Hypertension and antihypertensive treatment in HIV-infected individuals. A longitudinal cohort study

Objectives. Hypertension is a significant contributor to cardiovascular disease in HIV-infected individuals. The purposes of this study were to assess the development of new-onset hypertension and the use of antihypertensive treatment and blood pressure (BP) control. Methods. In a longitudinal study of 434 HIV-infected individuals (43 +/- 11 years, 72% males, follow-up 3.4 +/- 0.8 years), standardized BP recordings were undertaken at three clinical visits both at baseline and at follow-up, and cardiovascular risk factors were monitored. Adjusted odds ratio (OR) for new-onset hypertension (systolic BP >= 140 and/or diastolic BP >= 90 mmHg or initiation of antihypertensive treatment) was calculated using multiple logistic regression analyses. Results. New-onset hypertension occurred with an incidence of 29.8 per 1000 person-years (95% CI 20.3-42.2). HIV duration (OR = 1.10, 95% CI 1.01 = 1.20), mean BP (1.24, 95% CI 1.13 = 1.35) and abnormal urinary albumin excretion (OR = 5.47, 95% CI 1.07 = 27.85) were independent predictors for new-onset hypertension after adjustment. Use of antihypertensive treatment increased threefold from 17% to 49% in hypertensive patients. Adequate BP control was obtained in 22% of patients on antihypertensive therapy. Conclusions. HIV duration predicted new-onset hypertension, which could suggest involvement of low-grade inflammation; this hypothesis needs to be further explored. Despite increased use of antihypertensive treatment, enhanced awareness and adequate treatment of hypertension are still warranted in HIV-infected individuals.