Tavasoli Azin, Tang Bin, Andalibi Mohammadsobhan S, Franklin Donald R, Letendre Scott L, Heaton Robert K, Ellis Ronald J
Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA.
Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA.
Viruses. 2025 Mar 26;17(4):470. doi: 10.3390/v17040470.
Aging-related comorbidities such as cardiovascular disease and neurocognitive impairment are more common among people with HIV (PWH). Hypertension (HTN) has been implicated in cognitive decline, and antihypertensives with anticholinergic properties may exacerbate this decline. Our research probed the relationship between neurocognitive performance and antihypertensives in hypertensive PWH and in those without HIV (PWoH), examining whether increased antihypertensives followed the worsening in neurocognitive performance.
This longitudinal analysis encompassed seven visits over five years, enrolled between 1999 and 2022. Participants were included if they reported HTN or used antihypertensives. All participants underwent comprehensive cognitive assessments, and their global cognitive performance was evaluated using summary, demographically corrected T-scores. The association between the global T-score and the number of antihypertensives was evaluated using generalized linear mixed-effects models. Summary regression-based change score (sRCS) was analyzed as an indicator of global performance over time.
Among 1158 hypertensive PWH (79.9% were on ART), worsening cognitive performance was associated with an increased number of antihypertensives ( = 0.012) but not in PWoH ( = 0.58). PWH had lower mean arterial pressure (MAP) than PWoH after adjusting for demographics (β = -5.05, = 2.3 × 10). In PWH, an association between mean arterial pressure (MAP) and sRCS suggested that those with cognitive improvement had lower MAP ( = 0.027). PWH taking more anticholinergics were more likely to have worse cognitive performance over time ( < 0.001).
PWH with declining neurocognitive performance over time used increasing numbers of antihypertensives, suggesting that their providers prescribed more antihypertensives because of either treatment refractory HTN or poor adherence. Prescribers should avoid using antihypertensives with anticholinergic properties when possible.
与衰老相关的合并症，如心血管疾病和神经认知障碍，在感染艾滋病毒的人群（PWH）中更为常见。高血压（HTN）与认知功能下降有关，具有抗胆碱能特性的抗高血压药物可能会加剧这种下降。我们的研究探讨了高血压PWH和未感染艾滋病毒的人群（PWoH）的神经认知表现与抗高血压药物之间的关系，研究抗高血压药物的增加是否伴随着神经认知表现的恶化。
这项纵向分析涵盖了1999年至2022年期间五年内的七次随访。如果参与者报告患有高血压或使用抗高血压药物，则将其纳入研究。所有参与者都接受了全面的认知评估，并使用经人口统计学校正的汇总T分数评估他们的整体认知表现。使用广义线性混合效应模型评估总体T分数与抗高血压药物数量之间的关联。基于回归的汇总变化分数（sRCS）被分析为随时间推移的整体表现指标。
在1158名高血压PWH中（79.9%接受抗逆转录病毒治疗），认知功能恶化与抗高血压药物数量增加有关（P = 0.012），但在PWoH中则不然（P = 0.58）。在调整人口统计学因素后，PWH的平均动脉压（MAP）低于PWoH（β = -5.05，P = 2.3×10⁻⁶）。在PWH中，平均动脉压（MAP）与sRCS之间的关联表明，认知功能改善的患者MAP较低（P = 0.027）。随着时间的推移，服用更多抗胆碱能药物的PWH更有可能出现较差的认知表现（P < 0.001）。
随着时间的推移神经认知表现下降的PWH使用的抗高血压药物数量不断增加，这表明他们的医疗服务提供者因治疗难治性高血压或依从性差而开出了更多的抗高血压药物。开处方者应尽可能避免使用具有抗胆碱能特性的抗高血压药物。
