Immune markers, diurnal blood pressure profile and cardiac function in virologically suppressed HIV-infected patients.

PURPOSE: Non-dipping nocturnal blood pressure (BP) pattern has been reported prevalent among HIV-infected patients and is associated with adverse cardiovascular outcomes. The aims of this observational study were to identify predictors of nocturnal BP decline, and to explore whether diurnal BP profile is associated with alterations in cardiac structure and function. MATERIALS AND METHODS: A total of 108 treated HIV-infected patients with suppressed viremia underwent ambulatory BP measurement, 51 of these patients also underwent echocardiography. RESULTS: Non-dipping nocturnal BP pattern was present in 51% of the patients. Decreased nocturnal decline in systolic BP (SBP) correlated with lower CD4 count (rsp = 0.21, p = 0.032) and lower CD4/CD8 ratio (rsp = 0.26, p = 0.008). In multivariate linear regression analyses, lower BMI (p = 0.015) and CD4/CD8 ratio <0.4 (p = 0.010) remained independent predictors of nocturnal decline in SBP. Nocturnal decline in SBP correlated with impaired diastolic function, e' (r = 0.28, p = 0.049) as did nadir CD4 count (rsp = 0.38, p = 0.006). In multivariate linear regression analyses, nadir CD4 count <100 cells/µL (p = 0.037) and age (p < 0.001) remained independent predictors of e'. CONCLUSIONS: Compromised immune status may contribute to attenuated diurnal BP profile as well as impaired diastolic function in well-treated HIV infection.

Hypertension and antihypertensive treatment in HIV-infected individuals. A longitudinal cohort study.

OBJECTIVES: Hypertension is a significant contributor to cardiovascular disease in HIV-infected individuals. The purposes of this study were to assess the development of new-onset hypertension and the use of antihypertensive treatment and blood pressure (BP) control. METHODS: In a longitudinal study of 434 HIV-infected individuals (43±11 years, 72% males, follow-up 3.4±0.8 years), standardized BP recordings were undertaken at three clinical visits both at baseline and at follow-up, and cardiovascular risk factors were monitored. Adjusted odds ratio (OR) for new-onset hypertension (systolic BP≥140 and/or diastolic BP≥90 mmHg or initiation of antihypertensive treatment) was calculated using multiple logistic regression analyses. RESULTS: New-onset hypertension occurred with an incidence of 29.8 per 1000 person-years (95% CI 20.3-42.2). HIV duration (OR=1.10, 95% CI 1.01-1.20), mean BP (1.24, 95% CI 1.13-1.35) and abnormal urinary albumin excretion (OR=5.47, 95% CI 1.07-27.85) were independent predictors for new-onset hypertension after adjustment. Use of antihypertensive treatment increased threefold from 17% to 49% in hypertensive patients. Adequate BP control was obtained in 22% of patients on antihypertensive therapy. CONCLUSIONS: HIV duration predicted new-onset hypertension, which could suggest involvement of low-grade inflammation; this hypothesis needs to be further explored. Despite increased use of antihypertensive treatment, enhanced awareness and adequate treatment of hypertension are still warranted in HIV-infected individuals.

Effect of HIV duration on ambulatory blood pressure in HIV-infected individuals with high office blood pressure.

OBJECTIVE: There is a scarcity of data on ambulatory blood pressure (ABP) in HIV-infected individuals. The aim of the study was to identify possible predictors of ABP in HIV-infected individuals. METHODS: From a cohort of 542 HIV-infected patients, ABP monitoring was undertaken in 77 patients with high office blood pressure (BP) readings and without antihypertensive treatment. RESULTS: 24-h and daytime ABPs were associated with HIV duration (r=0.24-0.33, p=0.004-0.033), but not with duration of combined antiretroviral therapy. In multivariate linear regression analyses with the different ABPs as dependent variables, HIV duration (unstandardized beta=0.41-0.89, p=0.008-0.045) and log-transformed urinary albumin excretion (p=0.003-0.043) were predictors of all 24-h and daytime ABPs. Multiple logistic regression analysis revealed HIV duration (OR=1.14/year (95% CI 1.03-1.26)) as predictor of hypertension defined according to daytime ABP. Nocturnal hypertension was observed in 81%, white coat hypertension was present in 26%. CONCLUSIONS: HIV duration was an independent predictor of ABP and hypertension in a selected group of HIV-infected individuals. Nocturnal hypertension was prevalent, and white coat hypertension was present in one fourth of the patients.

Hypertension in an urban HIV-positive population compared with the general population: influence of combination antiretroviral therapy.

