Incidence and predictors of hypertension among adults with HIV initiating ART in southwestern Uganda
Background: Expanded access to anti-retroviral therapy (ART) in sub-Saharan Africa has increased life expectancy for people living with HIV (PLWH). In resource rich areas, there is evidence of increasing risk of non-communicable diseases among aging PLWH. Yet, there are limited data on the epidemiology of cardiovascular diseases in sub-Saharan Africa, which is home to approximately 90% of PLWH worldwide.
Methods: We abstracted sociodemographic and HIV-related clinical data (CD4 count, ART regimen) from adult patients initiating ART at the HIV clinic at Mbarara Regional Referral Hospital in Uganda from 2010-2012. Patients have a single blood pressure measured and recorded by a clinic nurse at each visit. Our outcome of interest was incidence of hypertension, defined as occurrence of 2 or more consecutive clinical visits with a systolic blood pressure >140mmHg and/or diastolic blood pressure recording of >90mmHg, or prescription for an antihypertensive medication. We calculated the crude incidence of hypertension by sex and age, and fit multivariable Cox proportional hazards regression models to determine predictors of incident hypertension.
Results: 3,400 patients initiated ART during the study period without a prior diagnosis of hypertension. Subjects attended a total of 22,783 clinic visits and contributed 3,996 person-years (median 396 days [IQR 170 – 628]). 67% were female and median age at enrollment was 32 years (IQR range 27 – 39). The incidence of hypertension was high in all age strata, and ranged from 87.9/1000 py in females <30 years old to 157.7/1000 py in males >40. In multivariable Cox proportional hazards models, male gender (AHR 1.86, 95%CI 1.47–2.35), increasing age (AHR 1.36, 95%CI 1.02–1.82 for those ³40 versus those <30), nadir CD4 count (AHR 1.57, 95%CI 1.01–2.54 for those with a nadir CD4<100 versus >1350), and increasing body mass index (AHR 3.07, 95%CI 1.81–5.22 for BMI >30 versus <25) were associated with increased risk of hypertension.
Conclusion: Incident hypertension is common among PLWH initiating ART in rural Uganda. Notably, lower nadir CD4 count is associated with increased risk of hypertension, independent of gender and BMI. Increased attention to screening of and treatment for hypertension should be prioritized in people living with HIV on ART in the region.
W. Muyindike, None
B. Annex, None
S. Haneuse, None
M. Siedner, None