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Multicenter Study
. 2024 Dec;81(12):2444-2453.
doi: 10.1161/HYPERTENSIONAHA.124.22834. Epub 2024 Sep 18.

Systolic Blood Pressure, Cardiovascular Health, and Neurocognition in Adolescents

Stephen R Hooper  1 , Marc B Lande  2 , Joseph T Flynn  3 , Coral D Hanevold  3 , Kevin E Meyers  4 , Joshua Samuels  5 , Richard C Becker  6 , Stephen R Daniels  7 , Bonita E Falkner  8 , Michael A Ferguson  9 , Julie R Ingelfinger  10 , Lisa J Martin  6 , Mark Mitsnefes  6 , Phillip Khoury  6 , Jangdong Seo  6 , Elaine M Urbina  6
Affiliations
Multicenter Study

Systolic Blood Pressure, Cardiovascular Health, and Neurocognition in Adolescents

Stephen R Hooper et al. Hypertension. 2024 Dec.

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.

Keywords: adolescence; ambulatory blood pressure; cardiovascular health risk; hypertension; neurocognition.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Auscultatory Systolic Blood Pressure z-Score and WJ-IV Verbal Attention.
Figure 2.
Figure 2.
ABPM Mean Wake Systolic Blood Pressure and WJ-IV Verbal Attention.
Figure 3.
Figure 3.
Number of Cardiovascular Risk Indicators and WJ-IV Verbal Attention.
See this image and copyright information in PMC

Comment in

  • Early Onset Hypertension Has Morbidity.
    Gidding SS. Gidding SS. Hypertension. 2024 Dec;81(12):2454-2456. doi: 10.1161/HYPERTENSIONAHA.124.23941. Epub 2024 Nov 20. Hypertension. 2024. PMID: 39565870 No abstract available.

References

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