Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis

Abstract

IntroductionAbnormal diurnal blood pressure (BP) rhythms may contribute to the high cardiovascular disease risk in HIV-positive (HIV+) individuals. To synthesize the current literature on ambulatory BP monitoring (ABPM) in HIV+ individuals, a systematic literature review and meta-analysis were performed.MethodsMedical databases were searched through November 11, 2015 for studies that reported ABPM results in HIV+ individuals. Data were extracted by 2 reviewers and pooled differences between HIV+ and HIV-negative (HIV-) individuals in clinic BP and ABPM measures were calculated using random-effects inverse variance weighted models.ResultsOf 597 abstracts reviewed, 8 studies with HIV+ cohorts met the inclusion criteria. The 420 HIV+ and 714 HIV- individuals in 7 studies with HIV- comparison groups were pooled for analyses. The pooled absolute nocturnal systolic and diastolic BP declines were 3.16% (95% confidence interval [CI]: 1.13%, 5.20%) and 2.92% (95% CI: 1.64%, 4.19%) less, respectively, in HIV+ versus HIV- individuals. The pooled odds ratio for non-dipping systolic BP (nocturnal systolic BP decline <10%) in HIV+ versus HIV- individuals was 2.72 (95% CI: 1.92, 3.85). Differences in mean clinic, 24-hour, daytime, or nighttime BP were not statistically significant. I2 and heterogeneity chi-squared statistics indicated the presence of high heterogeneity for all outcomes except percent DBP dipping and non-dipping SBP pattern.ConclusionsAn abnormal diurnal BP pattern may be more common among HIV+ versus HIV- individuals. However, results were heterogeneous for most BP measures, suggesting more research in this area is needed.

Race and sex differences in ambulatory blood pressure measures among HIV+ adults

“…7, 10, 18 In the Coronary Artery Risk Development in Young Adults (CARDIA) study (mean age = 30 years), nighttime SBP was 3.8 mmHg higher and the prevalence of non-dipping SBP was 2.44 times higher in African Americans compared with whites. 10 Several mechanisms may contribute to the higher prevalence of nocturnal hypertension and non-dipping BP among African Americans compared with whites.…”

“…5, 32 A recent systematic review identified 8 studies that conducted ABPM in HIV+ individuals, 7 of which had HIV- comparison groups. 7 In a meta-analysis containing 5 of these studies, HIV+ individuals had 2.72 times higher odds of non-dipping SBP, compared with HIV- controls. 7 Of the 8 studies identified from the review, 7 of them consisted of European, mostly white individuals.…”

“…6 In a recent systematic review, only eight studies of ABPM in HIV+ adults were identified. 7 While a high prevalence of nocturnal hypertension and non-dipping BP were present among HIV+ participants, none of these studies included African Americans. 7 …”

“…7 While a high prevalence of nocturnal hypertension and non-dipping BP were present among HIV+ participants, none of these studies included African Americans. 7 …”

Ambulatory Blood Pressure Monitoring

“…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.…”