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Randomized Controlled Trial
. 2018 Jul;36(7):1533-1539.
doi: 10.1097/HJH.0000000000001723.

Blood pressure and mortality in a prospective cohort of HIV-infected adults in Port-au-Prince, Haiti

Ashita S Batavia  1 , Patrice Severe  2 , Myung Hee Lee  1 , Alexandra Apollon  2 , Yuan Shan Zhu  1 , Kathryn M Dupnik  1 , Margaret L McNairy  1 , Jean W Pape  1   2 , Daniel W Fitzgerald  1 , Robert N Peck  1
Affiliations
Randomized Controlled Trial

Blood pressure and mortality in a prospective cohort of HIV-infected adults in Port-au-Prince, Haiti

Ashita S Batavia et al. J Hypertens. 2018 Jul.

Abstract

Objective: The objective of this study was to determine how baseline blood pressure and incident hypertension related to antiretroviral therapy (ART) initiation, HIV-related inflammation and mortality in HIV-infected adults in a low-income country.

Methods: We conducted long-term follow-up of HIV-infected adults who had participated in a trial of early vs. delayed initiation of ART in Port-au-Prince, Haiti. Between 2005 and 2008, 816 HIV-infected adults were randomized to early (N = 408) vs. delayed ART (when CD4 cell count <200 cells/μl or AIDS-defining condition; N = 408). Blood pressure was measured every 3 months. Hypertension was diagnosed according to the Joint National Committee (JNC-7) guidelines. Biomarkers of inflammation and coagulation were measured from banked enrolment plasma samples. Survival analyses were performed using Stata 14.

Results: The median age at enrolment was 39 years. The median follow-up time was 7.3 years. The hypertension incidence rate was 3.41 per 100 person-years, and was similar in early and delayed ART groups. In multivariable models, independent predictors of incident hypertension were older age, higher BMI and plasma interleukin (IL)-6 levels (adjusted hazard ratio, aHR = 1.23, P < 0.001). Systolic pressure more than 140 mmHg at enrolment was associated with increased mortality (aHR = 2.47, P = 0.03) as was systolic pressure less than 90 mmHg (aHR = 2.25, P = 0.04). Prevalent and incident hypertension were also significantly associated with mortality.

Conclusion: In a large prospective study of HIV-infected adults, we found a high incidence of hypertension associated with HIV-related inflammation. Baseline hypertension conferred a more than two-fold increased risk of death. Among HIV-infected adults in low-income countries, hypertension should be considered a serious threat to long-term survival.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1. Kaplan-Meier estimates for hypertension-free survival
Panel A presents hypertension-free survival in the whole CIPRA cohort (N=816). Panel B presents hypertension-free survival in the early group (N=408) and delayed groups (N=408).
Figure 2
Figure 2. Kaplan Meier estimates for survival by systolic blood pressure (SBP) measurement at enrollment
Panel A presents survival in participants with normal SBP (90 – 140 mmHg) vs. high SBP (>140 mmHg) at enrollment. Panel B presents survival in participants with normal SBP (90 – 140 mmHg) vs. low SBP (<90 mmHg) at enrollment.
See this image and copyright information in PMC

Comment in

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