Time trend in hypertension prevalence, awareness, treatment, and control in a contemporary cohort of HIV-infected patients: the HIV and Hypertension Study. Issue 2 (February 2017)

• Record Type: Journal Article
• Authors: De Socio, Giuseppe Vittorio; Ricci, Elena; Maggi, Paolo; Parruti, Giustino; Celesia, Benedetto Maurizio; Orofino, Giancarlo; Madeddu, Giordano; Martinelli, Canio; Menzaghi, Barbara; Taramasso, Lucia; Bonfanti, Paolo; Pucci, Giacomo; Schillaci, Giuseppe
• Is Part Of: Journal of hypertension. Volume 35:Issue 2(2017:Feb.)
• Publication Date: 2017-02
• Subjects: antiretroviral therapy -- blood pressure -- cardiovascular disease -- HIV -- hypertension -- integrase inhibitors -- new-onset hypertension; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000001150
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Background: Hypertension control is often inadequate in HIV patients. In a contemporary, nationwide cohort of Italian HIV-infected adults, we assessed time trends in hypertension prevalence, awareness, treatment, and control. We also evaluated predictors of cardiovascular events and of new-onset hypertension. Methods: Multicenter prospective cohort study, sampling 961 consecutive HIV patients (71% men, mean age 46 ± 9 years, 30% hypertensive) examined in 2010–2014 and after a median follow-up of 3.4 years. Results: Among hypertensive patients, hypertension awareness (63% at baseline and 92% at follow-up), treatment (54 vs. 79%), and control (35 vs. 59%) all improved during follow-up. The incidence of new-onset hypertension was 50.1/1000 person-years (95% confidence interval, 41.2–60.3). Multivariable-adjusted predictors of hypertension were age, BMI, estimated cardiovascular risk, blood pressure, and advanced HIV clinical stage. In total, 35 new cardiovascular events were reported during follow-up (11.1/1000 person-years). In a multivariate model, baseline cardiovascular risk and hypertensive status predicted incident cardiovascular events, whereas a higher CD4 + cell count had a protective role. In treated hypertensive patients, the use of integrase strand transfer inhibitors at follow-up was associated with a lower SBP (average yearly change, −3.8 ± 1.6 vs. −0.9 ± 0.5 mmHg in integrase strand transfer inhibitor users vs. nonusers, respectively, P = 0.02). Conclusion: Hypertension awareness, treatment, and control rates all improved in adult Italian HIV patients over the last few years, although hypertension remains highly prevalent (41%) in middle-aged HIV patients, and significantly impacts cardiovascular morbidity. Traditional risk factors and advanced HIV disease predict new-onset hypertension, whereas CD4 + cell count favorably affects future cardiovascular events.