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Predictors of Successful Blood Pressure Management in HIV-infected Patients at Moderate to High 10-year Risk of Coronary Heart Disease: The Swiss HIV Cohort Study
Heiner Bucher*1, T Glass1, R Weber2, P Vernazza3, M Rickenbach4, H Furrer5, E Bernasconi6, M Cavasini7, B Hirschel8, M Battegay9, and the Swiss HIV Cohort Study
1Basel Inst for Clin Epidemiology, Switzerland; 2Univ Hosp, Zürich, Switzerland; 3Kantonsspital St Gallen, Switzerland; 4Swiss HIV Cohort Study Data Ctr, Lausanne; 5Univ Hosp, Berne, Switzerland; 6Hosp Civico, Lugano, Switzerland; 7Ctr Univ Hosp Vaudois, Lausanne, Switzerland; 8Geneva Univ Hosp, Switzerland; and 9Univ Hosp, Basel, Switzerland
Background: We explored predictors and trends in
hypertension control and other risk factors for coronary heart disease (CHD) in
HIV-infected patients receiving ART.
Methods: From 2000 through 2004, individuals in the
Swiss HIV Cohort Study (SHCS) on ART for ³3 months, at moderate to
high 10-year risk (>10%) of CHD, with elevated blood pressure (BP, ³140/90
or ³135/85
mmHg in diabetics) were included. Time trends in elevated BP, total cholesterol
(TC), smoking cessation, use of antihypertensive and antilipidemic
drugs, and ART were explored graphically. Predictors were modeled for treatment
of elevated BP.
Results: 2688 (36.1%) individuals had an average BP on 2
consecutive visits above limits where antihypertensive medications are
recommended by Swiss guidelines. Of these, 416 patients were on ART for ³3
months with untreated hypertension and with at least 2 (range 2 to 9) follow-up
visits after the first elevated average BP value. There was no indication of
changes in systolic or diastolic BP over time. The percentage on
antihypertensive medication increased in both groups over the 5-year study
period, from 6.9% to 18.2% in the elevated BP group and from 7.8% to 18.6% in
the normal BP group. Older patients (OR 1.17; 95%CI 1.09 to 1.26), those with body
mass index >30 kg/m2 (OR 2.02; 95%CI 1.15 to 3.54), and at high
risk (>20% 10 years risk) for CHD (OR 1.41; 95%CI 1.00 to 1.99) were more
likely to receive antihypertensive medication but not more likely to normalize
their BP. Those with longer duration of ART (OR 1.60; 95%CI 1.23 to 2.08) and non-nucleoside
reverse transcriptase inhibitor (NNRTI)-based regimens (OR 1.67; 95%CI 1.26 to 2.22)
were more likely, while those with hepatitis C (OR 0.46; 95%CI 0.30 to 0.71)
were less likely, to receive lipid-lowering drugs for elevated TC. Use of
lipid-lowering drugs, of NNRTI and abacavir was increasing
over time while use of protease inhibitors and stavudine
was decreasing. Prevalence of smoking was decreasing.
Conclusions: Only one-third of patients in the SHCS receiving
ART with elevated BP or TC and at moderate to high 10-year risk for CHD are
receiving antihypertensive and antilipidemic drugs.
Trends suggest that risk factor management for CHD in HIV-infected patients on
ART is improving, but those at highest risk for CHD and being treated for
hypertension are not more likely to normalize their elevated BP.
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