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Hypertension – Causes

Causes

Whether hypertension is influenced by HIV infection per se and/or by antiretroviral (ARV) therapy is currently unclear.


  • HIV infection itself has been linked to hypertension in some studies,1–3 but not in others.4–6
  • Long-term use of combination ARV drug regimens may be associated with hypertension,4,5 though this is not the case in all analyses.7
  • An observational study found that treatment with lopinavir/ritonavir was associated with elevated blood pressure (BP), following the initiation of treatment.8
     


Guidelines from the European Society of Hypertension and European Society of Cardiology (ESH/ESC),9 and the United States Department of Health and Human Services (US DHHS),10 suggest conditions that may cause hypertension in the general population. These include:


  • sleep apnea
  • drug-induced hypertension (e.g. associated with steroid use)
  • chronic renal parenchymal disease
  • primary hyperaldosteronism
  • renovascular disease
  • Cushing’s syndrome
  • pheochromocytoma
  • coarctation of the aorta
  • thyroid or parathyroid disease
     


For further information on diagnostic assessments and recommendations for these causes of hypertension, see the ESH/ESC Guidelines and the US DHHS JNC7 Guidelines. 




 

References

  1. 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;92:2506–2512.
  2. 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;11:100–109.
  3. Gazzaruso C, Bruno R, Garzaniti A, et al. Hypertension among HIV patients: prevalence and relationships to insulin resistance and metabolic syndrome. J Hypertens. 2003;21:1377–1382.
  4. 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;19:953–960.
  5. 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;26:2126–2133.
  6. Jericó C, Knobel H, Montero M, et al. Hypertension in HIV-infected patients: prevalence and related factors. Am J Hypertens. 2005;18:1396–1401.
  7. Thiébaut R, El-Sadr WM, Friis-Møller N, et al. Predictors of hypertension and changes of blood pressure in HIV-infected patients. Antivir Ther. 2005;10:811–823.
  8. Crane HM, Van Rompaey SE, Kitahata MM. Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy. AIDS. 2006;20:1019–1026.
  9. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the Management of Arterial Hypertension. Eur Heart J. 2007;28:1462–1536.
  10. US Department of Health and Human Services. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. December 2003. Accessed 8 March 2011.