Pediatric Primary Hypertension Linked to Learning Disabilities

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Pediatric Primary Hypertension Linked to Learning Disabilities

Laurie Barclay, MD

November 11, 2010 — Pediatric primary hypertension is associated with learning

disabilities, according to the results of a retrospective study reported online

November 8 in Pediatrics.

" Children with sustained primary hypertension exhibit neuropsychological

impairments in attention, working memory, and parent ratings of executive

function skills, " write R. , PhD, from the Departments of Neurology

and Pediatrics, University of Rochester Medical Center in Rochester, New York,

and colleagues. " Previous studies excluded children with learning disabilities

or attention-deficit/hyperactivity disorder, which precluded examination of

associations between hypertension and academic problems. ...The objective was to

determine whether children with sustained primary hypertension are at increased

risk for learning disabilities (LDs), as a school-related manifestation of

neurocognitive problems. "

The investigators evaluated 201 children aged 10 to 18 years who were referred

because of elevated blood pressure. On the basis of blood pressure evaluation at

the initial hypertension clinic visit and subsequent confirmation of sustained

high blood pressure outside of the clinic setting, participants were categorized

as having hypertension (n = 100) or not having hypertension (n = 101). Parents

reported whether their child had a provider-confirmed LD or

attention-deficit/hyperactivity disorder (ADHD).

LDs were reported in 37 children (18%). Compared with children without

hypertension, those with hypertension were significantly more likely to have LDs

(18% vs 9%; P < .001), regardless of comorbid ADHD. Compared with children

without hypertension, those with hypertension had higher odds of having LDs,

after adjustment for demographic variables and obesity (odds ratio [OR], 4.1;

95% confidence interval [CI], 1.8 - 9.4).

" The rate of LDs, with or without ADHD treatment, was significantly higher for

children with sustained primary hypertension, compared with children without

hypertension, " the study authors write. " These findings add to the growing

evidence for an association between primary hypertension and cognitive function

and may inform treatment and monitoring decisions for these children who may be

at risk for learning problems. "

Limitations of this study include retrospective design; clinical evidence for

sustained hypertension not based on uniform criteria; definition of ADHD based

solely on medication history; and cross-sectional design, precluding causal

inferences.

" Future studies on the mechanism of this association and the impact of treatment

of hypertension on learning and other cognitive skills in children are

warranted, " the study authors conclude.

The National Institutes of Health supported this study. The study authors have

disclosed no relevant financial relationships.

Pediatrics. Published online November 8, 2010.