Uric Acid Associates With Executive Function in Children and Adolescents With Hypertension

Observational studies show that serum uric acid levels associate with cardiometabolic risk factors and subclinical target organ damage. The aim of the present study is to investigate the association of traditional cardiometabolic risk factors and uric acid with the executive performance in children and adolescents. Ninety-nine children and adolescents aged 5 to 18 years referred for assessment of primary hypertension were included. Traditional cardiometabolic risk factors, uric acid, and ambulatory blood pressure parameters were assessed. Executive performance was assessed by the validated Behavior Rating Inventory of Executive Function parent questionnaire. Serum uric acid correlated with cardiometabolic parameters, daytime and nighttime systolic blood pressure. High uric acid levels and ambulatory hypertension were associated with behavior regulation independently of other cardiometabolic risk factors or presence of metabolic syndrome. Participants with combined hypertension and high uric acid levels presented the lowest behavior regulation performance. Children with high uric acid had worse behavior regulation indices T scores with estimated marginal means 56.47 (95% CI, 51.68–61.27) compared with 49.22 (95% CI, 45.91–52.53) in those with low uric acid levels (P=0.023, adjusted for age, sex, nighttime systolic blood pressure, daytime and nighttime heart rate). Mediation analysis showed that part of the effect of high uric acid levels on behavior regulation was mediated by nighttime systolic blood pressure. In conclusion, we found a positive association of serum uric acid with worse executive performance in children at risk for primary hypertension. Extending these cross-sectional findings with longitudinal studies may determine whether high uric acid levels increases the risk of cognitive decline in youth.