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Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis

Abstract

Owing to antiretroviral drug-induced endothelial dysfunction, HIV-infected patients on antiretroviral therapy (ART) may have elevated blood pressure. We conducted a systematic review and meta-analysis to estimate the effects of ART on blood pressure levels and hypertension risk among HIV-infected populations worldwide. We sought articles that compared the mean blood pressure measurements and hypertension prevalence between HIV-infected adults naive and exposed to ART. Thirty-nine studies comprising 44 903 participants met the inclusion criteria. Overall, systolic (mean difference (MD) 4.52 mm Hg, 95% confidence interval (CI) 2.65–6.39, I2=68.1%, 19 studies) and diastolic blood pressure levels (MD 3.17 mm Hg, 95% CI 1.71–4.64, I2=72.5%, 16 studies) were significantly higher among ART-exposed patients compared with treatment-naive patients. Similarly, the risk of hypertension was significantly higher among ART-exposed patients, such that among 28 908 ART-exposed patients, 4195 (14.5%) had hypertension compared with 950 of 9086 (10.5%) in those who were treatment-naive (odds ratio 1.68, 95% CI 1.35–2.10, I2=81.5%, 32 studies). In summary, exposure to ART is significantly associated with increased systolic and diastolic blood pressure levels, and increased risk of hypertension, regardless of study-level sociodemographic differences. This meta-analysis supports the need for population-based strategies to reduce the risk of high blood pressure among people living with HIV on ART.

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References

  1. Dillon DG, Gurdasani D, Riha J, Ekoru K, Asiki G, Mayanja BN et al. Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis. Int J Epidemiol 2013; 42 (6): 1754–1771.

    Article  Google Scholar 

  2. Seaberg EC, Muñoz A, Lu M, Detelsb R, Margolickc JB, Riddle SA et al. Association between highly active antiretroviral therapy and hypertension in a large cohort of men followed from 1984 to 2003. AIDS 2005; 19 (9): 953–960.

    Article  Google Scholar 

  3. Stein JH . Dyslipidemia in the era of HIV protease inhibitors. Prog Cardiovasc Dis 2003; 45 (4): 293–304.

    Article  CAS  Google Scholar 

  4. Joint United Nations Programme on HIV/AIDS. Global report: UNAIDS report on the global AIDS epidemic, 2013. Available from http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Global_Report_2013_en_1.pdf (cited April 2015).

  5. Bergersen BM, Sandvik L, Dunlop O, Birkeland K, Bruun JN . Prevalence of hypertension in HIV-positive patients on Highly Active Anti-retroviral Therapy (HAART) compared with HAART-naïve and HIV-negative controls: results from a Norwegian study of 721 patients. Eur J Clin Microbiol Infect Dis 2003; 22: 731–736.

    Article  CAS  Google Scholar 

  6. Grandominico JM, Fichtenbaum CJ . Short-term effect of HAART on blood pressure in HIV-infected individuals. HIV Clin Trials 2008; 9 (1): 52–60.

    Article  Google Scholar 

  7. Jantarapakde J, Phanuphak N, Chaturawit C, Pengnonyang S, Mathajittiphan P, Takamtha P et al. Prevalence of metabolic syndrome among antiretroviral-naïve and antiretroviral-experienced HIV-1 infected Thai adults. AIDS Patient Care STDS 2014; 28 (7): 331–340.

    Article  Google Scholar 

  8. Medina-Torne S, Ganesan A, Barahona I, Crum-Cianflone NF . Hypertension is common among HIV-infected persons, but not associated with HAART. J Int Assoc Physicians AIDS Care (Chic) 2012; 11 (1): 20–25.

    Article  Google Scholar 

  9. Moher D, Liberati A, Tetzlaff J, Altman DG . The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-analyses: The PRISMA Statement. Open Med 2009; 3 (3): 123–130http://www.openmedicine.ca/article/view/285/247.

    Google Scholar 

  10. World Bank. Data: New country classifications, 2015. Available from: http://data.worldbank.org/news/new-country-classifications. (cited April 2015).

