Blood pressure trajectories among people with and without HIV in a U.S.-based prospective cohort study

BACKGROUND: People with HIV experience conventional and HIV-specific risk factors for increased blood pressure and may have different trajectories than people without HIV. Using data from the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS), we describe longitudinal patterns in blood pressure, hypertension, and vital status for people with HIV and without HIV. METHODS: We estimated longitudinal trajectories of systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure using generalized estimating equations. Using multinomial logistic regression and Kaplan-Meier curves, we estimated the proportion of participants in four states corresponding to vital and hypertensive status. RESULTS: We included men and women with HIV who reported antiretroviral therapy use (MACS: n = 1555; WIHS: n = 2765) and men and women without HIV (MACS: n = 1671; WIHS: n = 1145) between ages 20 and 70 from 1998 to 2019. Trajectory shapes were similar between people with and without HIV within cohorts. Men with and without HIV had similar blood pressure across ages. Women with HIV had lower blood pressure than those without HIV (average systolic difference -4.7 mmHg; 95% CI: -5.6, -3.8). Despite comparable average time alive without hypertension, people with HIV experienced higher mortality than those without HIV (risk at age 50, MACS: 13.1% vs. 8.1%; WIHS 33.3% vs. 9.6%). CONCLUSION: Blood pressure trajectories were similar between people with and without HIV, although blood pressure was slightly lower for women with HIV. High mortality among people with HIV (vs. without) may have resulted in a lower proportion of people with hypertension at older ages.