Parental assessments of internalizing and externalizing behavior and executive function in children with primary hypertension

Abstract

Objective: To determine the relations between hypertension and parental ratings of behavior and executive functions in children with primary hypertension and to examine the potential moderating influence of obesity.

Study design: Hypertensive and normotensive control groups were matched for age, sex, race, intelligence quotient, maternal education, household income, and obesity. Parents completed the Child Behavior Checklist to assess Internalizing and Externalizing problems and the Behavior Rating Inventory of Executive Function to assess behavioral correlates of executive function.

Results: Thirty-two hypertensive subjects and 32 normotensive control subjects (aged 10 to 18 years) were enrolled. On the Child Behavior Checklist, hypertensives had higher Internalizing T-scores (53 vs 44.5, P = .02) with 37% falling within the clinically significant range vs 6% of control subjects (P = .005). Internalizing score increased with increasing body mass index percentile in hypertensive but not normotensive subjects. Hypertensives had worse Behavior Rating Inventory of Executive Function Global Executive Composite T-scores compared with control subjects (50 vs 43, P = .009).

Conclusions: Children with both hypertension and obesity demonstrate higher rates of clinically significant internalizing problems, and hypertensives (irrespective of obesity) demonstrate lower parental ratings of executive function compared with normotensive control subjects.

Figure 1

Comparison of percent with Internalizing score in the clinical range with subjects stratified by both hypertension and obesity. Value inside bars shows the number of subjects in each stratum. * P < 0.05 compared with Nml BP/Nml Wt group.

Figure 2

The effect of hypertension on the relationship between BMI percentile and Internalizing score. Internalizing score and BMI percentile are both plotted as continuous variables.