Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

24-hour ambulatory blood pressure monitoring and hypertension related risk among HIV-positive and HIV-negative individuals: cross sectional study findings from rural Uganda

Journal of Human Hypertension volume 36, pages 144–152 (2022)Cite this article

Subjects

Abstract

Hypertension is diagnosed and treated based on blood pressure (BP) readings obtained in the clinic setting. Positive HIV status is associated with a higher prevalence of abnormal diurnal BP patterns, diagnosed with ambulatory BP monitoring rather than the conventional method of BP measurement. Little is known about ambulatory BP profiles in people living with HIV (PLHIV) in low-income countries, especially within sub-Saharan Africa. In this study, we compared 24-h ambulatory BP profiles of 140 HIV-positive individuals vs. profiles in 166 HIV negative individuals living in rural Uganda. HIV was well-controlled, with all HIV seropositive participants reporting use of anti-retroviral therapy, and ~123 (88%) having undetectable viral load. Most participants reported ART use duration of less than 10 years. Compared to HIV negative participants, HIV positive participants had lower median 24-h systolic BP (110.4 mmHg (IQR: 105.7, 118.7) vs 117.7 mmHg (IQR: 110.8, 129.8), p < 0.001), and 24-h diastolic BP (69.2 mmHg (IQR: 65.0, 74.9) vs. 71.9 mmHg (IQR: 67.2, 78.1), p = 0.004). Adjusted results showed greater percentage systolic nocturnal dipping among PLHIV compared to HIV negative individuals (difference = 2.70 (IQR: 0.94, 4.47), p < 0.05). Results of the adjusted Poisson regression suggested lower prevalence of 24-h and night hypertension among HIV positives compared to HIV negative, but were not statistically significant. Our data suggest that continuous 24-h BP measurements are lower in PLHIV on ART compared to HIV negative individuals.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Data availability

The data underlying the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Petersen M, Balzer L, Kwarsiima D, Sang N, Chamie G, Ayieko J, et al. Association of implementation of a universal testing and treatment intervention with HIV diagnosis, receipt of antiretroviral therapy, and viral suppression in East Africa. JAMA. 2017;317:2196–206.

    Article  Google Scholar 

  2. UNAIDS. HIV AND AIDS in East and Southern Africa regional overview. 2019. http://aidsinfo.unaids.org/. Accessed 16 Oct 2019.

  3. Currier JS, Taylor A, Boyd F, Dezii CM, Kawabata H, Burtcel B, et al. Coronary heart disease in HIV-infected individuals. J Acquir Immune Defic Syndr. 2003;33:506–12.

    Article  Google Scholar 

  4. Durand M, Sheehy O, Baril J-G, Lelorier J, Tremblay CL. Association between HIV infection, antiretroviral therapy, and risk of acute myocardial infarction: a cohort and nested case–control study using Québec’s public health insurance database. JAIDS J Acquired Immune Defic Syndromes. 2011;57:245–53.

    Article  Google Scholar 

  5. Triant VA. Cardiovascular disease and HIV infection. Curr HIV/AIDS Rep. 2013;10:199–206.

    Article  Google Scholar 

  6. Freiberg MS, Chang C-CH, Kuller LH, Skanderson M, Lowy E, Kraemer KL, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173:614–22.

    Article  CAS  Google Scholar 

  7. Fahme SA, Bloomfield GS, Peck R. Hypertension in HIV-infected adults. Hypertension. 2018;72:44–55.

    Article  CAS  Google Scholar 

  8. Islam F, Wu J, Jansson J, Wilson D. Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis. HIV Med. 2012;13:453–68.

    CAS  PubMed  Google Scholar 

  9. Policarpo S, Rodrigues T, Moreira AC, Valadas E. Cardiovascular risk in HIV-infected individuals: A comparison of three risk prediction algorithms. Rev Portuguesa de Cardiologia (Engl Ed). 2019;38:463–70.

    Google Scholar 

  10. Husain NE, Noor SK, Elmadhoun WM, Almobarak AO, Awadalla H, Woodward CL, et al. Diabetes, metabolic syndrome and dyslipidemia in people living with HIV in Africa: re-emerging challenges not to be forgotten. HIV AIDS. 2017;9:193–202.

    CAS  Google Scholar 

  11. Ataro Z, Ashenafi W, Fayera J, Abdosh T. Magnitude and associated factors of diabetes mellitus and hypertension among adult HIV-positive individuals receiving highly active antiretroviral therapy at Jugal Hospital, Harar, Ethiopia. HIV AIDS. 2018;10:181–92.

