24-h-Ambulatory Blood Pressure Monitoring in Sub-Saharan Africa: Hypertension Phenotypes and Dipping Patterns in Malawian HIV+ Patients on Antiretroviral Therapy

Abstract

Background: Cardiovascular disease and especially hypertension are a growing problem among people living with HIV (PLHIV) on antiretroviral therapy (ART) in sub-Saharan Africa. Objectives: As robust data on hypertension phenotypes associated with distinct cardiovascular risks among PLHIV are limited, we aimed to assess the frequency of white-coat (WCH), masked (MH) hypertension, and blood pressure dipping-patterns in a group of Malawian PLHIV. Methods: As part of the prospective Lighthouse-Tenofovir-Cohort-Study, we analyzed clinical, laboratory and 24-h-ambulatory blood pressure monitoring (ABPM) data of PLHIV from urban Lilongwe with treated or untreated hypertension or raised office blood pressure (OBP) during routine study-visits. Results: 118 PLHIV were included and data of 117 participants could be analyzed. Twentyfour-hour ABPM normotension was found in a total of 73 PLHIV including 14/37 on antihypertensive treatment (37.8%). Using strict definitions, i.e. normal OBP plus normal mean BP for all periods of ABPM, controlled hypertension was found in only 4/37 (10.8%) PLHIV on antihypertensive treatment while true normotension was observed in 10/24 untreated patients (41.7%) with previously diagnosed hypertension and 22/56 patients (39.3%) without a medical history of hypertension. WCH with normal BP during all periods of 24-h-ABPM was identified in 12/64 OBP-hypertensive PLHIV (18.8%), primarily in patients with grade 1 hypertension (11/41 patients; 26.8%). MH was found in 17/53 PLHIV with OBP-normotension (32.1%), predominantly in patients with high normal BP (11/20 patients; 55%). The estimated glomerular filtration rate tended to be lower in MH compared to strictly defined normotensive PLHIV (92.0±20.4 vs. 104.8±15.7 ml/min/m²). 64.1 percent of PLHIV (59.5% with 24-h hypertension and 66.7% with 24-h normotension) had abnormal systolic dipping. Conclusion:The high prevalence of WCH and MH with signs of early renal end-organ damage and an abnormal dipping in approximately 2/3 of PLHIV warrants further investigation as these factors may contribute to the increased cardiovascular risk in PLHIV in resource-limited settings like Malawi. Clinical Trial Registration: https://clinicaltrials.gov (NCT02381275), registered March 6th, 2015.

Nocturnal systolic blood pressure dipping among people living with HIV and people without HIV: a cross-sectional study in Rural Uganda

“…48 The few studies that have explored the profiles of nocturnal blood pressure (BP) dipping among individuals living with HIV (PLHIV) in Sub-Saharan Africa (SSA) support our finding of a high prevalence of non-dipping systolic BP among PLHIV. 49,50,51 Our observation of a prevalent non-dipping BP profile during the night among both PLHIV and PwoHIV closely aligns with recent research conducted by Nolan et al in Tanzania. 51 However, in contrast to our findings, Nolan et al reported a higher, albeit statistically insignificant, prevalence of non-dipping nocturnal BP among PLHIV compared to PwoHIV (64.2% [36/56] versus 53.1% [43/81]).…”

Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study

“…24-h ambulatory BP monitoring (24-h-ABPM) was not available when recruitment for the LighTen Study started. However, when 24-h-ABPM was performed in a subgroup of 117 LighTen participants, a median of 26 months (6–8 visits) after enrollment, white coat hypertension or white coat effect was identified in 18.8% of those with office hypertension [ 84 ]. Self-reported hypertension could have been another important source of bias and is known to be considerably flawed [ 85 ], but patients without antihypertensive drug treatment and BP values < 140/90 mmHg were not included in the calculation of the prevalence of hypertension.…”

Alterações metabólicas em pessoas que vivem com HIV: estudo de coorte retrospectivo

“…Além disso, estudos retrospectivos e transversais demonstram que a prevalência de hipertensão é maior em adultos infectados pelo HIV quando comparados aos não infectados (BATAVIA et al, 2018;CUNHA et al, 2018;KASPER et al, 2021). A Pressão Arterial (PA) elevada é um importante determinante da sobrevida em longo prazo em PVHIV (BATAVIA et al, 2018;BARROSO et al, 2021;KASPER et al, 2021;).…”