Incidence and risk factors for hypertension among HIV patients in rural Tanzania - A prospective cohort study

• Published in: PloS one 2017-03, Vol.12 (3), p.e0172089
• Main Authors: Rodríguez-Arbolí, Eduardo, Mwamelo, Kim, Kalinjuma, Aneth Vedastus, Furrer, Hansjakob, Hatz, Christoph, Tanner, Marcel, Battegay, Manuel, Letang, Emilio
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Analysis; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Biology and Life Sciences; Blood; Blood pressure; Body mass; Body Mass Index; Body size; Cardiovascular diseases; Care and treatment; Cohort analysis; Cohort Studies; Confidence intervals; Correlation analysis; Epidemiology; Female; Glomerular Filtration Rate; Hazard assessment; Health aspects; Health risks; Health screening; Hipertensió; HIV; HIV (Viruses); HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - mortality; HIV Infections - pathology; HIV patients; Human immunodeficiency virus; Humans; Hypertension; Hypertension - complications; Hypertension - diagnosis; Hypertension - epidemiology; Immunology; Incidence; Kaplan-Meier Estimate; Lentivirus; Longitudinal Studies; Male; Medical diagnosis; Medicine and Health Sciences; Middle Aged; Obesity; Patients; Pregnancy; Pregnant women; Proportional Hazards Models; Prospective Studies; Regression analysis; Regression models; Retroviridae; Risk analysis; Risk Factors; Rural Population; Statistical analysis; Statistical models; Tanzania - epidemiology; VIH (Virus); Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0172089

Scarce data are available on the epidemiology of hypertension among HIV patients in rural sub-Saharan Africa. We explored the prevalence, incidence and risk factors for incident hypertension among patients who were enrolled in a rural HIV cohort in Tanzania. Prospective longitudinal study including HIV patients enrolled in the Kilombero and Ulanga Antiretroviral Cohort between 2013 and 2015. Non-ART naïve subjects at baseline and pregnant women during follow-up were excluded from the analysis. Incident hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg on two consecutive visits. Cox proportional hazards models were used to assess the association of baseline characteristics and incident hypertension. Among 955 ART-naïve, eligible subjects, 111 (11.6%) were hypertensive at recruitment. Ten women were excluded due to pregnancy. The remaining 834 individuals contributed 7967 person-months to follow-up (median 231 days, IQR 119-421) and 80 (9.6%) of them developed hypertension during a median follow-up of 144 days from time of enrolment into the cohort [incidence rate 120.0 cases/1000 person-years, 95% confidence interval (CI) 97.2-150.0]. ART was started in 630 (75.5%) patients, with a median follow-up on ART of 7 months (IQR 4-14). Cox regression models identified age [adjusted hazard ratio (aHR) 1.34 per 10 years increase, 95% CI 1.07-1.68, p = 0.010], body mass index (aHR per 5 kg/m2 1.45, 95% CI 1.07-1.99, p = 0.018) and estimated glomerular filtration rate (aHR < 60 versus ≥ 60 ml/min/1.73 m2 3.79, 95% CI 1.60-8.99, p = 0.003) as independent risk factors for hypertension development. The prevalence and incidence of hypertension were high in our cohort. Traditional cardiovascular risk factors predicted incident hypertension, but no association was observed with immunological or ART status. These data support the implementation of routine hypertension screening and integrated management into HIV programmes in rural sub-Saharan Africa.