standardized nonverbal intelligence (β=-0.030, 95% confidence interval=[-0.054; -0.005]) after full adjustment. This association held up after excluding the top diastolic blood pressure decile (β=-0.042 [-0.075; -0.009]), suggesting that the relation holds in normotensives. Within the Rotterdam Study, standardized cognition associated linearly with standardized systolic blood pressure (β=-0.036 [-0.060; -0.012]), standardized pulse-wave velocity (β=-0.064 [-0.095; -0.033]), and standardized pulse pressure (β=-0.044 [-0.069; -0.020], and nonlinearly with standardized diastolic blood pressure (quadratic term β=-0.032 [-0.049; -0.015]) after full adjustment. Conclusions Blood pressure and cognition may already be related in the general population during early childhood, albeit differently than during adulthood.
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Affiliation(s)
- Sander Lamballais
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- The Generation R Study GroupErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Ayesha Sajjad
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Maarten J. G. Leening
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of CardiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of Clinical EpidemiologyHarvard T. H. Chan School of Public HealthBostonMA
| | - Romy Gaillard
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- The Generation R Study GroupErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Oscar H. Franco
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Francesco U. S. Mattace‐Raso
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of Internal MedicineErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Vincent W. V. Jaddoe
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- The Generation R Study GroupErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of PediatricsErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Sabine J. Roza
- Department of PsychiatryErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
| | - Henning Tiemeier
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of PsychiatryErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of Child and Adolescent Psychiatry and PsychologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of Social & Behavioral SciencesHarvard T. H. Chan School of Public HealthBostonMA
| | - M. Arfan Ikram
- Department of EpidemiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of RadiologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
- Department of NeurologyErasmus MC University Medical Center RotterdamRotterdamThe Netherlands
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32
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Urbina EM, Lande MB, Hooper SR, Daniels SR. Target Organ Abnormalities in Pediatric Hypertension. J Pediatr 2018; 202:14-22. [PMID: 30122368 DOI: 10.1016/j.jpeds.2018.07.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati Children's, Cincinnati, OH
| | - Marc B Lande
- Department of Pediatrics, Pediatric Nephrology, University of Rochester School of Medicine, Rochester, NY
| | - Stephen R Hooper
- Department of Allied Health Sciences and Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO.
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33
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Kupferman JC, Batisky DL, Samuels J, Adams HR, Hooper SR, Wang H, Lande MB. Ambulatory blood pressure monitoring and neurocognitive function in children with primary hypertension. Pediatr Nephrol 2018; 33:1765-1771. [PMID: 29948308 PMCID: PMC6129198 DOI: 10.1007/s00467-018-3954-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/13/2018] [Accepted: 03/28/2018] [Indexed: 12/19/2022]
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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Affiliation(s)
- Juan C Kupferman
- Department of Pediatrics, Maimonides Medical Center, 977 48th Street, Brooklyn, NY, 11219, USA.
| | | | - Joshua Samuels
- Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Heather R Adams
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Stephen R Hooper
- Departments of Allied Health Sciences and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester, Rochester, NY, USA
| | - Marc B Lande
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
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34
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Flouri E, Papachristou E, Midouhas E. The role of neighbourhood greenspace in children's spatial working memory. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2018; 89:359-373. [PMID: 30187470 PMCID: PMC6563484 DOI: 10.1111/bjep.12243] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/25/2018] [Indexed: 12/03/2022]
Abstract
Background Exposure to nature may be particularly beneficial for the brain regions that support spatial working memory, a strong correlate of academic achievement. Aims To explore whether children living in greener neighbourhoods (wards) have better spatial working memory. Sample Drawn from the UK's Millennium Cohort Study, the sample was 4,758 11‐year‐olds living in urban areas in England. Methods We fitted two‐level regression models, with children nested in wards, before and after adjustment for confounders, including poverty, parental education, sports participation, neighbourhood deprivation, and neighbourhood history. Spatial working memory was measured using the Cambridge Neuropsychological Test Automated Battery Spatial Working Memory task. Greenspace was measured as the percentage of greenery in the child's ward. Results Even after controlling for confounders, lower quantity of neighbourhood greenspace was related to poorer spatial working memory. Importantly, neighbourhood deprivation did not modify this relationship. Therefore, lower quantity of greenspace was related to poorer spatial working memory similarly in deprived and non‐deprived neighbourhoods. Conclusions Children living in greener urban neighbourhoods have better spatial working memory. If this association is causal, then our findings can be used to inform policy decisions about both education and urban planning.
