BLOOD PRESSURE CHANGES OVER 18 MONTHS AFTER INITIATION OF ANTIRETROVIRAL THERAPY IN HIV INFECTED PATIENTS IN LILONGWE, MALAWI

Abstract

Objective: The improved survival of people living with HIV (PLHIV) and the economic and demographic changes in sub-Saharan Africa are accompanied by a rising number of patients suffering from cardiovascular disease. According to a recent meta-analysis hypertension prevalence is higher in PLHIV on antiretroviral therapy (ART) compared to ART-naïve patients. As part of the ongoing prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we examined blood pressure (BP) changes in ambulatory PLHIV who initiated ART in urban Lilongwe, Malawi. Design and method: Anthropometric measurements of adult study participants at baseline and during study visits after 1, 3, 6 and every 6 months thereafter were recorded in an electronic patient registry. For the present analysis we surveyed systolic and diastolic BP values (oscillometric measurements) and body weight (BW) from this data base for patients who were still alive and active study participants at month 18. Student's t-test was used to compare systolic and diastolic BP, BW and their changes between baseline and month 18. Pearson's r was calculated to test for correlations between changes in BW and BP. Results: Data from 995 (577 females, mean age 36.7 ± 9.2 years) of the originally included 1436 PLHIV were analyzed. BW (p < 0.001) and systolic BP (p < 0.01) differed significantly between baseline and month 18. The change in systolic and diastolic BP correlated with the change in BW (r = 0.312 and r = 0.220, respectively; p < 0.01). There were significant differences (p < 0.001) in the mean change of systolic/diastolic BP between the lowest (-9.6 ± 18.8/-3.8 ± 12.9 mmHg) and highest (6.8 ± 19.2/4.3 ± 13.9 mmHg) quartile of the distribution of BW changes (decrease >1.39 kg vs. increase >6.09 kg). Also, the mean change in BW for normotensive patients at baseline who still had a BP < 140/90 at month 18 (n = 722, 89.6%) compared to those whose BP values had increased to 140/90 mmHg or higher (n = 84, 10.4%) was significantly lower (2.3 ± 6.2 kg vs. 5.6 ± 7.6 kg, p < 0.001). Conclusions: Increasing body weight due to the improved health status after ART initiation was associated with hypertensive BP values. Counselling of PLHIV regarding measures to control body weight should be embedded into patient education programs at HIV centers in countries like Malawi.