Race and sex differences in ambulatory blood pressure measures among HIV+ adults

Kent, Shia T.; Schwartz, Joseph E.; Shimbo, Daichi; Overton, Edgar Turner; Burkholder, Greer A.; Oparil, Suzanne; Mugavero, Michael J.; Muntner, Paul

doi:10.1016/j.jash.2017.05.002

Cited by 11 publications

(12 citation statements)

References 36 publications

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“…on ABPM profiles in HIV. [ 19 ] Thus, HIV infection itself or other non- traditional potential risk factors for non-dipping BP such as: mood disorders, psychosocial stress and poor sleep quality need to be considered. Health care providers should consequently be attentive towards diagnosing psychosocial stressors and mood disorders, depression in particular, which are the most frequent psychiatric complication associated with HIV.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies suggest a greater prevalence of nocturnal non-dipping BP in HIV-uninfected African Americans compared to their white counterparts. [ 18 , 19 ] However, ABPM patterns have been scarcely described in HIV-infected or uninfected black African populations. A South African study, comparing ABPM in black and Indian-ancestry medical students, revealed less nocturnal dipping and a higher left ventricular mass in the black students.…”

Section: Introductionmentioning

confidence: 99%

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High prevalence of “non-dipping” blood pressure and vascular stiffness in HIV-infected South Africans on antiretrovirals

et al. 2017

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BackgroundHIV-infected individuals are at increased risk of tissue inflammation and accelerated vascular aging (‘inflamm-aging’). Abnormal diurnal blood pressure (BP) rhythms such as non-dipping may contribute to an increased risk of cardiovascular and cerebrovascular events in HIV infected individuals. However, little data exists on ambulatory blood pressure (ABP) and measures of vascular stiffness in the black African HIV infected population.MethodsThis is a cross-sectional analysis of otherwise well, HIV infected outpatients on ART for >5 years. Study assessments included: 24hr ABP monitoring, pulse wave velocity (PWV) and central aortic systolic pressure (CASP) using a AtCor Medical Sphygmocor device, fasting lipogram, oral glucose tolerance test, high-sensitivity C-reactive protein (hsCRP) and anthropometric data. Patients completed a questionnaire of autonomic symptoms. CD4+ counts and viral loads were obtained from the National Laboratory results system.ResultsSixty seven black participants were included in the analysis of whom 91% (n = 61) were female with a mean age of 42.2 ± 8.6 years. The median duration on ART was 7.5 years (IQR = 6–10), 84% were virally supressed and the median CD4 count was 529.5cells/mm3 (IQR = 372.0–686.5). The majority (67%) were classified as overweight and 76% had an increased waist circumference, yet only 88% of participants were normotensive. A hsCRP level in the high cardiovascular risk category was found in 68% of participants. The prevalence of non-dipping BP was 65%. Interestingly, there was no association on multivariable analysis between dipping status and traditional risk factors for non-dipping BP, such as: obesity, autonomic dysfunction and older age.ConclusionThis relatively young cross-sectional sample of predominantly normotensive, but overweight black women on effective ART >5 years showed: a high prevalence of non-dipping BP, inflammation and vascular stiffness. Causality cannot be inferred but cardiovascular risk reduction should be emphasized in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High prevalence of “non-dipping” blood pressure and vascular stiffness in HIV-infected South Africans on antiretrovirals

et al. 2017

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“…This neuro-endocrine hyperactivity may be partially explained by psychosocial influences that have been shown to a play a role in hypertension, with investigators implicating stressors such as HIV-related stigma and mood disorders in autonomic dysfunction and disturbances of circadian rhythm. 88–90 The influence of circadian rhythm derangement is further supported by the observation that, even among HIV-infected individuals who did not meet diagnostic criteria for hypertension, there was a greater likelihood of elevated nocturnal pressures and a lesser incidence of dipping systolic blood pressure, both of which may be harbingers of impending hypertension. 88,91,92…”

Section: Mechanismsmentioning

confidence: 97%

Hypertension in HIV-Infected Adults

2018

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“…Some studies with HIV-infected patients conducted in South Africa also found a high proportion of MH, and other study conducted in United States shows a prevalence higher among African Americans than among whites. 39 - 41 Furthermore, high prevalence of MH had already been described in African Americans in large cohorts of non-HIV-infected population. 42 Additionally, the ICH proportion in patients previously diagnosed with hypertension is similar to that of our cohort, according to other authors.…”

Section: Discussionmentioning

confidence: 99%

“…A high proportion of patients with MH were diagnosed because they had nocturnal hypertension, which is exclusively diagnosed by ABPM. Nocturnal hypertension has been previously described in HIV-infected patients, especially among African Americans, 41 and it is considered that it has similar causal mechanisms with nondipper pattern. Nondipper pattern was found more frequently in HIV-infected than in non-HIV patients in previous case-control studies.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Blood Pressure Monitoring in HIV-Infected Patients: Usefulness for Cardiovascular Risk Assessment

Gómez-Berrocal

Santos-Gil

Abad-Pérez

et al. 2020

J Int Assoc Provid AIDS Care

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Background: There is a lack of consensus regarding the risk of hypertension in HIV-infected patients compared to the general population. Ambulatory blood pressure monitoring (ABPM) is the most accurate method for the hypertension diagnosis. Nevertheless, it is rarely used in HIV clinical care. Materials and Methods: All HIV-infected patients who underwent 24 hours ABPM were included. The agreement between office blood pressure (BP) readings and ABPM was analyzed. The rate of patients with masked hypertension (MH), isolated clinical hypertension, and nocturnal hypertension was obtained. Furthermore, it was analyzed if the differences between both methods may affect the cardiovascular risk (CVR) assessment. Results: A total of 116 patients were included. The κ coefficient between office BP and ABPM was 0.248. Over a quarter of the cohort was diagnosed with MH—25.8% (CI 95% 17.7%-34.0%), and 12% (CI 95%: 6.1%-16.1%) was diagnosed with ICH. Moreover, 19% of patients had hypertension exclusively during the night. The patients classified as low risk according to the CVR scores had a different diagnosis with ABPM than with office BP ( P < .001). Conclusions: The agreement between office BP and ABPM was low in HIV-infected patients. Ambulatory BP monitoring is useful in HIV-infected patients as a hypertension diagnosis method, especially among patients classified as low risk.

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Race and sex differences in ambulatory blood pressure measures among HIV+ adults

Cited by 11 publications

References 36 publications

High prevalence of “non-dipping” blood pressure and vascular stiffness in HIV-infected South Africans on antiretrovirals

High prevalence of “non-dipping” blood pressure and vascular stiffness in HIV-infected South Africans on antiretrovirals

Hypertension in HIV-Infected Adults

Ambulatory Blood Pressure Monitoring in HIV-Infected Patients: Usefulness for Cardiovascular Risk Assessment

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