Hypertension among people living with HIV ( PLHIV ) compared with people without HIV ( PWoH ): A systematic review with meta‐analysis

Introduction Hypertension is a major cardiovascular risk factor and has increased among people living with HIV. However, evidence on its association with HIV status remains inconsistent. This systematic review aimed to assess the association between HIV status and hypertension and to examine, through subgroup analyses, whether this association varies according to specific participant characteristics. Methods Searches were conducted in PubMed, Embase, Web of Science and Global Index Medicus, with an additional manual search of reference lists. Eligible observational studies included participants aged ≥18 years, with no geographical restrictions and defined hypertension using medical diagnosis, self‐reported hypertension, antihypertensive medication use or electronic health records. Studies involving individuals <18 years, pregnant women, non‐systemic hypertension and other study designs were excluded. Results Twenty‐six studies were included in the systematic review, and 23 cross‐sectional studies were incorporated into the meta‐analysis. In a synthesis of unadjusted associations, no association was observed between HIV status and hypertension (RR: 0.94; 95% CI: 0.79–1.12). Subgroup analyses by sex, overweight and obesity also showed no association. Among PLHIV with diabetes, a lower association with hypertension was observed compared with people without HIV with diabetes, although this finding should be interpreted with caution (RR: 0.32; 95% CI: 0.12–0.88). Substantial heterogeneity was observed ( I 2 = 99.5%). Five studies were of low methodological quality and 18 of moderate to high quality. The funnel plot showed no asymmetry, confirmed by Egger's test. Conclusion Although no association between HIV status and hypertension was observed, substantial heterogeneity and variable methodological quality limit definitive conclusions. High‐quality studies are needed to clarify whether HIV status modifies hypertension risk.