Abstract P152: Impact Of New Hypertension Guidelines On The Prevalence And Control Of Hypertension In A Clinical Hiv Cohort

Abstract

Introduction: People living with HIV (PLWH) with hypertension (HTN) have a higher risk of cardiovascular events and all-cause mortality compared with PLWH with normal blood pressure (BP) and HIV-uninfected adults with HTN. The prevalence and control of HTN among PLWH have not been widely studied since the release of newer 2017 ACC/AHA guidelines (new guidelines). To address this research gap, we evaluated and compared the prevalence and control of HTN using both 2003 JNC 7 (old guidelines) and new guidelines in a large clinical cohort of PLWH. Methods: We identified 3206 PLWH with HTN from the DC Cohort study in Washington, D.C, from 01/2018 to 06/2019. We defined HTN using International Classification of Diseases (ICD) -9/-10 diagnosis codes for HTN or ≥ 2 BP measurements obtained at least one month apart (>139/89 mm Hg per old or >129/79 mm Hg per new guidelines). We defined HTN control based on recent BP (≤139/≤89 mm Hg per old or ≤129/≤79 mm Hg per new guidelines). We identified socio-demographics, cardiovascular risk factors and co-morbidities associated with HTN control (per new guidelines) using multivariable logistic regression (adjusted Odds Ratio; 95% CI). Results: The prevalence of HTN was 50.9% per old versus 62.2% per new guidelines. Of the 3,206 PLWH with HTN based on 2017 ACC/AHA guidelines, 887 (27.7%) had a recent BP ≤129/≤79 mm Hg, 1,196 (37.3%) had a BP between 130-139/80-89 mm Hg and 1,123 (35.0%) had a BP ≥140/≥90mm Hg. After adjusting for socio-demographics, cardiovascular risk factor and co-morbidities, factors associated with HTN control included age 60-69 (vs. <40) years (1.42; 1.03-1.98), Hispanic (vs. non-Hispanic Black) race/ethnicity (1.49;1.04-2.15), receipt of HIV care at a hospital-based (vs. community-based) clinic (1.21; 1.00-1.47), being unemployed (1.42; 1.11-1.83), and diabetes (1.35; 1.13-1.63). Conclusion: In a large urban cohort of PLWH, nearly two-thirds had HTN and less than one-third of those met new guideline criteria. Older PLWH were more likely to have their HTN controlled compared to the younger PLWH. Our data suggests that more aggressive HTN control is warranted among PLWH, with attention to younger patients.