Abstract:

Objective: The objective of this study was to determine how baseline blood pressure and incident hypertension related to antiretroviral therapy (ART) initiation, HIV-related inflammation, and mortality in HIV-infected adults in a low-income country.

Methods: We conducted long-term follow-up of HIV-infected adults who had participated in a trial of early versus delayed initiation of ART in Port-au-Prince, Haiti. Between 2005-2008, 816 HIV-infected adults were randomized to early (N=408) versus delayed ART (when CD4<200 cells/mm3 or AIDS-defining condition; N=408). Blood pressure was measured every 3 months. Hypertension was diagnosed according to the Joint National Committee (JNC-7) guidelines. Biomarkers of inflammation and coagulation were measured from banked enrollment plasma samples. Survival analyses were performed using Stata 14.

Results: The median age at enrollment was 39 years. The median follow-up time was 7.3 years. The hypertension incidence rate was 3.41 per 100 person years, and was similar in early and delayed ART groups. In multivariable models, independent predictors of incident hypertension were older age, higher BMI, and plasma IL-6 levels (adjusted hazard ratio, aHR=1.23, p<0.001). Systolic pressure >140mmHg at enrollment was associated with increased mortality (aHR=2.47, p=0.03) as was systolic pressure <90mmHg (aHR=2.25, p=0.04). Prevalent and incident hypertension were also significantly associated with mortality.

Conclusions: In a large prospective study of HIV-infected adults we found a high incidence of hypertension associated with HIV-related inflammation. Baseline hypertension conferred a >2-fold increased risk of death. Among HIV-infected adults in low-income countries, hypertension should be considered a serious threat to long-term survival.