Effects of HIV status and antiretroviral therapy on blood pressure

Abstract

ObjectiveHigh blood pressure is a major risk factor for cardiovascular disease and concerns have been raised over its possible association with antiretroviral drugs. The objective of this study was to explore the associations among blood pressure, HIV status and two predefined highly active antiretroviral therapy (HAART) regimens: treatment with and without nonnucleoside reverse transcriptase inhibitors (NNRTIs) (NNRTI-and non-NNRTI-based HAART). MethodA cross-sectional survey was conducted among 612 adults attending the Sexual Health Outpatient Department at St Mary's NHS Hospital Trust, London. ResultsHIV-infected patients treated with NNRTIs had a blood pressure that was 4.6/4.2 mmHg higher than those who were HIV positive but treatment naïve. The diastolic difference remained statistically significant after adjusting for potential confounders of this association (2.4 mmHg; P 5 0.03). There was no difference in blood pressure between those treated with non-NNRTI-based regimens and those who were HIV positive but treatment naïve. ConclusionNNRTIs may be associated with an increase in blood pressure. Pending further more robust evidence from randomized clinical trials it would be prudent for clinicians to monitor blood pressure in all HIV-infected patients, particularly after initiating treatment with NNRTIs, and to commence antihypertensive therapy whenever appropriate. IntroductionDeaths from AIDS have declined dramatically since the introduction of highly active antiretroviral therapy (HAART) in patients infected with HIV [1]. However, the incidence of myocardial infarction has increased fourfold and cardiovascular disease is now one of the major causes of death in HIV-infected patients in Western industrialized countries [2,3]. Anecdotal reports from the Peart-Rose (hypertension) Clinic at St Mary's NHS Hospital Trust, Paddington, London, raised awareness of an increasing number of young HIV-positive adults being referred with hypertension, a major risk factor for cardiovascular disease. This raised the possibility that HIV and/or its treatment may be associated with raised blood pressure. However, the published evidence concerning these associations is both limited and conflicting [4][5][6][7][8][9][10][11][12][13][14][15]. While the current studies do provide useful insights into a potentially emerging problem, methodological problems, including the choice of control group [4][5][6][7][8][9][10], inadequate blood pressure measurement [11][12][13][14][15] and crude categorical outcome measures [4,5,7,14,15], may have generated bias and confounded results. Another potential problem is the consideration of HAART as a single entity, despite it being an umbrella term for different combinations of antiretroviral drugs [4,5,11,[13][14][15] Methods Study populationPatients eligible for inclusion in this cross-sectional survey were those attending routine appointments at the Sexual Health Outpatient Department at St Mary's NHS Hospital Trust, Paddington, London, between September 2005 and September 2006 and who ...

Correlates of Hypertension in Patients with AIDS in the Era of Highly Active Antiretroviral Therapy

“…(24) In a smaller, cross-sectional study of patients attending a sexual health clinic in London, Wilson et al found an association between NNRTI use and increased blood pressure. (25) In our study, neither HAART nor NNRTI-based HAART use at enrollment were associated with either prevalent or incident hypertension, further suggesting that HIV treatment may not, in and of itself, contribute to hypertension.…”

“…(22, 24) Inconsistent data exist about the effect of non-nucleoside reverse transcriptase inhibitors (NNRTIs) on hypertension in HIV-infected adults. (24–25) These studies encompass patients both with and without a diagnosis of AIDS. Because of the increased mortality risk of HIV-positive patients with AIDS, it is unclear whether these patients have the same risk of developing hypertension as do other HIV-positive patients.…”

Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis

“…A total of 573 abstracts and 17 full texts, including seven duplicate records, were excluded, leaving 39 eligible observational studies. [5][6][7][8]15,16, Thirty of these included studies were cross-sectional surveys, 5,16,[18][19][20][21][22][23][24][25][26]28,[31][32][33][34][35][36][37][39][40][41][42][44][45][46]48,49 whereas the other nine were cohort studies. A total of 44 903 HIV-infected patients (28% females) from 21 countries were included in our analyses, with significantly more study participants from high-income countries compared with low-and middle-income countries (89% versus 11%).…”

Dyslipidemia and its Correlates among HIV Infected Children on HAART Attending Mbarara Regional Referral Hospital

“…There is a scale up of HAART use in Uganda with about 24,735 children below 15 years on HAART by 2011 [3]. While HAART has improved and prolonged life, it has been associated with metabolic abnormalities that predispose patients to a poor quality of life [4,5] HAART is associated with lipid abnormalities (dyslipidemia) like: increase in low density lipoproteins (LDL), triglycerides (TG), cholesterol and low high density lipoproteins (HDL), [6–9]. These, together with chronic HIV associated inflammation and activation of the immune system, may result in damage to the arteries.…”