High prevalence of “non-dipping” blood pressure and vascular stiffness in HIV-infected South Africans on antiretrovirals

Abstract

BackgroundHIV-infected individuals are at increased risk of tissue inflammation and accelerated vascular aging (‘inflamm-aging’). Abnormal diurnal blood pressure (BP) rhythms such as non-dipping may contribute to an increased risk of cardiovascular and cerebrovascular events in HIV infected individuals. However, little data exists on ambulatory blood pressure (ABP) and measures of vascular stiffness in the black African HIV infected population.MethodsThis is a cross-sectional analysis of otherwise well, HIV infected outpatients on ART for >5 years. Study assessments included: 24hr ABP monitoring, pulse wave velocity (PWV) and central aortic systolic pressure (CASP) using a AtCor Medical Sphygmocor device, fasting lipogram, oral glucose tolerance test, high-sensitivity C-reactive protein (hsCRP) and anthropometric data. Patients completed a questionnaire of autonomic symptoms. CD4+ counts and viral loads were obtained from the National Laboratory results system.ResultsSixty seven black participants were included in the analysis of whom 91% (n = 61) were female with a mean age of 42.2 ± 8.6 years. The median duration on ART was 7.5 years (IQR = 6–10), 84% were virally supressed and the median CD4 count was 529.5cells/mm3 (IQR = 372.0–686.5). The majority (67%) were classified as overweight and 76% had an increased waist circumference, yet only 88% of participants were normotensive. A hsCRP level in the high cardiovascular risk category was found in 68% of participants. The prevalence of non-dipping BP was 65%. Interestingly, there was no association on multivariable analysis between dipping status and traditional risk factors for non-dipping BP, such as: obesity, autonomic dysfunction and older age.ConclusionThis relatively young cross-sectional sample of predominantly normotensive, but overweight black women on effective ART >5 years showed: a high prevalence of non-dipping BP, inflammation and vascular stiffness. Causality cannot be inferred but cardiovascular risk reduction should be emphasized in these patients.

Vibrotactile sensitivity of patients with HIV‐related sensory neuropathy: An exploratory study

“…Twenty two HIV‐PN participants were recruited consecutively from a cohort of a larger HIV “inflamm‐aging” neuropathy study (Borkum et al, ), which monitored patients after enrollment on a government‐sponsored ART program. These patients were recruited from the HIV clinic at Crossroads Community Health Centre in Cape Town, South Africa.…”

“…For the purposes of this study, we included patients consecutively, who satisfied the most widely used definition of HIV‐PN, namely the presence of at least 1 distal symmetrical neuropathic sign (see Centner et al, ; Maritz et al, ; Phillips et al, ). The parameters selected from the HIV “inflamm‐aging” neuropathy study (Borkum et al, ) for comparison with the VPT here were as follows: date since initiating ART, ART regimen, toe proprioception (see Centner et al, ), BPNS tuning fork test (BPNS‐TF), BPNS evaluation of ankle deep tendon reflexes (BPNS‐DTR), and the total BPNS score (BPNS‐total). Further, VPT was compared with the following outcomes from the TNSr: the distal–proximal extent of reduced abnormal vibration sensibility (TNSr‐TF), pinprick abnormalities, reduction in deep tendon reflexes (TNSr‐DTR), and the total TNSr score (TNSr‐total).…”

“…This work forms the initial part of an intervention study where we will apply subsensory electrical nerve stimulation or SENS (see Breen et al, ; Breen & Macefield, ; Breen et al, ; Breen et al, ; Serrador, ) to the recruited HIV‐PN and matched control participants. The intervention study presented a unique opportunity to report on baseline levels of vibration perception, in mechanical units (microns) at different vibration frequencies, and correlate them to clinical measures already performed on the HIV‐PN cohort as part of a larger HIV “inflamm‐aging” neuropathy study (Borkum et al, ).…”

Integrated care of hypertension and HIV infection

“…In addition, HIV+ patients with hypertension have a greater risk of cardiovascular events and all‐cause mortality either than HIV+ patients with normal BP or age‐ and sex‐matched HIV‐uninfected adults with hypertension . Abnormal circadian BP patterns, increased BP variability (BPV), and masked hypertension have been also associated with HIV infection, and they can contribute to end‐organ damage and cardiovascular complications . Indeed, far from being a background noise or a random effect phenomenon that dilutes the prognostic value of BP measurements, variability of BP is an independent determinant of coronary heart disease, stroke, cardiovascular mortality, cognitive impairment, and chronic kidney failure …”

“…6,7 Abnormal circadian BP patterns, increased BP variability (BPV), and masked hypertension have been also associated with HIV infection, and they can contribute to end-organ damage and cardiovascular complications. [8][9][10] Indeed, far from being a background noise or a random effect phenomenon that dilutes the prognostic value of BP measurements, variability of BP is an independent determinant of coronary heart disease, stroke, cardiovascular mortality, cognitive impairment, and chronic kidney failure. [11][12][13][14][15][16][17][18][19][20][21][22]…”