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Hypertension (HTN) in HIV Patients with Metabolic Dysregulation Johnson DL, Qian D, Briggs W, Louie S, Dube M, and Sattler FR*.
Univ. of Southern California, Los Angeles Background: Insulin resistance, elevated lipids and central obesity in persons with HIV is similar to Syndrome X which is also associated with HTN.
Methods: 42 consecutive patients were referred to a HIV Metabolic Clinic for peripheral fat loss (lipodystrophy [LD]) or central fat accumulation. Patients were matched by gender and age to a HIV+ control group (n=42) without LD and to 13 HIV-neg (n=13). BP readings for HIV+ patients for 6 months backward from the index visit (index period; IP) and during prior HAART (total study period; TSP) were evaluated. HTN was defined as systolic BP pressure (SBP) 140 or diastolic BP (DBP) 90 on 2 occasions.
Results: Age for the cohort, HIV+ controls, and HIV-neg controls was 42.6±7.7, 40.8±8.8, and 43.2±7.3 years. Seventeen (40%), 33 (79%), and 4 (31%) of the 3 groups were Hispanic. Six (14%), 13 (31%), and 1 (8%) in the 3 groups were smokers; 6 (14%), 2 (5%), and none (0%) had diabetes. HIV RNA was <400 in 62% of the cohort and in 72% of the HIV+ controls. At the index visit, SBP was 128±15, 129±15, and 119±13 mm Hg in the 3 groups; the DBP was 77±10, 77±8, and 72±10. Elevated BP was present during the IP in 27 (64%) of the cohort and in 13 (31%) of the HIV+ controls (p=0.001). During the TSP (2.9±2.0 vs 2.4±1.2 years for the 2 groups), 35 (86%) of the cohort and 28 (67%) of the HIV+ controls had elevated BP (p=0.08), based on 29.9±16.1 and 26.7±12.8 BP readings. The proportion of elevated readings during the TSP was 0.38±0.23 and 0.23±0.24, respectively (p=0.002), similar to the proportions in the IP. The 2 highest SBP readings in those with elevated BP during the TSP were 159±10 and 156±11, respectively; the DBP were 97±10 and 94±8. Abnormalities of fasting lipids in the HIV groups were similar.
Conclusions: Elevated BP was present in the cohort significantly more often than in the HIV+ controls, which were more hypertensive than the HIV-neg controls. Thus, HTN may be a component of metabolic dysregulation in HIV, as in Syndrome X, and may occur prior to lipodystrophy.
Key Words: Hypertension, Lipodystrophy, Metabolic
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