75 - Abstract (11th CROI)

Session 17 Oral Abstracts
Complications of HIV Infection and Antiretroviral Therapy
Tuesday, 10 am - 12:45 pm
Presentation Time: 10:45 am
Room 3000

75
Predictors of Hypertension and Changes in Blood Pressure in HIV-infected Patients in the D:A:D Study
R Thiébaut*¹, W El-Sadr², G Chenuc¹, N Friis-Moller³, M Rickenbach⁴, P Reiss⁵, A D’Arminio Monforte⁶, L Morfeldt⁷, C Pradier⁸, O Kirk⁹, S De Wit¹⁰, G Calvo¹¹, M Law¹², C Sabin^13,14, J D Lundgren³, and D:A:D Study group
¹Aquitaine Cohort, C.H.U. Bordeaux, INSERM U593, Bordeaux, France; ²CPCRA, Columbia Univ./Harlem Hosp., New York, NY, USA; ³Copenhagen HIV Prgm., Hvidovre Univ. Hosp., Denmark; ⁴SHCS, Ctr. Hosp. Univ. Vaudois, Lausanne, Switzerland; ⁵ATHENA, HIV Monitoring Fndn., Academic Med. Ctr., Amsterdam, The Netherlands; ⁶ICONA, L Sacco Hosp., Univ. of Milan, Milan, Italy; ⁷HivBivus, Karolinska Hosp., Stockholm, Sweden; ⁸Nice Cohort, CHU Nice Hosp. de l'Archet, France; ⁹EuroSIDA, CHIP, Hvidovre Univ. Hosp., Copenhagen, Denmark; ¹⁰Saint-Pierre Cohort, CHU Saint-Pierre Hosp., Brussels, Belgium; ¹¹BASS, Autonomous Univ. of Barcelona, Spain; ¹²AHOD, Natl. Ctr. in HIV Epidemiology and Clin. Res., Sydney, Australia; ¹³Royal Free Ctr. for HIV Med., Royal Free and Univ. Coll., London, UK; and ¹⁴Univ. Coll. London, UK

Background: Hypertension is a well-known cardiovascular risk factor. Factors affecting the blood pressure of HIV-infected patients are poorly understood, although it has been hypothesised that anti-HIV drugs may lead to elevations. We assessed predictors of changes in systolic and diastolic blood pressure and of occurrence of hypertension in HIV-1-infected patients enrolled in the prospective observational D:A:D cohort study.

Methods: A longitudinal analysis of changes in blood pressure using mixed effects models was performed in 16,002 patients with at least 1 blood pressure measurement after enrolment. Predictors of hypertension (systolic blood pressure >140 and/or diastolic blood pressure > 90 mmHg or initiation of antihypertensive treatment) after D:A:D enrolment were analyzed using a Cox model in 8,341 patients with a normal blood pressure level at baseline.

Results: A total of 43,501 blood pressure measurements with a median of 3 per patient [IQR: 1-3] were recorded in 16,002 patients, over a median follow-up of 1.5 years [0.8 - 1.7]. Risk factors significantly associated with higher predicted increase in systolic blood pressure (less than or equal to 5 mmHg) throughout follow-up compared to reference group were: older age (+12.8 and 14.5 mmHg at baseline and month 24, respectively, for 60 years old versus 30 years old), male (+7.0 and +6.6 at baseline and month 24, respectively, versus female), higher BMI (+16.4 and +15.6 at baseline and month 24, respectively, for those with BMI>30kg/m² versus <18) and blood pressure- lowering drugs (+8.3 mmHg at baseline and month 24 for those treated with an antihypertensive treatment). In 8,341 patients with normal blood pressure at baseline, 487 developed hypertension, providing an incidence of 35.8/1000 person-years, 95% CI = [32.6 - 39.0]. Factors associated with the occurrence of hypertension were similar to the findings above: male gender (hazard ratio [HR] 1.69, p <10^-4), higher BMI (HR=2.20 for BMI>30kg/m² versus [18-25], p <10^-4), older age (HR=2.08 for [43-83] years versus [17-33], p <10^-4), and higher blood pressure at baseline (HR = 2.40 for 130<systolic blood pressure <139 mmHg versus <120). Cumulative duration of exposure to each class of ARV (HR = 1.02 per year of exposure to NRTI, p = 0.48. HR = 0.85, p = 0.17 for NNRTI, HR = 0.97, p = 0.56 for PI) as well as type of treatment at baseline (p = 0.26) were NOT associated with occurrence of differences in blood pressure and the risk of hypertension.

Conclusions: High blood pressure in HIV-infected persons is associated with traditional risk factors for hypertension. Our findings do not support an independent role for anti-HIV therapy on blood pressure.

Keywords: Hypertension; blood pressure; cardiovascular risk