Isolated Nocturnal Hypertension in People Living With Human Immunodeficiency Virus: A Cross-Sectional Study.

BACKGROUND: Nocturnal hypertension (NH) is a potent cardiovascular risk factor described frequently in people with HIV (PWH). Isolated NH (INH) is less well reported in PWH because of the need for ambulatory blood pressure monitoring (ABPM) in office normotensive patients. We aim to document the prevalence of NH and INH and the clinical factors associated with these phenotypes. METHODS: Cross-sectional study from an HIV program in Argentina. Office and ABPM measurements, as well as clinical and laboratory exploration, were performed. We defined INH as NH with daytime normotension in patients with office normotension. RESULTS: We obtained ABPM in 66 PWH, 60% male, aged 44.7 (IQR 27-69) years; 87% receiving antiretroviral therapy, and 86.2% virologically suppressed. ABPM-based hypertension prevalence was 54.7% (95% CI: 42.5-66.3). The prevalence of NH was 48.5% (32/66), while the INH prevalence was 19.7% (95% CI: 11.7-30.9). No differences were found regarding sex, HIV viral load, CD4+ T lymphocytes count, or years of infection between normotensive and INH patients. Multiple linear regression model adjusted for sex and age determined that body mass index (ß = 0.93, P < 0.01), plasma uric acid (ß = 0.25, P = 0.04), plasma potassium (ß = -10.1, P = 0.01), and high-sensitivity C-reactive protein (hs-CRP) (ß = 0.78, P = 0.02) independently predicted nocturnal systolic blood pressure (BP) in PWH. In a multiple logistic regression model adjusted for age and sex, the presence of sedentariness, plasma potassium <4 mEq/L, BMI, and hs-CRP levels were predictors of INH. CONCLUSION: INH is highly prevalent in PWH. Metabolic and inflammatory markers predict nocturnal SBP in PWH.

Hipertensión y síndrome metabólico en pacientes con Virus de la Inmunodeficiencia-Humana / Hypertension and metabolic syndrome in HIV infected patients

Resumen La enfermedad cardiovascular y sus factores de riesgos como hipertensión arterial (HTA) y síndrome metabólico (SM), son una creciente causa de mortalidad entre los infectados con HIV. Nuestros objetivos fueron determinar la prevalencia HTA y SM en pacientes HIV positivos de la ciudad de Córdoba su asociación con el estado inmunológico, inflamación y terapia antirretroviral (TARAA). Fue un estudio aleatorizado de corte transversal. Se incluyeron 65 pacientes HIV positivos del programa provincial HIV-Córdoba, 57 (87%) recibían TARAA, 39 (60%) eran masculinos, con edad promedio de 44.7 ± 10 años. La concentración de linfocitos T CD4+ (LTCD4+) fue 404.4 ± 289.6 cel./ml. La carga viral (CV) fue indetectable en 56 (86.2%). La prevalencia de HTA fue de 40% (26/65) y se asoció a la duración de TARAA (p < 0.05). No hubo asociación entre años de infección por HIV, LTCD4+ y CV con HTA. La prevalencia de SM fue de 38.5% (25/65). El uso de TARAA fue más frecuente en aquellos con SM (OR: 1.80; IC95%: 1.43-2.28; p = 0.02). Pacientes bajo TARAA presentaron alta tasa de hipertrigliceridemia, intolerancia a la glucosa y niveles bajos de HDL (todos p < 0.01). SM se asoció a la duración de TARAA (p < 0.01). La TARAA se asoció a HTA y SM, no encontrándose relación con estado inmunológico, CV o marcadores de inflamación.

Abstract Cardiovascular diseases (CVD) are a growing cause of mortality between human immunodeficiency virus (HIV) infected patients. Hypertension (HTN) and metabolic syndrome (MS) are important causes of CVD. The prevalence of HTN and MS in HIV infected patients in Córdoba, Argentina is unknown. Our aim is to determine the prevalence of HTN and MS in HIV patients in Córdoba and their association with immunological state, inflammation and highly active antiretroviral therapy (HAART) in an observational study. Sixty-five HIV infected patients from the provincial HIV program were randomly selected. Fifty-seven (87%) were on HAART, 39 (60%) were males. The mean age was 44.7 ± 10 years. Mean CD4+ T lymphocytes (CD4+T) count was 404.4 ± 289.6 cells/ml. Viral load (VL) was undetectable in 56 (86.2%). The prevalence of HTN was 40%, and it was associated with the duration of HAART (p < 0.05). There was no association between years of HIV infection, CD4+T, VL and blood pressure. The prevalence of MS was 38.5% (25/65). MS was more frequent between those with HAART (OR: 1.80; CI 95%; 1.43-2.28; p = 0.02). Patients on HAART had higher rates of hypertriglyceridemia, impaired glucose tolerance and lower levels of HDLc (p < 0.01). MS was associated with the HAART duration (p < 0.01). HIV infected patients had a high prevalence of HTN and MS. HAART was associated with both HTN and MS, but there was no association between immunological status, VL or inflammatory markers.