What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension and HIV (n=1061). Intervention: Integrated HIV and hypertension care vs. Baseline. Primary outcome: Blood pressure control (<140/90 mmHg) at 6 months (association with comorbid diabetes mellitus) (OR 0.41, 95% CI 0.26-0.64, p=<0.001).

December 7, 2022Open Access

Factors associated with blood pressure control in patients with hypertension and HIV at a large urban HIV clinic in Uganda

Q: What are the key findings of this study?

Comorbid diabetes mellitus (OR 0.41) and HIV status disclosure (OR 0.73) were associated with a significantly lower likelihood of achieving blood pressure control at 6 months.

Resultado clave

Comorbid diabetes mellitus (OR 0.41) and HIV status disclosure (OR 0.73) were associated with a significantly lower likelihood of achieving blood pressure control at 6 months.

Diseño del estudio

Tipo

Observational (n=1,061)

Multicéntrico

PICO estructurado

What baseline factors are associated with blood pressure control at 6 months in hypertensive persons living with HIV?

Población

1061 hypertensive persons living with HIV on antiretroviral therapy, mean age 51.1, 62.6% female, receiving integrated HIV and hypertension care at a large urban clinic in Uganda.

Intervención

Antihypertensive treatment within integrated HIV and hypertension care

Resultado

Blood pressure control (<140/90 mmHg) at 6 monthssurrogate

In persons living with HIV and hypertension, comorbid diabetes and HIV status disclosure are associated with poorer blood pressure control at 6 months, highlighting the need for intensive management in these subgroups.

Resultado numérico

Estimación del efecto: OR 0.41 (95% CI 0.26-0.64)

valor p: p=<0.001

Limitaciones

Data on HIV status disclosure were self-reported without objective validation
Analysis focused on patients who received integrated care from a single clinic, not considering alternative facilities
Did not consider out-of-office blood pressure, which is a good predictor of sustained blood pressure control

Resumen

Globally, people living with HIV on antiretroviral therapy have an increased risk of cardiovascular disease. Hypertension is the most important preventable risk factor for cardiovascular disease and is associated with increased morbidity. We conducted an exploratory survey with hypertensive persons living with HIV who received integrated HIV and hypertension care in a large clinic in Uganda between August 2019 and March 2020 to determine factors associated with blood pressure control at six months. Controlled blood pressure was defined as <140/90 mmHg. Multivariable logistic regression was used to determine baseline factors associated with blood pressure control after 6 months of antihypertensive treatment. Of the 1061 participants, 644 (62.6%) were female. The mean age (SD) was 51.1 (9.4) years. Most participants were overweight (n = 411, 38.7%) or obese (n = 276, 25.9%), and 98 (8.9%) had diabetes mellitus. Blood pressure control improved from 14.4% at baseline to 66.1% at 6 months. Comorbid diabetes mellitus (odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.26-0.64, p < 0.001) and HIV status disclosure (OR = 0.73, 95% CI = 0.55-0.98, p = 0.037) were associated with the absence of controlled blood pressure at 6 months. In conclusion, comorbid diabetes mellitus and the disclosure of an individual's HIV status to a close person were associated with poor blood pressure control among persons living with HIV who had hypertension. Therefore, subpopulations of persons living with HIV with hypertension and comorbid diabetes mellitus may require more thorough assessments and intensive antihypertensive management approaches to achieve blood pressure targets.

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