Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos

The study by Elfassy et al1 in the June 2024 issue reports that middle-aged people (mean age 56.2 years) with a history of gestational hypertension alone had cognitive differences in information processing and executive function, but no differences were observed in people with preeclampsia or eclampsia. We applaud studies focusing on the effects of hypertensive disorders of pregnancy (HDP) and cognitive performance in a Hispanic population. The authors acknowledge factors that may have influenced their results, such as recall bias, the use of simplistic cognitive testing, and lack of validated pregnancy history data. It is noteworthy, however, that a history of mood disorders was not included in the models or an evaluation of anxiety and depression at the time of cognitive testing, which is highly relevant given its association with cognitive impairment. Prior studies with Puerto Rican populations have reported high rates of depression2–4; thus, this comorbidity may be of particular importance. People with HDP have increased risk of anxiety and depression, and more evidence demonstrates that depression contributes to the development of cognitive impairment, specifically in information processing.5,6 Additionally, studies have demonstrated that some Hispanic populations may have distinct psychosocial factors (ie, extensive social networks),7 and these factors can affect cognitive reserve and resilience. The capture of social determinants of health data is ideal, because these variables are relevant to outcomes of interest such as cognitive function. Although we commend the authors for completing this research, there are notable opportunities to strengthen this area of study in the future. The scientific community should focus on expanding and implementing both subjective and objective neurocognitive assessments in Spanish. This ultimately can improve generalizability and external validity of studies as well as improving brain health equity. Future research on HDP also should include an adjudicated HDP diagnosis that includes consideration of placental features, given important endotypes of HDP, longitudinal follow-up that includes cognitive data closer to the acute phase of the disease, and a comprehensive cognitive battery that includes both self-reported and objectively measured cognitive status.