  11. World Health Organization. Guidelines set new definitions, update treatment for hypertension, 1999. Available from: http://www.who.int/bulletin/archives/77(3)293.pdf (cited April 2015).

  12. Sterne JAC, Higins JPT, Reves BC . A Cochrane risk of bias assessment tool: for non-randomized studies of interventions. Cochrane Collaboration, 2014. Available from http://www.riskofbias.info (cited March 2015).

  13. DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials 1986; 7 (3): 177–188.

    Article  CAS  Google Scholar 

  14. Higgins JP, Thompson SG . Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11): 1539––1558.

    Article  Google Scholar 

  15. Friis-Moller N, Weber R, Reiss P, Thiebaut R, Kirk O, Monforte AD et al. Cardiovascular disease risk factors in HIV patients –association with antiretroviral therapy. Results from the DAD study. AIDS 2003; 17 (8): 1179–1193.

    Article  Google Scholar 

  16. Jericó C, Knobel H, Montero M, Sorli ML, Guelar A, Gimeno JL et al. Hypertension in HIV-infected patients: prevalence and related factors. Am J Hypertens 2005; 18: 1396–1401.

    Article  Google Scholar 

  17. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L . Comparison of two methods to detect publication bias in meta-analysis. JAMA 2006; 295: 676–680.

    Article  CAS  Google Scholar 

  18. Aboud M, Elgalib A, Pomeroy L, Panayiotakopoulus G, Skopelitis E, Kulasegaram R et al. Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study. Int J Clin Pract 2010; 64 (9): 1252–1259.

    Article  CAS  Google Scholar 

  19. Arruda Junior ER, Lacerda HR, Vilela Moura LCR, Pessoa MF, Filho DBM, Diniz GTN et al. Profile of patients with hypertension included in a cohort with HIV/AIDS in the state of Pernambuco, Brazil. Arq Bras Cardiol 2010; 95 (5): 640–647.

    Article  Google Scholar 

  20. Arruda Junior ER, Lacerda HR, Vilela Moura LCR, Pessoa MF, Filho DBM, Diniz GTN et al. Risk factors related to hypertension among patients in a cohort living with HIV/AIDS. Braz J Infect Dis 2010; 14 (3): 281–287.

    Article  Google Scholar 

  21. Awotedu K, Ekpebegh C, Longo-Mbenza B, Iputo J . Prevalence of metabolic syndrome assessed by IDF and NCEP ATP 111 criteria and determinants of insulin resistance among HIV patients in the Eastern Cape Province of South Africa. Diabetes Metab Syndr 2010; 4: 210–214.

    Article  Google Scholar 

  22. Edward AO, Oladayo AA, Omolola AS, Adetiloye AA, Adedayo PA . Prevalence of traditional cardiovascular risk factors and evaluation of cardiovascular risk using three risk equations in Nigerians living with human immunodeficiency virus. N Am J Med Sci 2013; 5 (12): 680–688.

    Article  Google Scholar 

  23. Bajaj S, Tyagi SK, Bhargava A . Metabolic syndrome in human immunodeficiency virus positive patients. Indian J Endocrinol Metab 2013; 17 (1): 117–120.

    Article  CAS  Google Scholar 

  24. Baekken M, Os I, Sandvik L, Oektedalen O . Hypertension in an urban HIV-positive population compared with the general population: influence of combination antiretroviral therapy. J Hypertens 2008; 26: 2126–2133.

    Article  CAS  Google Scholar 

  25. Bergesen BM, Sandvik L, Bruun JN, Tonstad S . Elevated Framingham risk score in HIV-positive patients on highly active retroviral therapy: results from Nogewian study of 721 subjenct. Eur J Clin Microbiol Infect Dis 2004; 23: 625–630.

    Google Scholar 

  26. Bergesen BM, Schumacher A, Sandvik L, Bruun JN, Birkeland K . Important differences in components of the metabolic syndrome between HIV-patients with and without highly active antiretroviral therapy and healthy controls. Scan J Infect Dis 2006; 38: 682–689.

    Article  Google Scholar 

  27. Bonfanti P, De Socio GV, Ricci E, Antinori A, Martinelli C, Vichi F et al. The feature of metabolic syndrome in HIV-naïve patients is not the same of those treated: results from a prospective study. Biomed Pharmacother 2012; 66: 348–353.

