Racial disparities in the prevalence and control of hypertension among a cohort of HIV-infected patients in the southeastern United States

Abstract

BackgroundAfrican Americans are disproportionately affected by both HIV and hypertension. Failure to modify risk factors for cardiovascular disease and chronic kidney disease such as hypertension among HIV-infected patients may attenuate the benefits conferred by combination antiretroviral therapy. In the general population, African Americans with hypertension are less likely to have controlled blood pressure than whites. However, racial differences in blood pressure control among HIV-infected patients are not well studied.MethodsWe conducted a cross-sectional study evaluating racial differences in hypertension prevalence, treatment, and control among 1,664 patients attending the University of Alabama at Birmingham HIV Clinic in 2013. Multivariable analyses were performed to calculate prevalence ratios (PR) with 95% confidence intervals (CI) as the measure of association between race and hypertension prevalence and control while adjusting for other covariates.ResultsThe mean age of patients was 47 years, 77% were male and 54% African-American. The prevalence of hypertension was higher among African Americans compared with whites (49% vs. 43%; p = 0.02). Among those with hypertension, 91% of African Americans and 93% of whites were treated (p = 0.43). Among those treated, 50% of African Americans versus 60% of whites had controlled blood pressure (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) (p = 0.007). After multivariable adjustment for potential confounders, prevalence of hypertension was higher among African Americans compared to whites (PR 1.25; 95% CI 1.12–1.39) and prevalence of BP control was lower (PR 0.80; 95% CI 0.69–0.93).ConclusionsDespite comparable levels of hypertension treatment, African Americans in our HIV cohort were less likely to achieve blood pressure control. This may place them at increased risk for adverse outcomes that disproportionately impact HIV-infected patients, such as cardiovascular disease and chronic kidney disease, and thus attenuate the benefits conferred by combination antiretroviral therapy.

Prevalence of diabetes mellitus and hypertension amongst the HIV-positive population at a district hospital in eThekwini, South Africa

“…39 In the United States, HT was more prevalent (46%) amongst the African American population, which was more than other ethnic groups. 40 There is a paucity of data reporting the association between ethnicity and the prevalence of DM and HT amongst patients living with HIV. Ethnicity was also not a significant risk factor for comorbidities in this study as the various ethnic groups were not equally represented.…”

The Intersection of HIV, Diabetes, and Race: Exploring Disparities in Diabetes Care among People Living with HIV

“…Despite having comparable hypertension treatment levels, African Americans in this study had lower rates of BP control and thus ABC control than Caucasians, which mirrors previous observations in PWH. 6 Among active-duty Air Force members, African Americans have been found to have a higher prevalence of hypertension and dyslipidemia than Caucasians. 18 Whether these differences are due to biological factors or socioeconomic disparities is unclear.…”

“…4,5 Though there is evidence that African Americans are less likely to achieve blood pressure (BP) control than Caucasians, racial disparities have not been explored in the context of diabetes control in PWH. 6 Addressing this knowledge gap is imperative to better understand the current state of diabetes management in the HIV population, where African American communities are already disproportionately impacted.…”

Proof of Concept for the FLEX Intervention: Feasibility of Home Based Coaching to Improve Physical Activity Outcomes and Viral Load Suppression among African American Youth Living with HIV

“…African Americans (AfAm) have some of the highest rates of preventable cardiometabolic disorders, such as diabetes and cardiovascular disease, 1 , 2 and AfAm youth living with human immunodeficiency virus (YLWH) are at even higher risk of developing these conditions. 3 , 4 Physical activity can prevent cardiometabolic disorders and improve immune function, mental health, and cognition. 5 , 6 Systematic reviews on the effects of physical activity interventions on the health of adults living with HIV have yielded promising results 7 , 8 ; thus, physical activity interventions that are tailored to the personal circumstances and preferences of AfAm YLWH are warranted.…”