Abstract
BackgroundAfrican Americans are disproportionately affected by both HIV and hypertension. Failure to modify risk factors for cardiovascular disease and chronic kidney disease such as hypertension among HIV-infected patients may attenuate the benefits conferred by combination antiretroviral therapy. In the general population, African Americans with hypertension are less likely to have controlled blood pressure than whites. However, racial differences in blood pressure control among HIV-infected patients are not well studied.MethodsWe conducted a cross-sectional study evaluating racial differences in hypertension prevalence, treatment, and control among 1,664 patients attending the University of Alabama at Birmingham HIV Clinic in 2013. Multivariable analyses were performed to calculate prevalence ratios (PR) with 95% confidence intervals (CI) as the measure of association between race and hypertension prevalence and control while adjusting for other covariates.ResultsThe mean age of patients was 47 years, 77% were male and 54% African-American. The prevalence of hypertension was higher among African Americans compared with whites (49% vs. 43%; p = 0.02). Among those with hypertension, 91% of African Americans and 93% of whites were treated (p = 0.43). Among those treated, 50% of African Americans versus 60% of whites had controlled blood pressure (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) (p = 0.007). After multivariable adjustment for potential confounders, prevalence of hypertension was higher among African Americans compared to whites (PR 1.25; 95% CI 1.12–1.39) and prevalence of BP control was lower (PR 0.80; 95% CI 0.69–0.93).ConclusionsDespite comparable levels of hypertension treatment, African Americans in our HIV cohort were less likely to achieve blood pressure control. This may place them at increased risk for adverse outcomes that disproportionately impact HIV-infected patients, such as cardiovascular disease and chronic kidney disease, and thus attenuate the benefits conferred by combination antiretroviral therapy.
Highlights
Due to the effectiveness of combination antiretroviral therapy (ART), non-human immunodeficiency virus (HIV)-related diseases have become the predominant cause of morbidity and mortality among HIV-infected patients in high income countries [1]
The prevalence of hypertension was higher among African Americans compared with whites (49% vs. 43%; p = 0.02)
Despite comparable levels of hypertension treatment, African Americans in our HIV cohort were less likely to achieve blood pressure control. This may place them at increased risk for adverse outcomes that disproportionately impact HIV-infected patients, such as cardiovascular disease and chronic kidney disease, and attenuate the benefits conferred by combination antiretroviral therapy
Summary
Due to the effectiveness of combination antiretroviral therapy (ART), non-human immunodeficiency virus (HIV)-related diseases have become the predominant cause of morbidity and mortality among HIV-infected patients in high income countries [1]. Prior studies of the general population have reported that African Americans with hypertension are more likely to have uncontrolled blood pressure (BP) than whites despite similar rates of awareness and treatment [19, 20]. These disparities in hypertension prevalence and control contribute to higher rates of stroke, CKD, and congestive heart failure observed among African Americans compared to whites [21]. Failure to modify risk factors for cardiovascular disease and chronic kidney disease such as hypertension among HIV-infected patients may attenuate the benefits conferred by combination antiretroviral therapy. Racial differences in blood pressure control among HIV-infected patients are not well studied
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