    Article  Google Scholar 

  28. Carey RAB, Rupali P, Abraham OC, Kattula D . Does first line antiretroviral therapy increase the prevalence of cardiovascular risk factors in Indian patients? A cross sectional study. J Postgrad Med 2013; 59: 258–262.

    Article  CAS  Google Scholar 

  29. Chow DC, Souza SA, Chen R, Richmond-Crum SM, Grandinetti A, Shikuma C . Elevated blood pressure in HIV-infected individuals receiving highly active antiretroviral therapy. HIV Clin Trials 2003; 4 (6): 411–416.

    Article  Google Scholar 

  30. Denue A, Muazu J, Gashau W, Nkami D, Ajayi NA . Effects of highly active antiretroviral therapy (HAART) on blood pressure changes and its associated factors in HAART naïve HIV-infected patients in North-Eastern Nigeria. Arch Appl Sci Res 2012; 4 (3): 1447–1452.

    CAS  Google Scholar 

  31. Dimodi HT, Etame LS, Nguimkeng BS . Prevalence of metabolic syndrome in HIV-infected cameroonian patients. WJA 2014; 4: 85–92.

    Article  Google Scholar 

  32. Eira M, Bensenor IM, Dorea EL, Cunha RS, Mill JG, Lotufo PA . Potent antiretroviral therapy for human immunodeficiency virus infection increases aortic stiffness. Arq Bras Cardiol 2012; 99 (6): 1100–1107.

    Article  Google Scholar 

  33. Ekali LG, Johnstone LK, Echouffo-Tcheugui JB, Kouanfack C, Dehayem MY, Fezeu L et al. Fasting blood glucose and insulin sensitivity are unaffected by HAART duration in Cameroonians receiving first-line antiretroviral treatment. Diabet & Metab 2013; 39: 71–77.

    Article  CAS  Google Scholar 

  34. Fontas E, van Leth F, Sabin CA, Friis-Mller N, Rickenbach M, d’Arminio Monfort A et al. Lipid profiles in HIV-infected patients receiving combination antiretroviral therapy: are different antiretroviral drugs associated with different lipid profiles? J Infect Dis 2004; 189: 1056–1074.

    Article  CAS  Google Scholar 

  35. Hansen BR, Petersen J, Haugaard SB, Madsbad S, Obel N, Suzuki Y et al. The prevalence of metabolic syndrome in Danish patients with HIV infection: the effect of antiretroviral therapy. HIV Med 2009; 10: 378–387.

    Article  CAS  Google Scholar 

  36. Kingsley LA, Cuervo-Rojas J, Munoz A, Palella FJ, Poste W, Witt MD et al. Subclinical coronary atherosclerosis, HIV infection and antiretroviral therapy: multicentre AIDS cohort study. AIDS 2008; 22 (13): 1589–1599.

    Article  Google Scholar 

  37. Lekakis J, Ikonomidis I, Palios J, Tsiodras S, Karatzis E, Poulakou G et al. Association of highly active antiretroviral therapy with increased arterial stiffness in patients infected with Human Immunodeficiency Virus. Am J Hypertens 2009; 22: 828–834.

    Article  CAS  Google Scholar 

  38. Lin Y–J, Yang C–H, Huang Y–F, Lai A–C . The incidence and prevalence of chronic diseases among HIV-infected patients on highly active antiretroviral therapy (HAART). Taiwan J Public Health 2011; 30 (6): 549–557.

    Google Scholar 

  39. Manuthu EM, Joshi MD, Lule GN, Karari E . Prevalence of dyslipidemia and dysglycemia in HIV infected patients. East Afr Med J 2008; 85 (1): 10–17.

    Article  CAS  Google Scholar 

  40. Mital P, Goyal LK, Saini HL, Agrawal A, Saigal R . Metabolic syndrome and sub clinical atherosclerosis: influence of HIV status and HAART. Sch J App Med Sci 2013; 1 (6): 830–836.

