Isolated Nocturnal Hypertension in People Living With HIV: Do We Need HIV-Specific Guidelines for Hypertension Diagnosis?

Cardiovascular disease (CVD) is emerging as the leading cause of early mortality among people living with HIV (PLWH). In PLWH, the incidence of CVD is more than double that of the general population and CVD causes nearly 40% of premature deaths in PLWH.1 The higher risk of CVD in PLWH is not fully explained by traditional risk factors such as clinic blood pressure.1 The higher incidence of CVD observed in PLWH may be related to abnormal diurnal variation in blood pressure as quantified by ambulatory blood pressure monitoring. We know that blood pressure should decline, or “dip,” during the night. Compared with the general population, PLWH may have a higher prevalence of nocturnal non-dipping of blood pressure,2,3 nocturnal hypertension,2 and masked hypertension.4 Ambulatory blood pressure is more strongly associated with CVD events and mortality than clinic blood pressure.5,6 Nighttime blood pressure is a particularly strong predictor of CVD events, CVD mortality, and overall mortality even after adjusting for office blood pressure.6 A 14-year, multinational population-based cohort study found that nighttime blood pressure was the strongest independent predictor of both CVD events and overall mortality in a diverse group of adults.5 Therefore, these abnormalities in nighttime blood pressure in PLWH are of great concern.