    CAS  Google Scholar 

  12. Palma AM, Rabkin M, Nuwagaba-Biribonwoha H, Bongomin P, Lukhele N, Dlamini X, et al. Can the success of HIV scale-up advance the global chronic NCD agenda? Glob Heart. 2016;11:403–8.

    Article  Google Scholar 

  13. Collaborators GBDRF. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–724.

    Article  Google Scholar 

  14. Angkurawaranon C, Nitsch D, Larke N, Rehman AM, Smeeth L, Addo J. Ecological study of HIV infection and hypertension in Sub-Saharan Africa: is there a double burden of disease? PloS One. 2016;11:e0166375–e.

    Article  CAS  Google Scholar 

  15. Kalyesubula R, Kayongo A, Semitala FC, Muhanguzi A, Katantazi N, Ayers D, et al. Trends and level of control of hypertension among adults attending an ambulatory HIV clinic in Kampala, Uganda: a retrospective study. BMJ Glob Health. 2016;1:e000055.

    Article  Google Scholar 

  16. Ryscavage P, Still W, Nyemba V, Stafford K. Prevalence of systemic hypertension among HIV-infected and HIV-uninfected young adults. Open Forum Infect Dis. 2017;4 Suppl 1:S59–S.

    Article  Google Scholar 

  17. önen NF, Overton ET, Seyfried W, Stumm ER, Snell M, Mondy K, et al. Aging and HIV infection: a comparison between older HIV-infected persons and the general population. HIV Clin Trials. 2010;11:100–9.

    Article  Google Scholar 

  18. Benzekri NA, Seydi M, Doye IN, Toure M, Sy MP, Kiviat NB, et al. Increasing prevalence of hypertension among HIV-positive and negative adults in Senegal, West Africa, 1994–2015. PLOS One. 2019;13:e0208635.

    Article  Google Scholar 

  19. 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;42:1754–71.

    Article  Google Scholar 

  20. Malaza A, Mossong J, Bärnighausen T, Newell M-L. Hypertension and obesity in adults living in a high HIV prevalence rural area in South Africa. PLOS One. 2012;7:e47761.

    Article  CAS  Google Scholar 

  21. Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. preventive services task force. Ann Intern Med. 2015;162:192–204.

    Article  Google Scholar 

  22. Drain PK, Hong T, Hajat A, Krows M, Govere S, Thulare H, et al. Integrating hypertension screening at the time of voluntary HIV testing among adults in South Africa. PLOS One. 2019;14:e0210161.

    Article  CAS  Google Scholar 

  23. Kent ST, Bromfield SG, Burkholder GA, Falzon L, Oparil S, Overton ET, et al. Ambulatory blood pressure monitoring in individuals with HIV: a systematic review and meta-analysis. PloS One. 2016;11:e0148920–e.

    Article  Google Scholar 

  24. Parati G, George S, O’Brien E, Roland A, Lawrence B, Grzegorz B, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32:1359–66.

    Article  CAS  Google Scholar 

  25. Borkum M, Wearne N, Alfred A, Dave JA, Levitt NS, Rayner B. Ambulatory blood pressure profiles in a subset of HIV-positive patients pre and post antiretroviral therapy. Cardiovasc J Afr. 2014;25:153–7.

    Article  Google Scholar 

  26. Borkum MS, Heckmann JM, Manning K, Dave JA, Levitt NS, Rayner BL, et al. High prevalence of “non-dipping” blood pressure and vascular stiffness in HIV-infected South Africans on antiretrovirals. PloS One. 2017;12:e0185003–e.

    Article  CAS  Google Scholar 

  27. Kasper P, Phiri S, Chaweza T, Tweya H, Neuhann F, Steffen HM. 24-H-ambulatory blood pressure monitoring in HIV(+) - individuals in Sub-saharan Africa: feasibility and preliminary results. J Hypertens. 2019;37:e126.

    Article  Google Scholar 

  28. Ivy A, Tam J, Dewhurst MJ, Gray WK, Chaote P, Rogathi J, et al.Ambulatory blood pressure monitoring to assess the white-coat effect in an elderly East African Population.J Clin Hypertension. 2015;17:389–94.

