Key considerations for people living with HIV

Hypertension plays a substantial aetiological role in the development of ischaemic heart disease, cerebrovascular disease, cardiac failure and renal failure.1

In a study of people living with HIV (PLWHIV; n=214), patients with hypertension had a much higher frequency of the following complications,  compared with those with normal blood pressure (BP):2

  • persistent proteinuria (41% versus 2.8%; p<0.001)
  • coronary heart disease (CHD; 16% versus 1.3%; p<0.0001)
  • myocardial infarction (MI; 8.1% versus 0.7%; p<0.005).

Lower glomerular filtration rate and more frequent microalbuminuria were also significantly associated with hypertension in another study.3

Significantly higher rates of hypertension have been noted in PLWHIV versus those without HIV.

  • In an analysis of a large number of PLWHIV (n=3,851), the prevalence of hypertension was 21.2% versus 15.9% in HIV-negative individuals (p<0.0001).
  • This finding was confirmed in other, smaller analyses,5,6 though some studies did not find a notable increase in the prevalence of systolic hypertension in HIV-positive versus HIV-negative individuals3,7,8
  • hypertension may be associated with the use of combination antiretroviral (ARV) therapy for a number of years.3,7

Testing for hypertension should form part of the regular screening assessment for all PLWHIV.9 See the Diagnostic tools section for more details. There are notable potential drug-drug interactions (DDIs) between anti-hypertensives and ARVs. Please access the HIV Drug-drug interactions section for more details.

References

  1. World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertension. 2003;21:1983–92.
  2. Jung O, Bickel M, Ditting T, et al. Hypertension in HIV-1-infected patients and its impact on renal and cardiovascular integrity. Nephrol Dial Transplant. 2004;19:2250–8.
  3. Baekken M, Os I, Sandvik L, Oektedalen O. Hypertension in an urban HIV-positive population compared with the general population: influence of combination antiretroviral therapy. J Hypertens. 2008;26:2126–33.
  4. Triant VA, Lee H, Hadigan C, et al. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506–12.
  5. Onen NF, Overton ET, Seyfried W, et al. Aging and HIV infection: a comparison between older HIV-infected persons and the general population. HIV Clin Trials. 2010;11:100–9.
  6. Gazzaruso C, Bruno R, Garzaniti A, et al. Hypertension among HIV patients: prevalence and relationships to insulin resistance and metabolic syndrome. J Hypertens. 2003;21:1377–82.
  7. Seaberg EC, Muñoz A, Lu M, et al. Association between highly active antiretroviral therapy and hypertension in a large cohort of men followed from 1984 to 2003. AIDS. 2005;19:953–60.
  8. Jericó C, Knobel H, Montero M, et al. Hypertension in HIV-infected patients: prevalence and related factors. Am J Hypertens. 2005;18:1396–401.
  9. European AIDS Clinical Society. Guidelines. Version 6.0. Accessed 18 October 2011.