# White Matter Integrity and Cognitive Performance in Adolescents with Primary Hypertension

> **NIH NIH R01** · UNIVERSITY OF ROCHESTER · 2021 · $603,988

## Abstract

PROJECT SUMMARY/ABSTRACT
The prevalence of primary hypertension (HTN) in children has increased significantly, a public health
phenomenon that parallels the current childhood obesity epidemic. This increase in childhood primary HTN
foreshadows an impending epidemic of premature cerebrovascular and cardiovascular disease. Already there
is evidence that HTN in adolescence and young adulthood is associated with cognitive decline and stroke in
midlife and beyond. However, there are significant evidence gaps regarding the current approach to treatment
of pediatric HTN, largely because HTN-associated events, such as stroke, occur in later decades, making
outcomes based treatment guidelines elusive. One strategy is to use early biomarkers of hypertensive target
organ damage (TOD) to predict clinical outcomes. However, reliable biomarkers of hypertensive TOD to the
brain in youth are lacking. Our goal is to identify and evaluate early biomarkers of TOD to the brain to help
focus studies on HTN treatment, and eventually modify the trajectory of HTN-induced morbidity. Our previous
results showing decreased neurocognitive test performance in HTN youth suggest that treating HTN beginning
in adolescence represents an opportunity to reduce subsequent cognitive decline and dementia later in life,
heretofore an elusive goal. However, the degree of structural brain injury in HTN youth and its reversibility are
not known. We now propose to study white matter microstructural integrity using diffusion magnetic resonance
imaging (dMRI) as an anatomic correlate of hypertensive TOD to the brain in adolescents. The presence of
altered white matter integrity could serve as a novel biomarker of hypertensive TOD to the brain in youth and
could provide a pathomechanistic link between adolescent HTN and subsequent cognitive outcomes. In
combination with neurocognitive testing, dMRI findings would serve as study outcomes to allow practical
longitudinal research on the effect of early HTN treatment on the brain in adolescence and beyond. We
propose to compare dMRI metrics of untreated, newly diagnosed hypertensive adolescents to that of matched
normotensive controls. As secondary measures, we will also assess the impact of HTN on vascular reactivity
and functional connectivity via resting state functional MRI. We will evaluate the association between altered
dMRI metrics and HTN severity, and we will evaluate the correlation between neuroimaging parameters and
neurocognitive test performance. In an observational exploratory aim, we will determine if there are longitudinal
changes in neuroimaging parameters after 18 months of usual care antihypertensive therapy in newly
diagnosed HTN subjects. This proposal represents a logical and innovative extension of our work and will lay
critical groundwork for the development of evidence-based treatment guidelines to improve downstream
cognitive outcomes.

## Key facts

- **NIH application ID:** 10078957
- **Project number:** 5R01HL098332-08
- **Recipient organization:** UNIVERSITY OF ROCHESTER
- **Principal Investigator:** MARC B LANDE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $603,988
- **Award type:** 5
- **Project period:** 2010-08-14 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10078957

## Citation

> US National Institutes of Health, RePORTER application 10078957, White Matter Integrity and Cognitive Performance in Adolescents with Primary Hypertension (5R01HL098332-08). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10078957. Licensed CC0.

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