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Affiliation(s)
- Eirini Flouri
- Department of Psychology and Human Development, UCL Institute of Education, University College London, UK
| | - Efstathios Papachristou
- Department of Psychology and Human Development, UCL Institute of Education, University College London, UK
| | - Emily Midouhas
- Department of Psychology and Human Development, UCL Institute of Education, University College London, UK
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35
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Bugge A, Möller S, Westfall DR, Tarp J, Gejl AK, Wedderkopp N, Hillman CH. Associations between waist circumference, metabolic risk and executive function in adolescents: A cross-sectional mediation analysis. PLoS One 2018; 13:e0199281. [PMID: 29912925 PMCID: PMC6005548 DOI: 10.1371/journal.pone.0199281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/05/2018] [Indexed: 12/12/2022] Open
Abstract
The main objective of this study was to investigate the associations between waist circumference, metabolic risk factors, and executive function in adolescents. Methods: The study was cross-sectional and included 558 adolescents (mean age 14.2 years). Anthropometrics and systolic blood pressure (sysBP) were measured and fasting blood samples were analyzed for metabolic risk factors. A metabolic risk factor cluster score (MetS-cluster score) was computed from the sum of standardized sysBP, triglycerides (TG), inverse high-density lipid cholesterol (HDLc) and insulin resistance (homeostasis model assessment). Cognitive control was measured with a modified flanker task. Results: Regression analyses indicated that after controlling for demographic variables, HDLc exhibited a negative and TG a positive association with flanker reaction time (RT). Waist circumference did not demonstrate a statistically significant total association with the cognitive outcomes. In structural equation modeling, waist circumference displayed an indirect positive association with incongruent RT through a higher MetS-cluster score and through lower HDLc. The only statistically significant direct association between waist circumference and the cognitive outcomes was for incongruent RT in the model including HDLc as mediator. Conclusions: These findings are consonant with the previous literature reporting an adverse association between certain metabolic risk factors and cognitive control. Accordingly, these results suggest specificity between metabolic risk factors and cognitive control outcomes. Further, results of the present study, although cross-sectional, provide new evidence that specific metabolic risk factors may mediate an indirect association between adiposity and cognitive control in adolescents, even though a direct association between these variables was not observed. However, taking the cross-sectional study design into consideration, these results should be interpreted with caution and future longitudinal or experimental studies should verify the findings of this study.
