Key result
African American HIV-infected patients treated for hypertension were significantly less likely to achieve blood pressure control compared to white patients (PR 0.80).
Why the study?
Does African American race affect hypertension prevalence and control in HIV-infected patients?
Cross-Sectional (n=1,664)
No
Does African American race affect hypertension prevalence and control in HIV-infected patients?
Relative Risk: 0.8 (95% CI 0.69–0.93)
Absolute Event Rate: 50% vs 60%
p-value: p=0.004
Despite comparable levels of hypertension treatment, African Americans with HIV are less likely to achieve blood pressure control compared to whites, placing them at increased risk for adverse cardiovascular outcomes.
May heighten cardiovascular risk in African Americans with HIV; extends racial disparity observations to this population but remains hypothesis-generating.
BACKGROUND: African Americans are disproportionately affected by both HIV and hypertension. Failure to modify risk factors for cardiovascular disease and chronic kidney disease such as hypertension among HIV-infected patients may attenuate the benefits conferred by combination antiretroviral therapy. In the general population, African Americans with hypertension are less likely to have controlled blood pressure than whites. However, racial differences in blood pressure control among HIV-infected patients are not well studied. METHODS: We conducted a cross-sectional study evaluating racial differences in hypertension prevalence, treatment, and control among 1,664 patients attending the University of Alabama at Birmingham HIV Clinic in 2013. Multivariable analyses were performed to calculate prevalence ratios (PR) with 95% confidence intervals (CI) as the measure of association between race and hypertension prevalence and control while adjusting for other covariates. RESULTS: The mean age of patients was 47 years, 77% were male and 54% African-American. The prevalence of hypertension was higher among African Americans compared with whites (49% vs. 43%; p = 0.02). Among those with hypertension, 91% of African Americans and 93% of whites were treated (p = 0.43). Among those treated, 50% of African Americans versus 60% of whites had controlled blood pressure (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) (p = 0.007). After multivariable adjustment for potential confounders, prevalence of hypertension was higher among African Americans compared to whites (PR 1.25; 95% CI 1.12-1.39) and prevalence of BP control was lower (PR 0.80; 95% CI 0.69-0.93). CONCLUSIONS: Despite comparable levels of hypertension treatment, African Americans in our HIV cohort were less likely to achieve blood pressure control. This may place them at increased risk for adverse outcomes that disproportionately impact HIV-infected patients, such as cardiovascular disease and chronic kidney disease, and thus attenuate the benefits conferred by combination antiretroviral therapy.
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Burkholder et al. (2018) conducted a cross-sectional in HIV and hypertension (n=1,664). African American race vs. White race was evaluated on Blood pressure control (SBP <140 mmHg and DBP <90 mmHg) among patients treated for hypertension (PR 0.80, 95% CI 0.69-0.93, p=0.004). African American HIV-infected patients treated for hypertension were significantly less likely to achieve blood pressure control compared to white patients (PR 0.80).
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