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Background:  Hypertension is an important cardiovascular risk factor. Little is known about the effects of antiretroviral medications on systolic and diastolic blood pressure (BP) among HIV-infected patients.

Methods:  We performed a retrospective examination of BP measurements among all HIV-infected patients attending a university-based HIV-specialty clinic who were ART naive and initiated their first HAART regimen. BP is routinely measured at all clinic visits and captured along with all clinical patient data in the University of Washington HIV Information System. Subjects were required to have at least 3 months of follow-up during treatment with their first HAART regimen. We examined mean BP prior to initiation of HAART (baseline) and during treatment with HAART. We used logistic regression to determine factors associated with a 10 mmHg increase in systolic or diastolic BP or a new diagnosis of hypertension and initiation of an antihypertensive medication. We examined ART medications by class and individual agent, body mass index, self-reported race, smoking status, gender, baseline BP, CD4 cell count, HIV-1 RNA level, and family history of hypertension.

Results:  A total of 607 patients met study criteria with 24,506 BP recordings available for analysis; 60 (9.9%) patients developed a 10-mmHg increase in mean diastolic BP or initiated antihypertensive therapy, and 80 (13.2%) patients developed a 10-mmHg increase in mean systolic BP or initiated antihypertensive therapy. No significant effect was found for CD4 count, HIV-1 RNA level, smoking history, family history of hypertension, body mass index, or baseline diastolic or systolic BP. In multivariate analysis adjusting for age, race, and gender, efavirenz use (OR 2.5, p > 0.001) and use of lopinavir/ritonavir (OR 4.9, p > 0.001) were significantly associated with increased systolic BP or initiation of antihypertensive medications during HAART. NNRTI use (OR 1.8, p = 0.036) was associated with increased diastolic BP or initiation of antihypertensive medications during HAART after controlling for age, race, and gender. Other protease inhibitors (PI) were not associated with elevations in systolic or diastolic BP.

Conclusions:  We found that increases in BP with HAART treatment appear to be independent of HIV disease stage, are likely related to particular antiretroviral agents including non-nucleoside reverse transcriptase inhibitors and lopinavir/ritonavir rather than other PI, particularly for systolic BP. Increased survival in the HAART era demands increased attention to the effect of ART on cardiovascular risk factors.

Keywords: cardiovascular disease; hypertension; antiretroviral medications