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Affiliation(s)
- Anna Bugge
- Centre of Research in Childhood Health, Institute for Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Sören Möller
- OPEN–Odense Patient Data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Daniel R. Westfall
- Department of Psychology, Northeastern University, Boston MA, United States of America
| | - Jakob Tarp
- Centre of Research in Childhood Health, Institute for Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne K. Gejl
- Centre of Research in Childhood Health, Institute for Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Niels Wedderkopp
- Centre of Research in Childhood Health, Institute for Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Sports Medicine clinic Orthopedic Department, Middelfart Hospital, Institute of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Charles H. Hillman
- Department of Psychology, Northeastern University, Boston MA, United States of America
- Department of Physical Therapy, Movement, & Rehabilitation Sciences, Northeastern University, Boston MA, United States of America
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36
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Ambulatory Blood Pressure Monitoring in Children and Adolescents: a Review of Recent Literature and New Guidelines. Curr Hypertens Rep 2017; 19:96. [DOI: 10.1007/s11906-017-0791-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Walker KA, Power MC, Gottesman RF. Defining the Relationship Between Hypertension, Cognitive Decline, and Dementia: a Review. Curr Hypertens Rep 2017; 19:24. [PMID: 28299725 DOI: 10.1007/s11906-017-0724-3] [Citation(s) in RCA: 277] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hypertension is a highly prevalent condition which has been established as a risk factor for cardiovascular and cerebrovascular disease. Although the understanding of the relationship between cardiocirculatory dysfunction and brain health has improved significantly over the last several decades, it is still unclear whether hypertension constitutes a potentially treatable risk factor for cognitive decline and dementia. While it is clear that hypertension can affect brain structure and function, recent findings suggest that the associations between blood pressure and brain health are complex and, in many cases, dependent on factors such as age, hypertension chronicity, and antihypertensive medication use. Whereas large epidemiological studies have demonstrated a consistent association between high midlife BP and late-life cognitive decline and incident dementia, associations between late-life blood pressure and cognition have been less consistent. Recent evidence suggests that hypertension may promote alterations in brain structure and function through a process of cerebral vessel remodeling, which can lead to disruptions in cerebral autoregulation, reductions in cerebral perfusion, and limit the brain's ability to clear potentially harmful proteins such as β-amyloid. The purpose of the current review is to synthesize recent findings from epidemiological, neuroimaging, physiological, genetic, and translational research to provide an overview of what is currently known about the association between blood pressure and cognitive function across the lifespan. In doing so, the current review also discusses the results of recent randomized controlled trials of antihypertensive therapy to reduce cognitive decline, highlights several methodological limitations, and provides recommendations for future clinical trial design.
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Affiliation(s)
- Keenan A Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446D 600 North Wolfe St., Baltimore, MD, 21287, USA
| | - Melinda C Power
- Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rebecca F Gottesman
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446D 600 North Wolfe St., Baltimore, MD, 21287, USA. .,Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Gallibois CM, Jawa NA, Noone DG. Hypertension in pediatric patients with chronic kidney disease: management challenges. Int J Nephrol Renovasc Dis 2017; 10:205-213. [PMID: 28794651 PMCID: PMC5538700 DOI: 10.2147/ijnrd.s100891] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In contrast to adults where hypertension is a leading cause of chronic kidney disease, in pediatrics, hypertension is predominantly a sequela, however, an important one that, like in adults, is likely associated with a more rapid decline in kidney function or progression of chronic kidney disease to end stage. There is a significant issue with unrecognized, or masked, hypertension in childhood chronic kidney disease. Recent evidence and, therefore, guidelines now suggest targeting a blood pressure of <50th percentile for age, sex, and height in children with proteinuria and chronic kidney disease. This often cannot be achieved by monotherapy and additional agents need to be added. Blockade of the renin angiotensin aldosterone system represents the mainstay of therapy, although often limited by the side effect of hyperkalemia. The addition of a diuretic, at least in the earlier stages of chronic kidney disease, might help mitigate this problem.
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Affiliation(s)
- Claire M Gallibois
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Natasha A Jawa
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Damien G Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
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39
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Cognitive function assessment in adolescent patients on hemodiaylsis. MIDDLE EAST CURRENT PSYCHIATRY 2017. [DOI: 10.1097/01.xme.0000516503.56927.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kupferman JC, Zafeiriou DI, Lande MB, Kirkham FJ, Pavlakis SG. Stroke and Hypertension in Children and Adolescents. J Child Neurol 2017; 32:408-417. [PMID: 28019129 DOI: 10.1177/0883073816685240] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hypertension is the single most important modifiable risk factor for adult stroke. Stroke mortality has significantly decreased over the last 5 decades; this decline has been mainly associated to improved blood pressure control. Though much less prevalent than in adults, stroke is an increasingly recognized cause of morbidity and mortality in children. Although hypertension has not been strongly identified as a risk factor in childhood stroke yet, there is preliminary evidence that suggests that elevated blood pressure may be associated with stroke in children. This review summarizes the literature that may link elevated blood pressure to the development of childhood ischemic and hemorrhagic stroke. The authors suggest that elevated blood pressure may be a significant risk factor that, alone or in combination with other multiple risk factors, leads to the development of stroke in childhood. It is therefore recommend that blood pressure be measured and assessed carefully in every child presenting with acute stroke.
