Ambulatory blood pressure profiles in a subset of HIV-positive patients pre and post antiretroviral therapy : cardiovascular topic

Borkum, Megan; Wearne, Nicola; Alfred, Athlet; Dave, Joel A.; Levitt, Naomi; Rayner, Brian

doi:10.5830/cvja-2014-029

Cited by 17 publications

(25 citation statements)

References 27 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among PLHIV in SSA, the overall rate of hypertension is 8% to 19% (90). HIV infection is also associated with ambulatory non-dipping status, which suggests an underlying dysregulation of the cardiovascular system (91). Higher blood pressure increases mortality in HIV-infected men with well-controlled HIV disease nearly 3-fold than in those with more advanced disease (92).…”

Section: Other Risk Factors For Hiv-associated Hf In Lmicsmentioning

confidence: 99%

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

Bloomfield

Alenezi

Barasa

et al. 2015

JACC: Heart Failure

View full text Add to dashboard Cite

Successful combination therapy for human immunodeficiency virus (HIV) has transformed this disease from a short-lived infection with high mortality to a chronic disease associated with increasing life expectancy. This is true for high- as well as low- and middle-income countries. As a result of this increased life expectancy, people living with HIV are now at risk of developing other chronic diseases associated with aging. Heart failure has been common among people living with HIV in the eras of pre- and post- availability of antiretroviral therapy; however, our current understanding of the pathogenesis and approaches to management have not been systematically addressed. HIV may cause heart failure through direct (e.g., viral replication, mitochondrial dysfunction, cardiac autoimmunity, autonomic dysfunction) and indirect (e.g., opportunistic infections, antiretroviral therapy, alcohol abuse, micronutrient deficiency, tobacco use) pathways. In low- and middle-income countries, 2 large observational studies have recently reported clinical characteristics and outcomes in these patients. HIV-associated heart failure remains a common cardiac diagnosis in people living with heart failure, yet a unifying set of diagnostic criteria is lacking. Treatment patterns for heart failure fall short of society guidelines. Although there may be promise in cardiac glycosides for treating heart failure in people living with HIV, clinical studies are needed to validate in vitro findings. Owing to the burden of HIV in low- and middle-income countries and the concurrent rise of traditional cardiovascular risk factors, strategic and concerted efforts in this area are likely to impact the care of people living with HIV around the globe.

show abstract

Section: Other Risk Factors For Hiv-associated Hf In Lmicsmentioning

confidence: 99%

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

Bloomfield

Alenezi

Barasa

et al. 2015

JACC: Heart Failure

View full text Add to dashboard Cite

show abstract

“…37, 38 Additionally, studies have suggested that ART in the current era is not associated with hypertension. 5, 6, 39 One study specifically reported that ABPM measures in HIV+ individuals did not change from before ART initiation to after 6 months of therapy. 39 The current study only included HIV+ individuals and there was no HIV- comparison group.…”

Section: Discussionmentioning

confidence: 99%

“…5, 6, 39 One study specifically reported that ABPM measures in HIV+ individuals did not change from before ART initiation to after 6 months of therapy. 39 The current study only included HIV+ individuals and there was no HIV- comparison group. We also did not examine possible mechanisms for observed differences in ABPM measures.…”

Section: Discussionmentioning

confidence: 99%

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

Kent

Schwartz

Shimbo

et al. 2017

Journal of the American Society of Hypertension

View full text Add to dashboard Cite

Ambulatory blood pressure monitoring (ABPM) can identify phenotypes that cannot be measured in the clinic. Determining race and sex disparities in ABPM measures among HIV+ individuals may improve strategies to diagnose and treat hypertension in this high risk population. We compared ABPM measures between 24 African American and 25 white HIV+ adults (36 men and 13 women). Awake systolic BP (SBP) and diastolic BP (DBP) were similar in African Americans and whites. After multivariable adjustment, sleep SBP and DBP were 9.7 (95%confidence interval [95%CI]: 4.7, 14.8) mmHg and 8.4 (95%CI: 4.3, 12.5) mmHg higher, respectively, among African Americans compared with whites. After multivariable adjustment, SBP and DBP dipping ratios were 5.2% (95%CI: 1.7%, 8.7%) and 6.1% (95%CI 2.0%, 10.3%) smaller among African Americans compared with whites. After multivariable adjustment, awake and sleep SBP and DBP were higher in men compared to women. There was no difference in SBP or DBP dipping ratios comparing men and women. The prevalence of awake masked hypertension was 42% in men versus 17% in women, and the prevalence of sleep masked hypertension was 57% among African Americans versus 18% among whites. These data suggest that ABPM measures differ by race and sex in HIV+ adults.

show abstract

“…One study of 30 HIV+ and 17 HIV− black South Africans reported nighttime systolic BP to be 11.0 mmHg (95 % CI 7.4-14.6) higher in HIV+ than HIV− individuals [79]. However, other studies have found no difference in nighttime BP by HIV status [80].…”

Section: Studies On Abpm Phenotypes In Hiv+ Individualsmentioning

confidence: 99%

“…For example, a cross-sectional study of HIV+ individuals reported no difference in the prevalence of nondipping BP by ART use [82]. Another study found that non-dipping BP status of HIV+ individuals did not change after 6 months of ART [79]. However, higher HIV viral load and low CD4 + count have been associated with a non-dipping BP, suggesting that the control of these factors through appropriate ART has the potential to improve ABPM measures [81].…”

Section: Studies On Abpm Phenotypes In Hiv+ Individualsmentioning

confidence: 99%

Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV

et al. 2015

View full text Add to dashboard Cite

HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.

show abstract

Ambulatory blood pressure profiles in a subset of HIV-positive patients pre and post antiretroviral therapy : cardiovascular topic

Cited by 17 publications

References 27 publications

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries

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

Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV

Contact Info

Product

Resources

About