Incidence and Predictors of Hypertension Among HIV Patients Receiving ART at Public Health Facilities, Northwest Ethiopia: A One-Year Multicenter Prospective Follow-Up Study

Abstract

Background: The introduction of highly active retroviral therapy has dramatically reduced mortality and improved survival among HIV patients. However, there is a possible risk of comorbid complications such as hypertension. Little evidence is available regarding the incidence of hypertension among HIV patients receiving anti-retroviral therapy in Ethiopia. Purpose: To assess the incidence and predictors of hypertension among HIV positive patients receiving ART at Public Health Facilities, Northwest Ethiopia. Patients and Methods: A one-year prospective follow-up study was conducted among a cohort of 302 new adult individuals initiating on a standard anti-retroviral therapy regimen with a median (IQR) age of 35 years (IQR=30-41). A pretested data extraction checklist was used to extract baseline patient records. The collected data were entered into Epi-Data version 3.1 and exported to STATA version 14 for analysis. The incidence rate was calculated, and a Kaplan-Meier survival curve was used to estimate the survival probabilities of developing hypertension. Cox proportional hazards model was fitted to identify the predictors of hypertension. Results: About 40 (13.25) new hypertensive cases were observed during the follow-up period, and the remaining 262 (86.75%) were censored. The overall incidence rate of hypertension was 16.35 per 1000 person-month with 2447 patient-month observations. Male sex (AHR = 2.45, 95% CI: 1.02, 6.14), old age (AHR = 2.83, 95% CI: 1.08, 7.45), high BMI (AHR = 6.54, 95% CI: 2.03, 21.13), diabetic comorbidity (AHR = 2.36, 95% CI: 1.07, 5.22), and patients who were on Zidovudine (AZT)-based ART regimen (AHR =3.47, 95% CI: 1.10, 10.94) were significant predictors for the development of hypertension. Conclusion:The findings of this study revealed that incident hypertension is a common problem among HIV patients receiving ART. Routine monitoring of blood pressure and screening and treating high blood pressure should be an integral part of follow-up for HIV patients in ART clinics.

Hypertension and associated factors in HIV-infected patients receiving antiretroviral treatment in Burundi: a cross-sectional study

“…The prevalence of 17.5% in our population is comparable to those reported in Nigeria 29 , Zimbabwe 30 , South Africa 31 Zambia 32 and Tanzania 33 , but lower than those reported in Uganda 34 , Cameroon 35 , Brazil 36 , China 17 , 18 Ugandan rural study 37 and Argentina 38 . Similarly, our findings are higher than those reported in Ethiopia 16,39,40 and Kenya 41 . www.nature.com/scientificreports/…”

“…Several studies have demonstrated that possible risk factors for hypertension in the HIV-infected population are old age, male gender, family history of HTN, long duration of HIV infection, low CD4 count, high viral burden, diabetes, high body mass index and certain medications combined with ART 16,43,44 . In our study HTN appears to be related to age, being overweight and obesity, diabetes, duration of HIV and the combined antiretroviral therapy for more than 5 years.…”

Factors influencing left ventricular diastolic dysfunction on echocardiography of people living with HIV in Kunming, China

“…In this study, 20.7% of PLWH had hypertension, consistent with studies by Musekwa et al 27 (18.4%) and Roozen et al 28 (23.0%). In previous studies, significant predictors of hypertension development in PLWH included age, 27,[29][30][31] male sex, [29][30][31] high BMI, 27,[29][30][31] abnormal waist circumference, 30 elevated low-density-lipoprotein cholesterol, 30 diabetes, [29][30][31] long ART duration, 31 and ART with dolutegravir 27 or zidovudine. 29 The higher prevalence of diabetes in PLWH is attributable to increased insulin resistance caused by HIV and ART.…”

“…In previous studies, significant predictors of hypertension development in PLWH included age, 27,[29][30][31] male sex, [29][30][31] high BMI, 27,[29][30][31] abnormal waist circumference, 30 elevated low-density-lipoprotein cholesterol, 30 diabetes, [29][30][31] long ART duration, 31 and ART with dolutegravir 27 or zidovudine. 29 The higher prevalence of diabetes in PLWH is attributable to increased insulin resistance caused by HIV and ART. Furthermore, it's noteworthy that female gender, advanced age, and protracted duration of HIV infection have been linked to insulin resistance within PLWH.…”

Risk Factors Attributable to Hypertension among HIV-Infected Patients on Antiretroviral Therapy in Selected Rural Districts of the Eastern Cape Province, South Africa

“…This variance in gender could be clarified using hormonal dissimilarities that shield women from hypertension. In addition, men are known to live a more sedentary lifestyle than women [ 56 ]. Moreover, the effect of gender on the risk of being hypertensive is not well reported, as there are contradictory results being stated regarding the association of gender and the prevalence of hypertension.…”