The longitudinal effects of hypertension on cognitive aging in underrepresented minority adults with HIV

项目摘要 高血压（HTN）影响了生活在美国的所有成年人的大约33%，特别是 非裔美国人占HTN患者的42%以上[1-2]。在衰老过程中，HTN与 认知功能下降，并增加有临床意义的认知障碍和事件的风险 年龄相关的神经退行性疾病[3-4]。HTN可能通过改变以下因素导致认知障碍风险： 大脑自动调节（CA）是由心脏和大脑的结构和功能变化引起的 高血压引起的血管病变[5]。HTN对不同年龄人群认知功能的影响 然而，艾滋病毒感染者（PLWH）的认知功能在很大程度上是未知的，特别是HTN是否会对认知功能产生差异性影响。 艾滋病毒+非裔美国人的结果。认知老化文献中的工作表明，HTN具有更大的 对非裔美国人的认知功能的影响比拉丁美洲人和非西班牙裔白人[6]。一 对这些差异的可能解释可能是由于HTN控制的差异， 美国黑人[7-8] 因此，我们假设随着年龄的增长，HTN以及HTN控制不良将加剧认知功能障碍。 在PLWH的损害，这种影响将是最大的非洲裔美国人。因此，第一个目标是 本研究旨在探讨高血压与认知功能之间的纵向关系 研究HTN和HTN控制对认知障碍风险的影响。这些数据 还将用于检查该队列中认知障碍率的种族差异。最后 鉴于我们对HTN对大脑功能和认知的生物学效应的了解有限，第三个目的是 这项研究的目的是评估脉压（PP）之间的纵向关系，PP是一个替代指标， 动脉僵硬度和认知间接探讨高血压对大脑的生物学后果 [9]故，关于HTN、HTN控制和PP对大脑的潜在影响的研究， 认知功能是相关的，因为HTN在老年PLWH中的患病率越来越高，特别是在 HIV+非裔美国人目前占美国所有HIV病例的50%， 高血压负担[10]。因此，该项目既具有高度的新颖性，又具有重要意义，因为它将是第一个 检查HTN，HTN控制，PP和认知之间的纵向关系，在一个非常好的- 具有广泛纵向结果的特征性和多样性样本。更好地了解 HTN和HTN控制对不同老化PLWH认知功能的影响对于阐明健康来源至关重要 经常影响到代表性不足的少数群体人口的不平等现象。因此，该项目的结果 对公共卫生也有重要意义，因为这项研究将提供经验证据， 制定有针对性的干预策略，可以减轻URM的认知功能障碍。

PROJECT SUMMARY Hypertension (HTN) affects approximately 33% of all adults living in the United States, particularly African Americans, who comprise over 42% of those with HTN [1-2]. In aging, HTN is associated with decreased cognitive functioning, and increased risk for clinically meaningful cognitive impairments and incident age-related neurodegenerative disorders [3-4]. HTN may confer risk for cognitive impairment via alterations in cerebral autoregulation (CA) caused by structural and functional changes to the cardiac and cerebral vasculature induced by HTN [5]. The impact of HTN on cognitive functioning in diverse, aging persons living with HIV (PLWH), however, is largely unknown, especially whether HTN differentially affects cognitive outcomes in HIV+ African Americans. Work in the cognitive aging literature suggests that HTN has a greater impact on cognitive functioning among African Americans than Latinos and non-Hispanic Whites [6]. One possible explanation for these differences may be due to disparities in HTN control that disproportionately affect African Americans [7-8]. As a result, we hypothesize that with aging, HTN as well as poor HTN control will exacerbate cognitive impairment in PLWH and that this effect will be greatest among African Americans. Therefore, the first aim of this study is to examine the longitudinal relationship between HTN and cognitive functioning in a diverse cohort of aging PLWH to examine the effects of HTN and HTN control on risk for cognitive impairments. These data will also be used to examine for racial disparities in the rates of cognitive impairment in this cohort. Finally given our limited understanding of the biological effects of HTN on brain functioning and cognition, the third aim of this study is to evaluate the longitudinal relationship between pulse pressure (PP), a surrogate marker of arterial stiffness, and cognition to indirectly explore the biological consequences of hypertension on the brain and CA [9]. Investigations regarding the potential impact of HTN, HTN control and PP on the brain and cognitive functioning are relevant given the increasing prevalence of HTN in aging PLWH, especially among HIV+ African Americans who currently comprise 50% of all HIV cases in the U.S. and experience greater hypertension burden [10]. Therefore, this project is both highly novel and significant as it will be the first to examine the longitudinal relationships between HTN, HTN control, PP and cognition in an exceptionally well- characterized and diverse sample with extensive longitudinal outcomes. Improved understanding of the role of HTN and HTN control on cognitive functioning in diverse, aging PLWH is critical to elucidate sources of health disparities frequently affecting underrepresented minority populations (URM). Thus, the results of this project also have important implications for public health, as this study will provide empirical evidence to inform and develop targeted intervention strategies that may mitigate cognitive dysfunction in URM.