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


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.

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Data availability

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


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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.


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.

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Authors and Affiliations



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.

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Correspondence to Anxious J. Niwaha.

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The authors declare that they have no conflict of interest.

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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.

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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).

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