PREVALENCE AND INCIDENCE OF ARTERIAL HYPERTENSION OVER 36 MONTHS IN AMBULATORY HIV INFECTED PATIENTS ON ANTIRETROVIRAL THERAPY IN LILONGWE, MALAWI

Abstract

Objective: According to a meta-analysis hypertension (HT) prevalence is higher in HIV infected patients (PLHIV) on antiretroviral therapy (ART) compared to ART-naïve patients. As part of the prospective LighTen Cohort Study (ClinicalTrials.gov NCT02381275) we examined blood pressure (BP) changes in ambulatory PLHIV who had initiated tenofovir-containing ART. Design and method: Anthropometric measurements of study participants (age > = 18 years) were documented at baseline and during study visits after 1, 3, 6 and every 6 months thereafter. Systolic and mean office BP values (OBP, oscillometric measurements) for PLHIV, who were still active study participants at month 36 were analyzed. Age, gender, and anthropometric measurements were included in univariate and multivariate multilevel analysis to test for their effects on changes in BP (R statistical software, version 4.1.2). Results: BP measurements on at least two occasions were available for 1,288 PLHIV and HT was confirmed at baseline and during follow-up in 173 (13.4%) and 50 cases (4.7%), respectively. For the whole cohort systolic and mean BP increased from month 12 onwards with a significant (p < 0.001) impact of weight gain and age while female sex was protective. 36-month data from 799 (474 females, 325 males, mean age 37.1 ± 9.2 years) could be analyzed. Although the number of patients on antihypertensive drug treatment (HT Tx) nearly tripled (23 vs. 61), BP was uncontrolled in 125/799 PLHIV (15.6%) compared to 115/799 (14.4%) at baseline (Chi2-test p < 0.001). Conclusions: The proportion of patients with hypertensive BP values increased after initiating ART despite higher HT Tx rates. Counselling of PLHIV on measures regarding control of body weight and improved HT Tx compliance should be embedded into patient education programs at HIV centers.