1-minute read. Low school performance and arterial hypertension in children and adolescents. An overlooked link.

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This post has been written by Dr. Guillermo Alberto Perez Fernandez and represents his personal opinion on the topic.

September is already going on. In most countries, this month denotes the start of the academy year in the school system, thereby, I felt that this post would fit in well.

It has been addressed before on this blog the repercussions of arterial hypertension since early in life. However, there is an effect that most times is missed: the impact on the school performance in our children and adolescence.

Unlike some people might think, there is a connection.

Although it is well-known the influence of hypertension on several organs of the human body as kidney, heart and brain among others in adults. The impact on the brain since childhood has been barely described and most reports in the past were limited to gross neurologic events, such as facial palsy, seizure and stroke in children with malignant hypertension.

Nowadays, the medical community is focusing on the association of arterial hypertension and neurocognition since early in life.

Neurocognition: Any form of cognition (the mental process of thinking and understanding) that is associated with the functioning of one or more specific areas of the brain.

What has the medical community found out on this so far?

Children with newly diagnosed or untreated primary hypertension have decreased performance on neurocognitive measures of attention, learning, memory, and fine motor ability compared with those being normotensive regardless maternal education, race, ethnicity, age and sex.

Hypertension in early in life often clusters with other cardiovascular risk factors with further negative effects on cognition, including obstructive sleep apnea, metabolic syndrome, insulin resistance and hyperlipidemia (1,2)

Therefore, the impact of hypertension early in life on neurocognition is clear.

In addition, to make things more complicated, often the school environment may be stressful and challenging for some children which adds up stress to the equation; another variable proven to be strongly related with high blood pressure as I already published some time ago (3)

Then, my recommendation is this: check on any children or adolescent with a poor school performance. Hypertension might be backstage.

Thanks,

The author

References.

1- Lande, M.B., Kupferman, J.C., and Adams, H.R. Neurocognitive alterations in hypertensive children and adolescents. J Clin Hypertens (Greenwich). 2012; 14: 353–359.

2- Hooper SR. Risk Factors for Neurocognitive Functioning in Children with Autosomal Recessive Polycystic Kidney Disease. Front Pediatr. 2017 May 15;5:107.

3- Perez Fernández GA. Hipertensión arterial, estrés y rendimiento académico para la evaluación integral del adolescente hipertenso o en riesgo. Medicentro. 2011; 15(3). (Available at : http://www.medicentro.sld.cu/index.php/medicentro/article/view/238)

Long screen time and cardiovascular disease in children and adolescents. Social media and video games might be taking their toll.

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Whenever someone have asked me- What makes so difficult to approach and control arterial hypertension and its related health conditions?

My response is loud and clear: The complexity of the tangled skein we must deal with as health care providers.   

The problem is that there is a growing number of risk factors with a very complex interrelation.

Nowadays, another has been summed up to the list: the screen time or in other words, the time spent on social media, video games, watching television, music videos, advertising, etc.

It is not a secret that is increasingly rare to see kids and adolescents playing games outdoor unless these are part of the school program they belong to. Children are no longer playing hide-and-seek outside or reading a good hard-cover book. Instead, they’ve dived into a world of constant digital media through television, mobile devices and video games.

According to the latest statistics about the topic: Continue reading “Long screen time and cardiovascular disease in children and adolescents. Social media and video games might be taking their toll.”

Today’s Audio. Sodium intake might be killing the future. It will get your attention.

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Now our blog supports audio. Today you can listen to Dr. Bonita Falkner, chair of the International Pediatric Hypertension Association giving insigtful comments about this topic.

Thanks to Sheila Kay McIntyre on LinkedIn: “Today’s ShoutOutThursday Winners are 1 Guillermo Alberto Perez Fernandez…

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Today’s ShoutOutThursday Winners are 1 Guillermo Alberto Perez Fernandez  Cardiologist, Ph.D (read more about his fascinating Cardiovascular Health Article > https://lnkd.in/en4Ws2f  & under my latest comment! & 2 Melton McClanahan thank you for being such a valuable member of S.O.T, supporting so many with your positive comments, likes, re-posts & helpful articles! I want to Thank you 2 Great Men for all that you do for this Community!

Source: Sheila Kay McIntyre on LinkedIn: “Today’s ShoutOutThursday Winners are 1 Guillermo…

1.0 K views in less than one month. We strive for more.

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“It’s always further than it looks. It’s always taller than it looks. And it’s always harder than it looks.” – The 3 rules of mountaineering.

