Background
People with HIV (PWH) experience age-related health problems, including cardiovascular disease and cognitive decline. Some medications used to treat hypertension exhibit anticholinergic properties. This study investigated the effects of cognitive performance on antihypertensive use and mean arterial pressure (MAP) in hypertensive PWH and people without HIV (PWoH), focusing on whether worsening cognitive function influenced antihypertensive use and blood pressure control.
Methods
This longitudinal analysis spanned up to seven follow-up visits in multisite, observational cohort studies over five years. Participants were included if they reported hypertension or used antihypertensive medications. Analyses examined the relationship between cognitive performance (global T-score) and the number of antihypertensives reported over time, including a linear mixed effects model with random intercepts and slopes, stratified by HIV status and adjusted for confounding variables such as age, sex, ethnicity, body mass index (BMI), and HIV disease markers. We also analyzed the relationship between summary regression change score (sRCSs) and MAP.
Results
The 1158 PWH with hypertension were mostly middle-aged, white, and male. 79.9% were on antiretroviral therapy (ART); 59.7% had plasma HIV RNA ≤ 50 copies/ml. PWoH (n=272) were older than PWH and more likely to be female. In PWH, a significant association between MAP and sRCSs suggested those with greater cognitive improvement had lower MAP (multivariable analysis p=0.0498). In PWH, a 10-unit decrease in global T-score (worsening cognitive performance) was associated with an 8.7% increase in the number of antihypertensives over time (univariable analysis RR=0.916, p=0.027; multivariable analysis RR=0.907, p=0.014). lagged effects of global T-score on antihypertensives were not significant in both PWH and PWoH. A higher number of anticholinergics correlated with the number of antihypertensives (β= 0.45, p=0.001). PWH taking more anticholinergics were more likely to have worse cognitive performance over time (p<0.001).
Conclusions
Our findings suggest that healthcare providers may prescribe more antihypertensives to PWH whose cognitive performance declines over time, possibly due to inadequately controlled high blood pressure. Antihypertensives can have anticholinergic effects that may worsen cognitive decline. Conversely, PWH with cognitive improvement had lower MAP, suggesting better blood pressure control may be linked to enhanced cognitive function.
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