ADVERSE EFFECTS OF HIV INFECTION ON DAY-NIGHT BLOOD PRESSURE VARIABILITY: PP.14.29

Abstract

Objective: An attenuation of the physiological day-night blood pressure (BP) reduction is an important predictor of cardiovascular events and death. Human immunodeficiency virus (HIV) infection has been linked with atherosclerotic cardiovascular complications, irrespective of antiretroviral therapy. It is unclear whether patients with HIV infection have an attenuated nocturnal BP reduction. Design: Cross-sectional case-control study, case:control matching ratio 1:3. Methods: Fifty-two antiretroviral therapy-naïve-HIV-infected patients (85% men, age 39 ± 11 years, BP 125/78 ± 11/9 mmHg) and 156 age- and BP-matched healthy controls (85% men, age 39 ± 10 years, BP 125/78 ± 9/7 mmHg) underwent 24-hour BP monitoring. Hypertension, diabetes, cardiovascular and renal disease, obesity, treatment with vasoactive drugs were exclusion criteria. Subjects with a nocturnal reduction of systolic BP <10% were defined as nondippers. Results: Average daytime BP did not differ in HIV and control subjects (124/80 ± 11/9 vs 124/79 ± 9/7 mmHg, p = n.s.). Nighttime BP was higher in HIV-infected subjects (113/69 ± 11/9 vs 109/67 ± 8/6 mmHg, p = 0.008/0.005). As shown in the Figure, nocturnal systolic/diastolic BP reduction was 8.8/13.2% in cases and 11.7/17.2% in controls (p = 0.002/0.001). The prevalence of nondippers was 35% in cases and 15% in controls (p = 0.003). In a multivariate analysis, nocturnal systolic BP fall was predicted by HIV infection (β=-0.22, p = 0.001). HIV viral load, low CD4 + cell count and AIDS progression risk were all related with a flattened day-night BP profile (p < 0.01). Conclusions: HIV infection per se influences negatively circadian BP rhythm. These findings, obtained in subjects without major cardiovascular risk factors and antiretroviral naive, suggest that day-night BP changes may play a role in HIV-related increase in cardiovascular risk.