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Affiliation(s)
- Juan C Kupferman
- 1 Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA
| | - Dimitrios I Zafeiriou
- 2 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marc B Lande
- 3 Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Fenella J Kirkham
- 4 Developmental Neuroscience, UCL Institute of Child Health, London, United Kingdom
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Peterson CG, Miyashita Y. The Use of Ambulatory Blood Pressure Monitoring As Standard of Care in Pediatrics. Front Pediatr 2017; 5:153. [PMID: 28713799 PMCID: PMC5492637 DOI: 10.3389/fped.2017.00153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/19/2017] [Indexed: 12/16/2022] Open
Abstract
Hypertension (HTN) is a significant global health problem, responsible for 7.5 million deaths each year worldwide. The prevalence of HTN is increasing in the pediatric population likely attributed to the increase in childhood obesity. Recent work has also shown that blood pressure (BP) tends to track from childhood to adulthood including BP-related target organ damage. In the last 25-30 years, pediatric use of ambulatory blood pressure monitoring (ABPM) has been expanding mainly in the setting of initial elevated BP measurement evaluation, HTN therapy efficacy follow-up, and renal disease. However, there are many clinical areas where ABPM could potentially be used but is currently underutilized. This review summarizes the current knowledge and the uses of pediatric ABPM and explores clinical areas where it can be very useful both to detect HTN and its longitudinal follow-up. And thus, ABPM could serve as a critical tool to potentially prevent early cardiovascular mortality and morbidity in wide variety of populations. With solid data to support ABPM's superiority over clinic BP measurements and these clinical areas for its expansion, ABPM should now be part of standard of care in BP evaluation and management in pediatrics.
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Affiliation(s)
- Caitlin G Peterson
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Yosuke Miyashita
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Lande MB, Batisky DL, Kupferman JC, Samuels J, Hooper SR, Falkner B, Waldstein SR, Szilagyi PG, Wang H, Staskiewicz J, Adams HR. Neurocognitive Function in Children with Primary Hypertension. J Pediatr 2017; 180:148-155.e1. [PMID: 27692987 PMCID: PMC5183510 DOI: 10.1016/j.jpeds.2016.08.076] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/21/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare neurocognitive test performance of children with primary hypertension with that of normotensive controls. STUDY DESIGN Seventy-five children (10-18 years of age) with newly diagnosed, untreated hypertension and 75 frequency-matched normotensive controls had baseline neurocognitive testing as part of a prospective multicenter study of cognition in primary hypertension. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed. Parents completed rating scales of executive function and the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD). RESULTS Hypertension and control groups did not differ significantly in age, sex, maternal education, income, race, ethnicity, obesity, anxiety, depression, cholesterol, glucose, insulin, and C-reactive protein. Subjects with hypertension had greater PSQ-SRBD scores (P = .04) and triglycerides (P = .037). Multivariate analyses showed that hypertension was independently associated with worse performance on the Rey Auditory Verbal Learning Test (List A Trial 1, P = .034; List A Total, P = .009; Short delay recall, P = .013), CogState Groton Maze Learning Test delayed recall (P = .002), Grooved Pegboard dominant hand (P = .045), and Wechsler Abbreviated Scales of Intelligence Vocabulary (P = .016). Results indicated a significant interaction between disordered sleep (PSQ-SRBD score) and hypertension on ratings of executive function (P = .04), such that hypertension heightened the association between increased disordered sleep and worse executive function. CONCLUSIONS Youth with primary hypertension demonstrated significantly lower performance on neurocognitive testing compared with normotensive controls, in particular, on measures of memory, attention, and executive functions.
