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The Longitudinal Effects of Blood Pressure and
Hypertension on Neurocognitive Performance in People Living With HIV
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Guzman, Vanessa A. PhDa,b,c; Cham, Heining PhDc; Gutierrez, Jose MD, MPHa; Byrd, Desiree PhDb,d; Morris, Emily P. MSc,e; Tureson, Kayla MSc,f; Morgello, Susan MDb,g; Mindt, Monica R. PhDb,c; for the Manhattan HIV Brain Bank
"longitudinal increases in both DBP and SBP were associated with performance declines in (nondominant hand) psychomotor speed and fine motor dexterity. The longitudinal increase in DBP was also associated with performance declines on a measure of executive functions, particularly in the areas of abstract reasoning, cognitive flexibility, and set shifting....greater odds of being hypertensive were significantly associated with poorer NC performance in abstract reasoning and cognitive flexibility on a measure of executive functions......HTN has also recently been implicated as an important prognostic indicator of decreased vascular integrity and arterial compliance, including increased carotid intima media thickness and arterial wall thickness, 2 significant predictors of NC impairment in PLWH.
Furthermore, observed associations between performance declines in psychomotor speed and executive functions with longitudinal increases in BP and HTN risk in this cohort also suggest HTN and HIV may interact to exacerbate HIV-associated neurologic dysfunction, which disproportionately and adversely affects the cerebral white matter, particularly subcortical and frontostriatal networks, to increase the risk for NC impairment and/or HAND in PLWH".
Compared with the normotensive participants, the hypertensive participants were older and more likely to be non-Latinx Black. The hypertensive group had significantly higher weight, body mass index, BP, PP, and prevalent diabetes than the normotensive group. The hypertensive group was also more likely to be on ART at baseline and exhibited higher absolute CD4 counts, lower HIV viral loads, and longer duration of infection at entry, compared with the normotensive group.
Abstract
Background:
Hypertension (HTN) and HIV are salient risk factors for cerebral small vessel disease and neurocognitive (NC) impairment, yet the effects of HTN on NC performance in persons living with HIV remain poorly understood. This is the first study to examine the longitudinal associations between blood pressure (BP), HTN, and pulse pressure (PP) with NC performance in persons living with HIV.
Setting:
New York City.
Methods:
Analysis of medical, NC, and virologic data from 485 HIV+ participants was collected by the Manhattan HIV Brain Bank, a prospective, observational, longitudinal study of neuroHIV. A series of multilevel linear growth curve models with random intercepts and slopes were estimated for BP, HTN status, and PP to predict the change in NC performance.
Results:
The baseline prevalence of HTN was 23%. Longitudinal changes in diastolic and systolic pressure were associated with a 10.5-second and 4-second increase in the Grooved Pegboard Test nondominant hand performance, respectively. A longitudinal change in diastolic BP was also associated with a 0.3-point decline in correct categories and 3-point increase in perseverative responses and total errors on the Wisconsin Card Sorting Test. Increasing odds of prevalent and/or incident HTN were associated with a 0.1-point decrease in correct categories and a 0.8-point increase in total errors on the Wisconsin Card Sorting Test. There was no association between PP and NC performance.
Conclusions:
The results indicate linear longitudinal relations for BP and HTN with poorer NC test performance, particularly in psychomotor and executive functions in persons with HIV.
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