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Inadequate hypertension control raises dementia risk similarly regardless of HIV status, suggesting other factors drive higher dementia rates in HIV.

Inadequately controlled hypertension is similarly associated with increased dementia risk in people with HIV and in people without HIV, according to a study published in the journal AIDS.

“Overall, our findings indicate that the impacts of uncontrolled hypertension on dementia do not appear to be different by HIV status,” wrote corresponding author Jennifer O. Lam, PhD, MPH, and colleagues.

Cognitive impairment rates are higher in people with HIV than in the general population, the authors explained in the study. Researchers investigated whether poorer control of hypertension could be a driver of the excess dementia risk observed in people with HIV.

The retrospective cohort study included 3,099 patients with hypertension and HIV and a comparator group of just over 66,000 patients with hypertension but without HIV from the Kaiser Permanente Northern California healthcare system. Using data from electronic medical records, researchers characterized hypertension control using a disease management index (DMI). The DMI was based on the degree and duration of time above the following treatment goals: systolic blood pressure (SBP) less than 140 mm Hg and diastolic blood pressure (DBP) less than 90 mm Hg.

“DMI values ranged from 0 to 100% (perfect control); hypertension was considered ‘inadequately controlled’ if DMI was less than 80% (i.e., not in control for at least 80% of the time),” researchers wrote. “Annual, time-updated DMI was calculated separately for SBP and DBP.”

Over an average 5-year follow-up, the cumulative incidence of dementia by age 85 was 24.9% in people with HIV compared with 17.3% in people without HIV, the study found.

“Inadequate control of both SBP and DBP was associated with higher risk of dementia, and these associations were similar by HIV status,” the authors wrote.

Specifically, adjusted hazard ratios for incident dementia with each year of inadequate control of SBP were 1.26 in people with HIV and 1.27 in people without HIV. Adjusted hazard ratios with inadequate control of DBP were 1.43 in people with HIV and 1.71 in people without HIV.

“This suggests,” researchers advised, “that while hypertension may play a significant role in dementia risk, worse hypertension control likely does not explain the higher cumulative incidence of dementia among people with HIV.”