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Affiliation(s)
- Marc B Lande
- Department of Pediatrics, University of Rochester, Rochester, NY.
| | | | - Juan C Kupferman
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY
| | - Joshua Samuels
- Department of Pediatrics, University of Texas at Houston, Houston, TX
| | - Stephen R Hooper
- Departments of Allied Health Sciences and Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Bonita Falkner
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA
| | - Shari R Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD
| | - Peter G Szilagyi
- Department of Pediatrics, University of California at Los Angeles (UCLA), Los Angeles, CA
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester, Rochester, NY
| | | | - Heather R Adams
- Department of Neurology, University of Rochester, Rochester, NY
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Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB, Gulati M, Kamel H, Knopman DS, Launer LJ, Saczynski JS, Seshadri S, Zeki Al Hazzouri A. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension 2016; 68:e67-e94. [PMID: 27977393 DOI: 10.1161/hyp.0000000000000053] [Citation(s) in RCA: 463] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. METHODS Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. CONCLUSIONS After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.
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Rubens M, Ramamoorthy V, Saxena A, George F, Shehadeh N, Attonito J, McCoy HV, Beck-Sagué CM. Relationship Between Metabolic Syndrome and Cognitive Abilities in U.S. Adolescents. Metab Syndr Relat Disord 2016; 14:397-403. [DOI: 10.1089/met.2016.0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Muni Rubens
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Venkataraghavan Ramamoorthy
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Anshul Saxena
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Florence George
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Nancy Shehadeh
- College of Business, Florida Atlantic University, Boca Raton, Florida
| | - Jennifer Attonito
- College of Business, Florida Atlantic University, Boca Raton, Florida
| | - H. Virginia McCoy
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Consuelo M. Beck-Sagué
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
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Knopf JA, Finnie RKC, Peng Y, Hahn RA, Truman BI, Vernon-Smiley M, Johnson VC, Johnson RL, Fielding JE, Muntaner C, Hunt PC, Phyllis Jones C, Fullilove MT. School-Based Health Centers to Advance Health Equity: A Community Guide Systematic Review. Am J Prev Med 2016; 51:114-26. [PMID: 27320215 PMCID: PMC5759331 DOI: 10.1016/j.amepre.2016.01.009] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/04/2016] [Accepted: 01/19/2016] [Indexed: 11/23/2022]
Abstract
CONTEXT Children from low-income and racial or ethnic minority populations in the U.S. are less likely to have a conventional source of medical care and more likely to develop chronic health problems than are more-affluent and non-Hispanic white children. They are more often chronically stressed, tired, and hungry, and more likely to have impaired vision and hearing-obstacles to lifetime educational achievement and predictors of adult morbidity and premature mortality. If school-based health centers (SBHCs) can overcome educational obstacles and increase receipt of needed medical services in disadvantaged populations, they can advance health equity. EVIDENCE ACQUISITION A systematic literature search was conducted for papers published through July 2014. Using Community Guide systematic review methods, reviewers identified, abstracted, and summarized available evidence of the effectiveness of SBHCs on educational and health-related outcomes. Analyses were conducted in 2014-2015. EVIDENCE SYNTHESIS Most of the 46 studies included in the review evaluated onsite clinics serving urban, low-income, and racial or ethnic minority high school students. The presence and use of SBHCs were associated with improved educational (i.e., grade point average, grade promotion, suspension, and non-completion rates) and health-related outcomes (i.e., vaccination and other preventive services, asthma morbidity, emergency department use and hospital admissions, contraceptive use among females, prenatal care, birth weight, illegal substance use, and alcohol consumption). More services and more hours of availability were associated with greater reductions in emergency department overuse. CONCLUSIONS Because SBHCs improve educational and health-related outcomes in disadvantaged students, they can be effective in advancing health equity.
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Affiliation(s)
- John A Knopf
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Ramona K C Finnie
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Yinan Peng
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
| | - Robert A Hahn
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia.