I must add, however, it’s possible.

Keep going through this blog further below.

Thanks,

Dr. Guillermo Alberto Perez Fernandez

 

(1-minute read) “Emotional” hypertension. Do not get mixed up. There is more on the table.

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The diagnosis of arterial hypertension has made it increasingly complex over time. It is no longer just to tell a patient “you suffer from arterial hypertension”. Nowadays, there are more abnormal blood pressure categories added to the list as prehypertension, “white-coat” hypertension and “masked” hypertension. No doubts, the complexity of the human been plays its role in all this (1)

Many patients have been said over years that they had “emotional hypertension” since her or his blood pressure (BP) at the medical office was elevated even after several BP readings at prudent intervals during the consultation, whereas at home blood pressure remained normal.

The abovementioned situation was overlooked by the medical community for a long time and there was a long-standing thinking that it was simply the result of patient’s stress arising from the patient-doctor encounter at the clinic. However, as time went by, the so-called white-coat effect was study in-depth and as a result, the “white-coat” hypertension term emerged (2)

Is it dangerous?  Yes indeed, several investigations have shown that: Continue reading “(1-minute read) “Emotional” hypertension. Do not get mixed up. There is more on the table.”

Poor buccal hygiene might lead to an acute myocardial infarction. Time to make the difference.

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Dedicated to Dental Department at the Cuban Hospital in Qatar.

After several years studying the subject of cardiovascular disease early in life and with some papers published recently about it (1-5) I can say that nowadays, as health care providers, we are facing several cardiovascular disease contributing risk factors (hypertension, obesity, smoking, unhealthy diet, etc.) which prompts a large burden on our shoulders as they keep leading to a long-lasting and quite steady worldwide prevalence of heart conditions, stroke, kidney failure, premature death and disability for the last 20 years. (6)

Even, children and adolescents are not spared from this. For instance, according to the latest European (7) and North American Guidelines about the subject (8), the prevalence of high blood pressure in children and adolescents ranges between 3 to 11 % and rises up to 40 % when obesity is in place as well.

The above mentioned is a known fact that unfortunately is ongoing with some ups and downs but continue to be a pending endeavor yet to be solved by the medical community. Thus, I do not want to dwell on it on this post.

At the moment, I am more interested on reflecting how these spotlighted main risk factors might be blindfolding us from seeing “little facts” that are having also an impact on the complex setting related with the development of cardiovascular disease and sadly are often overlooked.

In this light, there is one fact which is not as publicized as the main risk factors mentioned above which is critical my opinion. I am referring to the buccal hygiene and its links to cardiovascular disease.

To get started, it is worth mentioning that the surfaces of the human body are heavily colonized by a varied microbial ecosystem called the microbiota, in other words, this is a mixed community of microorganisms composed of bacteria, viruses, archaea, and eukaryotic microbes that coinhabit in our body . The gathering of those microbes and their genes is named the human microbiome  and each person has a unique microbiome which varies along with our genetic background, age and life style (9)

As per the aim of this paper, I will point out at the oral microbiome, which is considered one of the most highly dynamic ecosystems in the human body.

According to the latest investigations, the estimated number of bacteria in the mouth is up to 100 billion and comprised nearly 700 identified bacterial species being the most prevalent Firmicutes and Proteobacteria, along with Bacteroidetes, Actinobacteria, and Fusobacteria (10)

Though, the oral microbiome is dynamic in terms of functioning, as ecosystem must be stable in its composition and structure. Any disruption in it leads to a state called dysbiosis.

Recently, multiple animal and human studies have examined the relationship between the oral microbiome disruption (dysbiosis) and blood pressure and have reported important insights explaining such links.

The most important proposed links to hypertension would be the following:

  • Increasing sympathetic nervous system activity.
  • Inflammation and endothelial dysfunction with vascular remodeling (11)

The above links, in turn are known triggering factors for high blood pressure through complex mechanisms beyond the scope of this article.

Now, I will lay out a question: How many time have you been asked by a doctor (no a dentist) in a clinic when feeling some cardiac-like symptoms about your buccal hygiene habits?

The response to this question will come later… Continue reading “Poor buccal hygiene might lead to an acute myocardial infarction. Time to make the difference.”