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. 2016 Jul 15;63(2):242-8.
doi: 10.1093/cid/ciw223. Epub 2016 Apr 18.

Hypertension Among HIV-infected Patients in Clinical Care, 1996-2013

Nwora Lance Okeke  1 , Thibaut Davy  2 , Joseph J Eron  2 , Sonia Napravnik  2
Affiliations

Hypertension Among HIV-infected Patients in Clinical Care, 1996-2013

Nwora Lance Okeke et al. Clin Infect Dis. .

Abstract

Background: Persons infected with human immunodeficiency virus (HIV) are at higher risk for major cardiovascular disease (CVD) events than uninfected persons. Understanding the epidemiology of major traditional CVD risk determinants, particularly hypertension, in this population is needed.

Methods: The study population included HIV-infected patients participating in the UNC CFAR HIV Clinical Cohort from 1996 to 2013. Annual incidence rates of hypertension were calculated. Multivariable Poisson models were fit to identify factors associated with incident hypertension.

Results: 3141 patients contributed 21 956 person-years (PY) of follow-up. Overall, 57% patients were black, 28% were women, and the median age was 35 years. Hypertension age-standardized incidence rates increased from 1.68 cases per 100 PYs in 1996 to 5.35 cases per 100 PYs in 2013 (P < .001). In adjusted analyses, hypertension rates were higher among obese patients (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI], 1.43-2.02), and those with diabetes mellitus (IRR 1.44, 95% CI, 1.14-1.83) and renal insufficiency (IRR 1.36, 95% CI, 1.16-1.61), but lower among patients with a CD4 nadir of ≥500 cells/mm(3) (IRR 0.73, 95% CI, .53-1.01).

Conclusions: The incidence of hypertension increased from 1996 to 2013, alongside increases in traditional hypertension risk determinants. Notably, HIV-related immunosuppression and ongoing viral replication may contribute to an increased hypertension risk. Aggressive CVD risk factor management, early HIV diagnosis, linkage to care, antiretroviral therapy initiation, and durable viral suppression, will be important components of a comprehensive primary CVD prevention strategy in HIV-infected persons.

Keywords: HIV; UCHCC; cardiovascular disease; epidemiology; hypertension.

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Figures

Figure 1.
Figure 1.
Annual unadjusted hypertension incidence rate with trendline by calendar year. Solid line is the annual unadjusted incidence rate; 95% confidence intervals are shaded area, and dotted line is the linear regression line with slope of 0.17. Abbreviation: PY, person years.
Figure 2.
Figure 2.
Age-adjusted incidence rates and 95% confidence intervals of hypertension stratified by calendar year- 1996–2013. *Standardized to the age distribution at the midpoint of participant follow-up. Abbreviation: PY, person years.
See this image and copyright information in PMC

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