The Longitudinal Effects of Hypertension on Cognitive Aging in Underrepresented Minority Adults with HIV

This study investigated the longitudinal effects of blood pressure (BP), hypertension (HTN), and pulse pressure on neurocognitive (NC) functioning in diverse, aging persons living with HIV (PLWH). The primary aim of this study was to determine if the additional burden of HTN differentially and/or adversely affected NC functioning in aging PLWH. The second aim of this study was to determine if underrepresented minority (URM) adults were differentially impacted by HTN to elucidate sources of health disparities in PLWH. The final aim of this study was to investigate the longitudinal relationship between pulse pressure, a surrogate marker of arterial stiffness, and NC functioning to indirectly examine the effects of HTN on cerebral autoregulation and improve understanding of the neurobiological consequences of HTN in aging PLWH. Hierarchical linear growth curve models revealed longitudinal increases in diastolic BP and HTN status were associated with declines in executive functioning. Longitudinal increases in diastolic and systolic BP were also associated with declines in psychomotor speed and fine motor dexterity. The results also revealed significant racial disparities in systolic BP and HTN that disproportionately affected HIV+ non-Hispanic Blacks, compared with their HIV+ non-Hispanic White and Latinx counterparts. Results of the moderation analyses indicated a significant interaction between race/ethnicity and change in BP on NC decline in the domains of learning and executive functioning. A significant interaction was also observed between race/ethnicity and change in hypertension status on a measure of processing speed. Finally, the results revealed no association between pulse pressure and NC functioning over time. Overall, the study findings suggest longitudinal increases in BP and HTN status are primarily associated with NC decline in the domains of executive and psychomotor functioning in diverse, aging PLWH. The study also revealed significant racial and ethnic disparities in BP and HTN that disproportionately affected HIV+ URM over time. Taken together, this study has important implications for public health as the findings provide empirical evidence to support and inform potential intervention strategies that address modifiable risk factors and mitigate sources of health disparities on NC dysfunction in PLWH, especially HIV+ URM