Characteristics of hypertension among people living with HIV in Ghana: Impact of new hypertension guideline

Abstract

Data on the burden of hypertension among people living with HIV (PLWH) in Africa are limited, especially after new expert consensus hypertension guidelines were published in 2017. The authors sought to assess the prevalence and factors associated with hypertension among PLWH. This is a cross‐sectional study involving PLWH on combination antiretroviral therapy (cART) (n = 250) compared with sex‐matched cART‐naïve PLWH (n = 201) in Ghana. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or use of antihypertensive drugs. The authors also assessed the prevalence and predictors associated with hypertension using the recent guideline recommended cutoff BP ≥ 130/80 mm Hg. Multivariate logistic regression models were fitted to identify factors associated with hypertension among PLWH. The mean age of PLWH on cART was 45.7 ± 8.6 years, and 42.9 ± 8.8 years among PLWH cART‐naive with 81% of study participants being women. The prevalence of hypertension among PLWH on cART and PLWH cART‐naïve was 36.9% and 23.4%, P = 0.002 at BP ≥ 140/90 mm Hg and 57.2% and 42.3%, respectively, P = 0.0009, at BP ≥ 130/80 mm Hg. Factors associated with hypertension at BP ≥ 140/90 mm Hg in the PLWH group with adjusted odds ratio (95% CI) were increasing age, 2.08 (1.60‐2.71) per 10 years, and body mass index, 1.53 (1.24‐1.88) per 5 kg/m2 rise. At BP ≥ 130/80 mm Hg, cART exposure, aOR of 1.77 (95% CI: 1.20‐2.63), family history of hypertension, aOR of 1.43 (1.12‐1.83), and hypertriglyceridemia, aOR of 0.54 (0.31‐0.93), were associated with hypertension. Among PLWH, cART exposure was associated with higher prevalence of hypertension per the new guideline definition, a finding which warrants further investigation and possible mitigation.

Duration of antiretroviral therapy among people living with HIV and incidence of hypertension in Ghana

“…Thus prevalent hypertension is commoner among PLWH on cART than cART‐naïve group in consonance with several previous studies 11‐14 . Indeed in this same cohort, the factors associated with prevalent not incident hypertension in a previous study 14 were increasing age, 2.08 (1.60‐2.71) per 10 years, and higher body mass index, 1.53 (1.24‐1.88) per 5 kg/m 2 rise 14 . It is noteworthy that individuals found to have hypertension at enrollment were excluded from the present analysis looking at incident hypertension.…”

“…It is important to highlight from the outset that 17.6% of the cART established group had hypertension compared with 9.0% among the cART‐naïve group. Thus prevalent hypertension is commoner among PLWH on cART than cART‐naïve group in consonance with several previous studies 11‐14 . Indeed in this same cohort, the factors associated with prevalent not incident hypertension in a previous study 14 were increasing age, 2.08 (1.60‐2.71) per 10 years, and higher body mass index, 1.53 (1.24‐1.88) per 5 kg/m 2 rise 14 .…”

“…Our findings of decreased risk of incident hypertension with increasing age and rising baseline BMI were unexpected since it contradicts previous studies where increasing age and higher BMI were associated with hypertension in HIV populations. [11][12][13][14] 25 There are corroborative data from US studies demonstrating that lower limb fat among PLWH correlated with higher insulin resistance. 26,27 Thus, there appear to be a There are also pathophysiologic mechanisms linking our observed association between high HIV viral load with risk of developing hypertension.…”

“…Regional differences in prevalence of hypertension in the PLWH has been well characterized. For instance, while a prevalence of 13%‐25% has been reported from high‐income countries, 8,9 that from sub‐Saharan Africa, home to 70% of global burden of HIV, 10 has ranged between 13% and 38% 11‐14 …”

“…home to 70% of global burden of HIV, 10 has ranged between 13% and 38%. [11][12][13][14] While several comparative analyses on the prevalence of hypertension between PLWH on cART versus cART-naïve PLWH have been done, none to date has compared and contrasted the rates and determinants of incident hypertension between PLWH established on cART with those who has recently initiated cART. The pertinence of such studies is justified by the recent global strategy to initiate cART regardless of baseline immunosuppression status or clinical severity of HIV disease.…”