Prehypertension, Hypertension, and the Risk of Acute Myocardial Infarction in HIV-Infected and -Uninfected Veterans

Armah, Kaku A.; Chang, Chung‐Chou H.; Baker, Jason V.; Vasan, Ramachandran S.; Budoff, Matthew J.; Crane, Heidi M.; Gibert, Cynthia L.; Goetz, Matthew Bidwell; Leaf, David A.; McGinnis, Kathleen A.; Oursler, Kris Ann; Rimland, David; Rodriguez‐Barradas, Maria C.; Sico, Jason J.; Warner, Alberta; Hsue, Priscilla Y.; Kuller, Lewis H.; Justice, Amy C.; Freiberg, Matthew S.

doi:10.1093/cid/cit652

Cited by 105 publications

(74 citation statements)

References 30 publications

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“…1,2 Hypertension in HIV-infected individuals is common, with prevalence estimates ranging from 13–45%, 3–7 and associated with a twofold increased risk of acute myocardial infarction. 8 Despite these observations, our understanding of risk factors for hypertension in the HIV-infected population is limited. 9–12 …”

Section: Introductionmentioning

confidence: 99%

Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women

et al. 2017

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Subclinical kidney disease is associated with developing hypertension in the general population, but data are lacking among HIV-infected persons. We examined associations of kidney function and injury with incident hypertension in 823 HIV-infected and 267 HIV-uninfected women in the Women’s Interagency HIV Study, a multicenter, prospective cohort of HIV-infected and uninfected women in the United States. Baseline kidney biomarkers included estimated glomerular filtration rate using cystatin C (eGFR), urine albumin-to-creatinine ratio (ACR), and seven urine biomarkers of tubular injury: alpha-1-microglobulin, interleukin-18 (IL-18), kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, liver fatty acid binding protein, N-acetyl-beta-D-glucosaminidase (NAG), and alpha1-acid-glycoprotein (AAG). We used multivariable Poisson regression to evaluate associations of kidney biomarkers with incident hypertension, defined as two consecutive visits of anti-hypertensive medication use. Over a median follow-up of 9.6 years, 288 HIV-infected women (35%) developed hypertension. Among the HIV-infected women, higher ACR was independently associated with incident hypertension (RR=1.13 per ACR doubling, 95%CI: 1.07, 1.20), as was lower eGFR (RR=1.10 per 10 ml/min/1.73m2 lower eGFR, CI: 1.04, 1.17). No tubular injury and dysfunction biomarkers were independently associated with incident hypertension in HIV-infected women. In contrast, among the HIV-uninfected women, ACR was not associated with incident hypertension, whereas higher IL-18, AAG and NAG were significantly associated with incident hypertension. These findings suggest that early glomerular injury and kidney dysfunction may be involved in the pathogenesis of hypertension in HIV-infected persons. The associations of the tubular markers with hypertension in HIV-uninfected women should be validated in other studies.

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Section: Introductionmentioning

confidence: 99%

Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women

et al. 2017

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“…Cardiometabolic risk factors such as hypertension, dyslipidemia, and diabetes are also common in HIV infection, partly attributable to certain antiretroviral medications, and associated with cardiovascular events. [4, 16-18] However, newer ART drugs have more favorable cardiometabolic profiles[19], and some data suggest ART initiation with modern regimens may reduce risk for the metabolic syndrome[17]. Ultimately, with availability of well-established approaches to target traditional risk factor modification, an important unmet need in the field remains understanding and targeting non-traditional risk factors.…”

Section: Introductionmentioning

confidence: 99%

Immune activation and cardiovascular disease in chronic HIV infection

Longenecker

Sullivan

Baker³

2016

Current Opinion in HIV and AIDS

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Purpose of review To describe the potential contribution of immune activation in the pathogenesis of HIV-associated cardiovascular disease (CVD)—a leading cause of morbidity and mortality among HIV positive persons with access to antiretroviral therapy (ART). Recent findings We review recent literature that suggests abnormalities in both adaptive and innate immunity contributes to CVD risk among persons with HIV infection. In particular, potentially atherogenic T-cell mechanisms include persistent high-level T-cell activation (and associated pro-inflammatory mechanisms), as well as the presence of co-pathogens (e.g., CMV) providing an ongoing stimulus for cytotoxic T-cell responses. More recent data has then emphasized the potential impact of monocyte/macrophage-mediated inflammation and injury within atherosclerotic lesions. The pathology driving innate immune activation many not fully reverse with ART treatment, highlighting the need for interventions that target inflammation as a CVD prevention strategy. Summary Premature CVD among persons with HIV infection is due, in part, to persistent abnormalities in immune activation and systemic inflammation despite viral suppression. Prevention strategies for persons with HIV infection include those that target traditional CVD risk factors as well as newer candidate treatments with potential immunomodulatory benefits.

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“…An example of this includes individuals with HIV who have been shown to be at an increased risk for CV diseases (CVD), including hypertension. 42 Although studies of ABPM in HIV + individuals are limited, HIV + individuals have an increased prevalence of non-dipping BP 43 which may put them at increased risk for CV events. Identifying the factors associated with abnormal BP phenotypes within HIV + individuals would help elucidate the mechanisms underlying the excess CVD risk among this population and potentially identify new targets for intervention that can mitigate this excess risk.…”

Section: The Potential Applicability and Current Use Of Ambulatory Blmentioning

confidence: 99%

Ambulatory Blood Pressure Monitoring

Abdalla

2017

Cardiology Clinics

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Ambulatory blood pressure monitoring (ABPM) can assess out-of clinic blood pressure. ABPM is an underutilized resource in low and middle-income countries but should be considered as a complimentary strategy to clinic blood pressure measurement for the diagnosis and management of hypertension. Potential uses for ABPM in low and middle-income countries include the use of ABPM for the screening of high-risk individuals who have concurrent communicable diseases such as HIV and the use of ABPM in task-shifting healthcare strategies.

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Prehypertension, Hypertension, and the Risk of Acute Myocardial Infarction in HIV-Infected and -Uninfected Veterans

Cited by 105 publications

References 30 publications

Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women

Association of Kidney Function and Early Kidney Injury With Incident Hypertension in HIV-Infected Women

Immune activation and cardiovascular disease in chronic HIV infection

Ambulatory Blood Pressure Monitoring

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