Key result
People living with HIV were more likely to remain undiagnosed for hypertension compared with those without HIV.
Why the study?
Longitudinal evidence describing progression and regression through the hypertension care cascade comparing people living with HIV and those not living with HIV in South Africa remains limited.
Does living with HIV affect progression and regression across the hypertension care cascade in adults receiving chronic care?
Observational (n=23,855)
Yes
Does living with HIV affect progression and regression across the hypertension care cascade in adults receiving chronic care?
Answers are grounded in this paper and cite their sources.
People living with HIV experienced significantly lower rates of hypertension diagnosis and blood pressure control, as well as higher rates of regression to uncontrolled or untreated states, underscoring critical gaps in integrated chronic care.
BACKGROUND: Hypertension (HTN) constitutes a major and growing public health challenge in South Africa, a setting where HIV prevalence also remains high. Despite this dual burden, longitudinal evidence describing how individuals move through the HTN care cascade particularly comparing people living with HIV (PLHIV) and people not living with HIV (PNLHIV) remains limited. Understanding patterns of progression and regression across the cascade is essential to inform health system strategies for integrated chronic disease management. METHODS AND FINDINGS: We conducted a longitudinal secondary analysis using data collected from the iHEART-SA trial, implemented across nine public primary healthcare clinics in Johannesburg between August 2022 and May 2024, with follow-up through May 2025. Adults (≥18 years) receiving chronic care, with a known HIV status and a completed medical file review were included. Progression and regression were assessed across the HTN care cascade. Of 23,855 participants, 78.5% were PLHIV (median age 42 years, IQR 36-49; 69% female). The median SBP was 132 mmHg (IQR: 120-145 mmHg). Along the HTN care cascade, PLHIV were substantially more likely to remain undiagnosed compared with PNLHIV (aRR 3.40; 95% [CI 2.45, 4.73]; p < 0.001). Among those treated, PLHIV were less likely to achieve BP control (aRR 0.85; 95% [CI 0.75, 0.97]; p = 0.012). During follow-up, PLHIV experienced higher rates of cascade regression, including regression to untreated HTN (22% versus 11%; aRR 1.51; 95% [CI 1.03, 2.23]; p = 0.037) and from controlled to uncontrolled BP (aRR 1.10; 95% [CI 1.02, 1.18]; p = 0.010). The main study limitations were the use of routinely collected clinical data, variable follow-up, and treatment ascertainment based on documented medication use. CONCLUSIONS: PLHIV had lower HTN diagnosis and higher regression, including treatment discontinuation and loss of BP control, underscoring persistent gaps in longitudinal HTN management within HIV programmes and the need for integrated and targeted chronic care models that ensure treatment continuity and sustained control.
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Gumede et al. (2026) conducted an observational in Hypertension and HIV (n=23,855). HIV infection vs. People not living with HIV was evaluated on Remaining undiagnosed for hypertension (aRR 3.40, 95% CI 2.45-4.73, p=< 0.001). People living with HIV were more likely to remain undiagnosed for hypertension compared with those without HIV.
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