Related Experiment Video
Updated: May 10, 2025
Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty
Published on: October 6, 2016
Implications of Cognitive Impairment on Antihypertensive Medication Use in HIV
Azin Tavasoli1, Bin Tang2, Mohammadsobhan S Andalibi1
1Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA.
Insights
Worsening cognitive performance in people with HIV (PWH) correlated with increased antihypertensive use. Prescribers should avoid anticholinergic medications in PWH to mitigate cognitive decline.
Area of Science:
- Neuroscience
- Cardiology
- Infectious Diseases
Background:
- Aging-related comorbidities are prevalent in people with HIV (PWH).
- Hypertension (HTN) is linked to cognitive decline, potentially worsened by anticholinergic antihypertensives.
- Research explored the link between neurocognitive performance and antihypertensives in hypertensive PWH and people without HIV (PWoH).
Purpose of the Study:
- To investigate the association between neurocognitive performance and antihypertensive medication use in hypertensive individuals with and without HIV.
- To determine if increased antihypertensive prescriptions correlate with worsening neurocognitive function over time.
- To examine the role of anticholinergic properties of antihypertensives in cognitive decline among PWH.
Main Methods:
- Longitudinal analysis over five years with seven visits (1999-2022).
- Inclusion criteria: reported HTN or used antihypertensives.
- Cognitive assessments evaluated global performance using demographically corrected T-scores; generalized linear mixed-effects models analyzed associations.
Main Results:
- Worsening cognitive performance associated with increased antihypertensives in PWH (p=0.012), but not in PWoH (p=0.58).
- PWH exhibited lower mean arterial pressure (MAP) than PWoH (β = -5.05, p < 10⁻¹¹).
- In PWH, increased anticholinergic use correlated with poorer cognitive performance over time (p < 0.001).
Conclusions:
- PWH experiencing cognitive decline were prescribed more antihypertensives, possibly due to refractory HTN or poor adherence.
- Antihypertensive prescribing practices for PWH require careful consideration.
- Avoidance of antihypertensives with anticholinergic properties is recommended for PWH.
Background:
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.
Methods:
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.
Results:
Among 1158 hypertensive PWH (79.9% were on ART), worsening cognitive performance was associated with an increased number of antihypertensives (p = 0.012) but not in PWoH (p = 0.58). PWH had lower mean arterial pressure (MAP) than PWoH after adjusting for demographics (β = -5.05, p = 2.3 × 10-11). In PWH, an association between mean arterial pressure (MAP) and sRCS suggested that those with cognitive improvement had lower MAP (p = 0.027). PWH taking more anticholinergics were more likely to have worse cognitive performance over time (p < 0.001).
Conclusions:
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.
More Related Videos
05:53Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
Published on: July 24, 2013
07:30Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:21Factors Affecting Drug Response: Overview
01:15Chronopharmacokinetics: Circadian Rhythms and Influence on Drug Response
The time of drug administration is an important factor to consider, as it can influence the toxic dose of a drug. For example, a study conducted by Prins et al. in 1997 examined the effects of the timing of...
01:30Cognitive Enhancers: Cholinesterase Inhibitors and NMDA Receptor Antagonists
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
01:28Drug Therapy
Antianxiety Medications