    Google Scholar 

  41. Muhammad S, Sani MU, Okeahialam BN . Cardiovascular disease risk factors among HIV-infected Nigerians receiving highly active antiretroviral therapy. Niger Med J 2013; 54 (3): 185–190.

    Article  Google Scholar 

  42. Ngala RA, Fianko K . Effects of HIV infection and antiretroviral therapy on cardiovascular risk factors. Trends in Mol Sci 2013; 10: 1–7.

    Google Scholar 

  43. Palacios R, Santos J, Garcı'a A, Castells E, Gonza'lez M, Ruiz J et al. Impact of highly active antiretroviral therapy on blood pressure in HIV-infected patients. A prospective study in a cohort of naive patients. HIV Med 2006; 7: 10–15.

    Article  CAS  Google Scholar 

  44. Peck RN, Shedafa R, Kalluvya S, Downs JA, Todd J, Suthanthiran M et al. Hypertension, kidney disease, HIV and antiretroviral therapy among Tanzanian adults: a cross-sectional study. BMC Med 2014; 12 (125): 1–11.

    Google Scholar 

  45. Scholten F, Mugisha J, Seeley J, Kinyanda E, Nakubukwa S, Kowal P et al. Health and functional status among older people with HIV/AIDS in Uganda. BMC Public Health 2011; 11 (886): 1–10.

    Google Scholar 

  46. Shapiro RL, Souda S, Parekh N, Binda K, Kayembe M, Lockman S et al High prevalence of hypertension and placental insufficiency, but no in utero HIV transmission, among women on HAART with stillbirths in Botswana. PLoS ONE 2012; 7 (2): 1–7.

    Article  Google Scholar 

  47. Thiebaut R, El-Sadr WM, Friis-Moller N, Rickenbach M, Reiss P, Monforte AD et al. Predictors of hypertension and changes in blood pressure in HIV-infected patients. Antivir Ther 2003; 10: 811–823.

    Google Scholar 

  48. Wilson SL, Scullard G, Fidler SJ, Weber JN, Poulter NR . Effects of HIV status and antiretroviral therapy on blood pressure. HIV Med 2009; 10: 388–394.

    Article  CAS  Google Scholar 

  49. Zeng Y, Ye YC, Luo L, Qiu ZF, Han Y, Li XM et al. Premature atherosclerosis in patients with acquired immunodeficiency syndrome. Chin Med J (Engl) 2010; 123 (23): 3396–3399.

    CAS  Google Scholar 

  50. Stamler J, Stamler R, Neaton JD . Blood pressure, systolic and diastolic, and cardiovascular risks: US population data. Arch Intern Med 1993; 153: 598–615.

    Article  CAS  Google Scholar 

  51. Stamler R . Implications of the INTERSALT study. Hypertension 1991; 17 (suppl I): 16–20.

    Article  Google Scholar 

  52. University of California San Francisco Centre for HIV Information. Database for antiretroviral drug reactions: interactions between cardiovascular medications and antiretrovirals, 2014. Available from http://hivinsite.ucsf.edu/insite?page=ar-00-02&post=10&param=18 (cited April 2015).

  53. Austin PC . An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46 (3): 399–424.

    Article  Google Scholar 

  54. Rosenbaum PR . Does a dose–response relationship reduce sensitivity to hidden bias? Biostatistics 2003; 4 (1): 1–10.

    Article  Google Scholar 

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Acknowledgements

CUN acknowledges the support from the University of Warwick Scholarship (Warwick ID 1160088). OAU acknowledges the support from the FAS Marie Curie International PostDoc (2012–0064).

Author contributions

CUN conceived of the study and participated in designing the study, data acquisition, meta-analysis and interpreting the data and drafting the manuscript. AMS participated in data acquisition and drafting the manuscript. OAU participated in designing the study, meta-analysis and interpreting the data. CUN, SS, PKK and OAU critically revised the manuscript. All authors have read and approved the final manuscript.

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Correspondence to C U Nduka.

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Nduka, C., Stranges, S., Sarki, A. et al. Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis. J Hum Hypertens 30, 355–362 (2016). https://doi.org/10.1038/jhh.2015.97

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