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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The data underlying the findings of this study are available from the corresponding author upon reasonable request.
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.
UNAIDS. HIV AND AIDS in East and Southern Africa regional overview. 2019. http://aidsinfo.unaids.org/. Accessed 16 Oct 2019.
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.
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.
Triant VA. Cardiovascular disease and HIV infection. Curr HIV/AIDS Rep. 2013;10:199–206.
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.
Fahme SA, Bloomfield GS, Peck R. Hypertension in HIV-infected adults. Hypertension. 2018;72:44–55.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Statistics UBo. The national population and housing census 2014–main report. UBOS Kampala, Uganda; 2016.
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.
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.
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.
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.
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.
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.
Health Mo. Consolidated guidelines for prevention and treatment of HIV in Uganda. 2016.
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.
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.
Conflict of interest
The authors declare that they have no conflict of interest.
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). https://doi.org/10.1038/s41371-020-00464-6