Effect of High Blood Pressure and Antihypertensive Treatment on Brain Functioning in Children
Effect of High Blood Pressure and Antihypertensive Treatment on Brain Functioning in Children
High blood pressure, or hypertension, affects up to 10% of minority children and adolescents.
 Although complications of high blood pressure, such as stroke and heart attack, are uncommon
 in childhood, high blood pressure-related organ damage can occur at a young age. Studies with
 young adults have indicated that high blood pressure can affect the central nervous system,
 resulting in deficits in brain function. However, more research is necessary to confirm the
 association between neurocognitive deficits and high blood pressure in children and to
 determine if these deficits are reversible with treatment. This study will determine whether
 high blood pressure in children and adolescents has subtle effects on learning, attention,
 and concentration. The study will also determine the effect of an antihypertensive treatment
 plan, involving a combination of diet, weight loss, increased exercise, and if needed, blood
 pressure medication, on brain function in children and adolescents receiving treatment for
 high blood pressure.
High blood pressure is a condition that normally affects adults, but can affect young
 children and adolescents, as well. High blood pressure in children is most commonly caused by
 unhealthy lifestyle or family history, but it can also be due to disease, such as kidney or
 heart disease. When a person has high blood pressure, the heart must work harder to pump
 blood throughout the body. If left untreated, high blood pressure can eventually cause damage
 to the heart, kidneys, and eyes. Recent studies have linked high blood pressure in children
 to deficits in brain functioning. However, more information is needed to confirm this
 connection and to determine the effectiveness of antihypertensive treatments in restoring
 brain function. This study will determine the effect of high blood pressure on brain
 functioning in children and adolescents. The study will also determine the effect of an
 antihypertensive treatment plan, involving a combination of diet, weight loss, increased
 exercise, and if needed, blood pressure medication, on brain function in children and
 adolescents receiving treatment for high blood pressure.

 Participation in this study will last 12 months and will involve children with high blood
 pressure and children with normal blood pressure. Information on participants' medical
 history and sleep patterns, as well as parent's income and education level, will be
 collected. Participants with suspected high blood pressure will then undergo 24-hour blood
 pressure monitoring using an ambulatory blood pressure cuff. Afterwards, participants who are
 determined to have high blood pressure will undergo an echocardiogram of the heart. These
 participants will soon return to the General Clinical Research Center (GCRC) to undergo
 additional testing, which will include measurements of height, weight, and body mass index; a
 urine sampling; and a blood draw.

 Before beginning potential treatment, both healthy and high blood pressure participants will
 complete a series of thinking and learning tests that will take about 90 minutes. Parents of
 participants will also be asked to answer a 10-minute questionnaire about their child's
 behavior and emotions. Participants with high blood pressure will then start a 12-month
 antihypertensive treatment plan, which will involve a combination of diet, weight loss,
 increased exercise, and if needed, blood pressure medication. A digital blood pressure cuff
 will be provided to participants for at-home blood pressure monitoring. During the treatment
 period, a study nurse will call participants every 1 to 2 weeks for the first 3 months and
 monthly for the remaining 9 months to check on blood pressure readings and to refill
 medications. Participants will be seen at the GCRC once every 3 to 4 months to monitor and
 adjust treatment as needed. Healthy participants will undergo no study treatment during the
 treatment phase.

 Upon completion of the 12 months of treatment, all participants will undergo repeat thinking
 and learning tests, and parents of participants will complete repeat questionnaires.
 Participants with high blood pressure will also repeat the 24-hour blood pressure monitoring
 test.
Inclusion Criteria:

 -  English speaking

 -  No known learning disorder, disorders of cognitive function, treatment with
 medications for attention deficit, or history of severe head injury (loss of
 consciousness for more than 30 minutes)

 -  Casual blood pressure greater than or equal to 90th percentile for age, gender, and
 height during clinic visit and on at least two other previous occasions

 Exclusion Criteria:

 -  Secondary cause of high blood pressure

 -  Chronic disease

 -  History of treatment for elevated lead level

 -  History of maternal substance use during pregnancy

 -  Evidence of obstructive sleep apnea