The University of Rochester Medical Center study, which was presented in abstract form at the Pediatric Academic Society meeting today in Baltimore, shows that children with hypertension are four times as likely to have a learning disability and/or ADHD.

"Clinicians should be aware that these conditions commonly occur together," said Marc Lande, M.D., a pediatric nephrologist at the University of Rochester Medical Center and author of the abstract. "More studies investigating the potential association between hypertension and neurocognitive deficits are definitely needed."

Lande authored a paper in the Journal of Pediatrics earlier this year that showed children with high blood pressure are not as good at complicated, goal-directed tasks, have more working memory problems and are not as adept at planning as their peers without hypertension. If they are both hypertensive and obese, they are also more likely to have anxiety and depression.

The new study followed 201 children 10 to 18 years old who were referred to specialists for high blood pressure. Of those, 100 were diagnosed with hypertension while 101 were determined to either not have hypertension or to have white coat high blood pressure (or normal blood pressure that shoots up when nervous in an exam room). Almost 28 percent of children with hypertension had a learning disability and 20 percent had ADHD. Some of those children had both a learning disability and ADHD, so in total, 40 percent of children with hypertension had a learning disability and/or ADHD.

Dr. Lande points out, "This apparent association between hypertension and learning problems is particularly important in light of the recent increase in hypertension in children in this country that has occurred as a result of the dramatic rise in obesity."

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Sponsorship bias is a recurring concern in trials of virtually all new medications. In the Cochrane reviews themselves, one of the co-authors has received research funds and speaking fees from the companies Asahi Kasei, Astellas, Dai-Nippon Sumitomo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen, Kyowa Hakko, Meiji, Nikken Kagaku, Organon, Otsuka, Pfizer and Yoshitomi. The Japanese Ministry of Education, Science and Technology, and the Japanese Ministry of Health, Labour and Welfare have also funded some of his research.

However, the co-authors of these Cochrane reviews also published a recent study in The Lancet that was free of any potential funding bias. The study also used a more complex statistical method to analyze data from 117 randomized controlled trials involving 25,928 participants.

The findings support the Cochrane reviews, Cipriani said, with sertraline and escitalopram ranking as the best treatments.

"Such findings have enormous implications," said Sagar Parikh, M.D., of the University of Toronto, in a commentary published along with The Lancet study. "For the clinician, prudent engagement of the patient in treatment ideally involves giving the patient a choice.?? A new gold standard of reliable information has been compiled for patients to review."

In early studies, new medical treatments are typically compared to sham treatments. Once the effectiveness of certain approaches is well established, new options must be judged against the best existing treatments.

Cipriani argued that this time has come for antidepressants, and that sertraline is the drug to beat. "We need new treatments in psychiatry, but they have to be proved better than other treatments," he said. "We should be comparing new drugs to the best available existing drugs."

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