    Article  Google Scholar 

  29. Statistics UBo. The national population and housing census 2014–main report. UBOS Kampala, Uganda; 2016.

  30. Parati G, Stergiou G, O’Brien E, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32:1359.

    Article  CAS  Google Scholar 

  31. Schillaci G, Maggi P, Madeddu G, Pucci G, Mazzotta E, Penco G, et al. Symmetric ambulatory arterial stiffness index and 24-h pulse pressure in HIV infection: results of a nationwide cross-sectional study. J Hypertens. 2013;31:560–7.

    Article  CAS  Google Scholar 

  32. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. Task Force Members. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    Article  CAS  Google Scholar 

  33. Kwarisiima D, Balzer L, Heller D, Kotwani P, Chamie G, Clark T, et al. Population-based assessment of hypertension epidemiology and risk factors among HIV-positive and general populations in rural Uganda. PloS one. 2016;11:e0156309–e.

    Article  Google Scholar 

  34. Xu Y, Chen X, Wang K. Global prevalence of hypertension among people living with HIV: a systematic review and meta-analysis. J Am Soc Hypertens. 2017;11:530–40.

    Article  Google Scholar 

  35. Nduka C, Stranges S, Sarki A, Kimani P, Uthman O. Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis. J Hum Hypertension. 2016;30:355–62.

    Article  CAS  Google Scholar 

  36. Health Mo. Consolidated guidelines for prevention and treatment of HIV in Uganda. 2016.

  37. Kwarisiima D, Atukunda M, Owaraganise A, Chamie G, Clark T, Kabami J, et al. Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study. BMC Public Health. 2019;19:511.

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge the skilled assistance of the research assistants Kukunda Rabecca and Chemutayi Sarah, as well as the contributions of all the participants, members of staff of the Nakaseke Hospital and other health centres in Nakaseke district. We are grateful to Maria Musisi, Maria Gorreti and Paula M. Namayanja (Makerere University-John Hopkins Research Collaboration) for providing study regulatory monitoring support. We acknowledge the management of African Community Center for Social Sustainability (ACCESS) for supporting the team during data collection.

Funding

This project was supported by NIH Research Training Grant (# D43 TW009340) funded by the NIH Fogarty International Center, NINDS, NIMH, and NHBLI. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Makerere University Joint AIDS Program (MJAP), Makerere University College of Health Sciences, Kampala, Uganda

    Anxious J. Niwaha & Fred C. Semitala

  2. Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Anxious J. Niwaha, Adaeze C. Wosu, Alex Kayongo, Trishul Siddharthan & William Checkley

  3. Non-Communicable Diseases (NCD) Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda

    Anxious J. Niwaha, Moffat J. Nyirenda & Robert Kalyesubula

  4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Adaeze C. Wosu

  5. School of Statistics and Planning, Makerere University, Kampala, Uganda

    Christabellah Namugenyi

  6. Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda

    Alex Kayongo, Fred C. Semitala & Robert Kalyesubula

  7. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA

    Trishul Siddharthan & William Checkley

  8. African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda

    Robert Kalyesubula

Authors
  1. Anxious J. Niwaha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adaeze C. Wosu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christabellah Namugenyi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alex Kayongo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Moffat J. Nyirenda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Trishul Siddharthan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. William Checkley
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fred C. Semitala
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Robert Kalyesubula
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design, AJN, TS, AK, FCS, RK and WC. Analysis and interpretation, AJN, ACW, CN, TS, MJN, FCS, RK and WC. Drafting the manuscript for important intellectual content, AJN, ACW, TS, MJN, FCS, RK and WC.

Corresponding author

Correspondence to Anxious J. Niwaha.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics consideration

The procedures for all the study activities were approved by Makerere University School of Medicine, Research Ethics Committee (SOM-REC: Ref 2018-019) and Uganda National Council of Science and Technology (UNCST: Ref SS 4531). Administrative authorization was provided by the Nakaseke District health officer as well as the respective hospital and clinic heads. Before carrying out study procedures, written informed consent was obtained from literate participants, or thumb-printed and signed by a witness for participants who could not read or write.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Niwaha, A.J., Wosu, A.C., Namugenyi, C. et al. 24-hour ambulatory blood pressure monitoring and hypertension related risk among HIV-positive and HIV-negative individuals: cross sectional study findings from rural Uganda. J Hum Hypertens 36, 144–152 (2022). https://doi.org/10.1038/s41371-020-00464-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-020-00464-6

Search

Advanced search

Quick links