Prevalence of and Factors Associated with Hypertension Among Adults on Dolutegravir-Based Antiretroviral Therapy in Uganda: A Cross Sectional Study

Abstract

Introduction Dolutegravir-based anti-retroviral therapy (ART) regimens were rolled out as first line HIV treatment in Uganda due to their tolerability, efficacy and high resistance barrier to human immunodeficiency virus (HIV). They have however been associated with weight gain, dyslipidemia and hyperglycemia which are cardiometabolic risk factors of hypertension. We assessed the prevalence and factors associated with hypertension among adults on dolutegravir regimens. Methods We conducted a cross-sectional study on 430 systematically sampled adults on dolutegravir-based ART for ≥ 6 months. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or history of use of antihypertensive agents. Results The prevalence of hypertension was 27.2% (117 of 430 participants) [95% CI: 23.2–31.6]. Majority were female (70.7%), the median age 42 [34, 50] years, with body mass index (BMI) ≥ 25 kg/m 3 (59.6%) and median duration on DTG-based regimens of 28 [15, 33] months. Being male [aPR: 1.496, 95% CI: 1.122–1.994, P = 0.006], age ≥ 45 years [aPR: 4.23, 95% CI: 2.206–8.108, P < 0.001] and 35–44 years [aPR: 2.455, 95% CI: 1.216–4.947, P < 0.012] as compared with age < 35 years, BMI ≥ 25 kg/m 3 [aPR: 1.489, 95% CI: 1.072–2.067, P = 0.017] as compared with BMI < 25 kg/m 3 , duration on dolutegravir-based ART [aPR: 1.008, 95% CI: 1.001–1.015, P = 0.037], family history of hypertension [aPR: 1.457, 95% CI: 1.064–1.995, P = 0.019] and history of heart disease [aPR: 1.73, 95% CI: 1.205–2.484, P = 0.003] were associated with hypertension. Conclusion One in every four people with HIV (PWH) on dolutegravir-based ART has hypertension. We recommend the integration of hypertension management in the HIV treatment package and policies to improve existing supply chains for low cost and high-quality hypertension medications.

Hypertension Among Cohort of Persons With Human Immunodeficiency Virus Initiated on a Dolutegravir-Based Antiretroviral Regimen in Ghana

“…Our study again revealed that older adults (aged ≥50 years) on DTG-based regimens have slightly higher risk (2%) of developing HTN, even though this difference is not clinically significant. These findings are consistent with what was found in a study in Uganda to determine factors associated with HTN among adults on DTG-based regimen [ 16 , 36 ]. This could be associated with the aging process, which leads to various alterations in the arterial vasculature’s structure and function and reduced blood supply to the heart [ 37 ].…”

“…Another study by Brennan et al in South Africa also reported a 14.2 percentage point increase in the risk of HTN in patients exposed to DTG for 12 months compared to those that remained on efavirenz [ 28 ]. Similarly, a cross-sectional study conducted in Uganda reported a prevalence of 27.2% among patients initiated on DTG for a median duration of 28 months [ 16 ]. Results of the New Antiretroviral and Monitoring Strategies in HIV-Infected Adults in Low-Income countries (NAMSAL) study showed a significant increase in BP comparing baseline versus week 192 [ 29 ].…”

“…It is widely believed that estrogen exerts a beneficial influence on the vasodilation of blood vessels, thus contributing to the regulation of HTN. This biological protection among women is more evident in adolescence and adulthood and becomes insignificant during the menopausal stage [ 16 , 34 ]. Poor health-seeking behavior exhibited by men could also account for these findings.…”

“…HTN is more common among PWH, with prevalence of 35% compared to 30% among the HIV-uninfected population [ 2 , 14 ]. Traditional risk factors such as age, obesity, family history, diabetes, smoking, dyslipidemia, and a sedentary lifestyle contribute to the development of HTN [ 15 , 16 ]. In addition for PWH, the HIV infection itself contributes to the pathogenesis of HTN and CVD through viral replication, decreased CD4 + T-cell count, chronic systemic inflammation and endothelial dysfunction, and lipodystrophy [ 17 , 18 ].…”