| | - Benedict I Truman
- Office of the Associate Director for Science, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, Atlanta, Georgia
| | | | - Veda C Johnson
- Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia
| | | | | | - Carles Muntaner
- University of Toronto, Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | | | - Camara Phyllis Jones
- Satcher Health Leadership Institute at the Morehouse School of Medicine, Atlanta, Georgia
| | - Mindy T Fullilove
- Columbia University Mailman School of Public Health, New York, New York
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No Evidence of Causal Effects of Blood Pressure on Cognition in the Population at Large. Twin Res Hum Genet 2016; 19:17-26. [PMID: 26810864 DOI: 10.1017/thg.2015.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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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Urbina EM, Khoury PR, McCoy CE, Daniels SR, Dolan LM, Kimball TR. Comparison of mercury sphygmomanometry blood pressure readings with oscillometric and central blood pressure in predicting target organ damage in youth. Blood Press Monit 2016; 20:150-6. [PMID: 25647284 DOI: 10.1097/mbp.0000000000000110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Hypertension (HT) is an important risk factor for target organ damage (TOD). New methods for measuring BP are replacing mercury sphygmomanometry in many clinics. We examined the utility of different BP measurement techniques in predicting subclinical TOD in adolescents and young adults. METHODS Participants in a study of the cardiovascular effects of obesity and type 2 diabetes were evaluated (N=677, 18±3.3 years, 35% male, 60% non-White, 30% with type 2 diabetes). We measured adiposity, laboratory data, left ventricular mass, carotid intima-media thickness, and pulse wave velocity. BP was measured three times by mercury sphygmomanometry (BPm), using an oscillometric device (BPo), and by arterial tonometry to measure central aortic BP (BPc). Participants were stratified as normotensive, prehypertensive, or hypertensive. RESULTS The prevalence of HT in this cohort with a mean BMI of 31 was the highest on BPo measurement (16%), followed by BPm (11%) and BPc (9%; P≤0.001) measurements. BPm was the most consistent in differentiating left ventricular mass and pulse wave velocity among participants in the prehypertensive group as compared with the normotensive and hypertensive groups. Mercury BP measurement was also more sensitive and specific at predicting greater left ventricular mass, pulse wave velocity, and carotid thickness compared with other BP measurement techniques in logistic regression. CONCLUSION We conclude that mercury sphygmomanometry should remain the gold standard for evaluation of HT and the risk for TOD in adolescents and young adults.
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Affiliation(s)
- Elaine M Urbina
- aCincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio bDepartment of Pediatrics, University of Colorado, Aurora, Colorado, USA
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Ruebner RL, Laney N, Kim JY, Hartung EA, Hooper SR, Radcliffe J, Furth SL. Neurocognitive Dysfunction in Children, Adolescents, and Young Adults With CKD. Am J Kidney Dis 2015; 67:567-75. [PMID: 26476795 DOI: 10.1053/j.ajkd.2015.08.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/15/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Neurocognitive dysfunction is a known complication in children with chronic kidney disease (CKD). However, less is known about putative mechanisms or modifiable risk factors. The objective of this study was to characterize and determine risk factors for cognitive dysfunction in children, adolescents, and young adults with CKD compared with controls. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS The Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults With Chronic Kidney Disease (NiCK) Study included 90 individuals aged 8 to 25 years with CKD compared with 70 controls. PREDICTORS CKD versus control, estimated glomerular filtration rate (eGFR), ambulatory blood pressure. OUTCOMES Performance on neurocognitive assessment with relevant tests grouped into 11 domains defined a priori by expert opinion. Results of tests were converted to age-normalized z scores. MEASUREMENTS Each neurocognitive domain was analyzed through linear regression, adjusting for eGFR and demographic and clinical variables. For domains defined by multiple tests, the median z score of tests in that domain was used. RESULTS We found significantly poorer performance in multiple areas of neurocognitive function among individuals with CKD compared with controls. Particular deficits were seen in domains related to attention, memory, and inhibitory control. Adjusted for demographic and clinical factors, we found lower performance in multiple domains with decreasing eGFRs (attention: β=0.053, P=0.02; visual spatial: β=0.062, P=0.02; and visual working memory: β=0.069, P=0.04). Increased diastolic load and decreased diastolic nocturnal dipping on ambulatory blood pressure monitoring were independently associated with impairments in neurocognitive performance. LIMITATIONS Unable to assess changes in neurocognitive function over time, and neurocognitive tests were grouped into predetermined neurocognitive domains. CONCLUSIONS Lower eGFR in children, adolescents, and young adults is associated with poorer neurocognitive performance, particularly in areas of attention, memory, and inhibitory control. Hypertension identified on ambulatory blood pressure monitoring may be an important risk factor, illustrating that neurocognitive function is an area of target-organ damage in CKD.
