Cognitive and behavioral aspects of childhood hypertension

Primary hypertension in childhood is associated with evidence of targetorgan damage. Most studies have concentrated on hypertensive cardiovascular effects, showing that children with primary hypertension demonstrate left ventricular hypertrophy (LVH) and increased carotid intima-media thickness (Belsha CW. Ambulatory blood pressure monitoring and hypertensive target-organ damage in children. Blood Press Monit. 1999;4 3-4:161-4; Lande MB, Carson NL, Roy J, Meagher CC. Effects of childhood primary hypertension on carotid intima media thickness: a matched controlled study. Hypertension 2006;48 1:40-4). By contrast, there has been a paucity of studies of the effects of hypertension on the brain, with most reports in children being limited to the most obvious neurological manifestations of severe hypertension, such as stroke, seizure, and posterior reversible encephalopathy syndrome (Sharma M, Kupferman JC, Brosgol Y, Paterno K, Goodman S, Prohovnik I, et al. The effects of hypertension on the paediatric brain: a justifiable concern. Lancet neurol 2010; 9 9:933-40; Wong LJ, Kupferman JC, Prohovnik I, Kirkham FJ, Goodman S, Paterno K, et al. Hypertension impairs vascular reactivity in the pediatric brain. Stroke 2011; 42 7:1834-8). This chapter reviews emerging preliminary evidence that children with hypertension may also manifest more subtle adverse effects on the brain.