OBJECTIVES: Hypertension is a major risk factor for cardiovascular diseases and mortality. The introduction of combination antiretroviral therapy for HIV-infected patients has changed their prognosis substantially, but there is an additional cost from the increased risk of cardiovascular diseases. We aimed to assess the prevalence of hypertension in an HIV-infected population and to identify possible predictors. METHODS: A cohort of 542 unselected HIV-infected individuals had their blood pressure measured at three consecutive clinical visits. They were compared with an age-matched, sex-matched and body mass index-matched population-based control group (n=24 968). RESULTS: The prevalence of hypertension among the white HIV-infected individuals was 36.5%, which was not significantly different from the general population. The mean diastolic blood pressure was higher in HIV-infected individuals. The highest prevalence of hypertension was found in those who had been treated by combination antiretroviral therapy for more than 5 years (44.4%). Patients with hypertension were characterized by older age, male sex, white ethnicity, higher body mass index, total cholesterol and low-density lipoprotein cholesterol, lower glomerular filtration rate, more frequent microalbuminuria, longer time with known HIV-positive status and longer combination antiretroviral therapy duration compared with normotensive individuals. Multivariate analysis revealed age, sex, body mass index, cholesterol, combination antiretroviral therapy duration and microalbuminuria as independent predictors of hypertension. CONCLUSION: Diastolic blood pressure was increased in these white HIV-infected patients compared with the general population, but there was no difference in the prevalence of hypertension. However, the duration of combination antiretroviral therapy predicted hypertension independently.

Microalbuminuria associated with indicators of inflammatory activity in an HIV-positive population.

BACKGROUND: The survival of human immunodeficiency virus (HIV)-infected patients has increased significantly since the introduction of combination antiretroviral therapy, leading to the development of important long-term complications including cardiovascular disease (CVD) and renal disease. Microalbuminuria, an indicator of glomerular injury, is associated with an increased risk of progressive renal deterioration, CVD and mortality. However, the prevalence of microalbuminuria has barely been investigated in HIV-infected individuals. METHODS: Based on three prospective urine samples in an unselected nonhypertensive, nondiabetic HIV-positive cohort (n = 495), we analysed the prevalence of microalbuminuria and compared the Caucasian share with that of a nonhypertensive, nondiabetic population-based control group (n = 2091). Significant predictors for microalbuminuria were analysed within the HIV-positive cohort. RESULTS: The prevalence of microalbuminuria was 8.7% in the HIV-infected cohort, which is three to five times higher than that in the general population. HIV-infected patients with microalbuminuria were older, and had higher blood pressure, longer duration of HIV infection, higher serum beta 2-microglobulin, higher serum creatinine and a reduced glomerular filtration rate of < or =90 mL/min, compared with those with normal albumin excretion. In multivariate analysis, systolic blood pressure, serum beta 2-microglobulin and duration of HIV infection were found to be independent predictors of microalbuminuria. CONCLUSIONS: Our findings indicate that in addition to haemodynamic effects, inflammatory activity may be implicated as a cause of the development of microalbuminuria. With respect to the increasing risk of developing CVD or renal diseases and mortality, the high prevalence of microalbuminuria in HIV-infected individuals warrants special attention.

Low nadir CD4 cell count predicts sustained hypertension in HIV-infected individuals.

Hypertension is associated with cardiovascular disease in the human immunodeficiency virus (HIV)-infected population. The authors aimed to test the hypothesis whether advanced immunosuppression with low nadir CD4 lymphocyte cell count is a predictor of sustained hypertension in HIV-infected individuals. In a longitudinal study of an HIV cohort of 434 patients (43±11 years, 72% men, 71% Caucasians), standardized blood pressure was measured in duplicate during 3 clinical visits both at baseline and after 3.4±0.8 years. The lowest CD4 cell count in the individual history was recorded as nadir CD4. Both nadir CD4 cell count<50 cells/µL and duration of antiretroviral therapy (ART) were associated with sustained hypertension, and the highest proportion of hypertensive patients was observed in those who had both nadir CD4 cell count<50 cells/µL and prolonged ART duration. Nadir CD4 cell-count<50 cells/µL was an independent predictor of hypertension (adjusted odds ratio [OR], 2.48; 95% confidence interval [CI], 1.27-4.83), as was ART duration (adjusted OR, 1.13; 95% CI, 1.03-1.24). The predictive power of ART duration was more pronounced in patients with nadir CD4 cell count<50 cells/µL. Delaying ART initiation until a state of advanced immunosuppression might add to and even fuel the cardiovascular risk associated with ART.