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Affiliation(s)
- Rebecca L Ruebner
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Nina Laney
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ji Young Kim
- Biostatistics Core, Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Erum A Hartung
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jerilynn Radcliffe
- Department of Clinical Psychology in Pediatrics, Clinical and Translational Research Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Susan L Furth
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Analysis of 24-Hour Ambulatory Blood Pressure Monitoring in Children With Obstructive Sleep Apnea: A Hospital-Based Study. Medicine (Baltimore) 2015; 94:e1568. [PMID: 26448004 PMCID: PMC4616740 DOI: 10.1097/md.0000000000001568] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 12/04/2022] Open
Abstract
In the present study, we aimed to verify associations between ambulatory blood pressure (ABP) and pediatric obstructive sleep apnea (OSA) in a hospital-based population. This was a cross-sectional observational study on children aged 4 to 16 years with OSA-related symptoms from a tertiary referral medical center. All children received overnight polysomnography and 24-hour recording of ABP. Severity of the disease was classified as primary snoring (apnea-hypopnea index, AHI <1), mild OSA (AHI 1-5), and moderate-to-severe OSA (AHI >5). For 195 children enrolled in this study (mean age, 7.8 ± 3.4 years; 69% boy), ABP increased as severity of OSA increased. During daytime, children with moderate-to-severe OSA had significantly higher systolic blood pressure (BP) (117.0 ± 12.7 vs 110.5 ± 9.3 mmHg), mean arterial pressure (MAP) (85.6 ± 8 .1 vs 81.6 ± 6.8 mmHg), and diastolic BP load (12.0 ± 9.6 vs 8.4 ± 10.9 mmHg) compared with children with primary snoring. During nighttime, children with moderate-to-severe OSA had significantly higher systolic BP (108.6 ± 15.0 vs 100.0 ± 9.4 mmHg), MAP (75.9 ± 9.6 vs 71.1 ± 7.0 mmHg), systolic BP load (44.0 ± 32.6 vs 26.8 ± 24.5 mmHg), systolic BP index (0.5 ± 13.1 vs -6.8 ± 8.5 mmHg), and higher prevalence of systolic hypertension (47.6% vs 14.7 %) compared with children with primary snoring. Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP and MAP after adjusting for adiposity variables. This large hospital-based study showed that children with moderate-to-severe OSA had a higher ABP compared with children who were primary snorers. As elevated BP in childhood predicts future cardiovascular risks, children with severe OSA should be treated properly to prevent further adverse cardiovascular outcomes.
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Affiliation(s)
- Kun-Tai Kang
- From the Department of Otolaryngology, National Taiwan University Hospital (K-TK, W-CH); Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City (K-TK); Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University (K-TK); Department of Pediatrics (S-NC, W-CW); Sleep Center (W-CW, P-LL, W-CH); and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (P-LL)
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Halbach S, Flynn J. Treatment of hypertension in children with chronic kidney disease. Curr Hypertens Rep 2015; 17:503. [PMID: 25432895 DOI: 10.1007/s11906-014-0503-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hypertension (HTN) is increasingly recognized as a common feature of pediatric chronic kidney disease (CKD). A growing body of evidence demonstrates that HTN is both underdiagnosed and undertreated in this population. The consequences of untreated HTN include adverse effects on CKD progression, markers of cardiovascular morbidity, and neurocognitive functioning. Consensus guidelines issued over the past decade have incorporated recent research on the consequences of HTN in recommendations for the diagnosis and treatment of HTN in pediatric CKD and include lower BP targets. Agents which target the renin-angiotensin-aldosterone system (RAAS) should be considered first-line therapy in CKD-associated HTN in children, though multiple medications may be required to achieve sufficient BP control.
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Affiliation(s)
- Susan Halbach
- Division of Nephrology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OC.9.820, Seattle, WA, 98105, USA,
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