The Impact of Elevated and Pre-hypertensive Systolic Blood Pressure and the Risk of Acute Myocardial Infarction in HIV+ and HIV– Veterans
Kaku Armah*1, A Justice2,3, K Oursler4,5, M Budoff6, S Brown7,8, A Warner9, M Rodriguez-Barradas10,11, J Baker12, P Hsue13,14, M Freiberg1,15, and the VACS Project Team
1Univ of Pittsburgh Grad Sch of Publ Hlth, PA, US; 2Yale Univ Sch of Med, New Haven, CT, US; 3VA Connecticut Hlthcare System, West Haven, US; 4Univ of Maryland Med Ctr, Baltimore, US; 5VAMC, Baltimore, MD, US; 6Los Angeles Biomed Res Inst at Harbor-UCLA Med Ctr, Torrance, CA, US; 7VAMC, Bronx, NY, US; 8Mt Sinai Sch of Med, New York, NY, US; 9Univ of California, Los Angeles, David Geffen Sch of Med, US; 10Baylor Coll of Med, Houston, TX, US; 11Michael E DeBakey VAMC, Houston, TX, US; 12Univ of Minnesota Med Sch, Minneapolis, US; 13Univ of California, San Francisco, US; 14San Francisco Gen Hosp, CA, US; and 15Univ of Pittsburgh Sch of Med, PA, US
Background: HIV infection is an independent predictor of acute myocardial infarction (AMI) with a magnitude of association similar to that of diabetes mellitus. In the general population, current guidelines recommend more aggressive treatment of blood pressure among those with diabetes. Similar rationale may apply to HIV infection. The objective of this study was to examine whether the association between systolic blood pressure (SBP) and risk for AMI differed by HIV status.
Methods: We analyzed data on 84,444 people from the observational Veterans Aging Cohort Study Virtual Cohort (VC), who were free of cardiovascular diseases at baseline. HIV+ and HIV– veterans were matched 1:2 on age, gender, race/ethnicity, and clinical site. We collected data on SBP and antihypertensive medications, diabetes, dyslipidemia, smoking, hepatitis C, body mass index, renal disease, and substance abuse at baseline and on the incidence of clinically confirmed AMI from October 2003 until September 2008 as part of the VA Ischemic Heart Disease Quality Enhancement Research Initiative. SBP was the average of the three outpatient routine clinical blood pressure measurements performed closest to the baseline date (first clinical visit after April 2003). SBP categories used in the analyses were based on JNC-7 blood pressure criteria. Analyses were performed using Cox proportional hazards regression.
Results: During a median 4.6 years, there were 443 AMI events (47% HIV+). Rates and adjusted hazard ratios (HR) for the risk of AMI stratified by SBP categories and HIV status are presented in the table.
Conclusions: We found that elevated systolic blood pressure is associated with a substantially greater relative risk of AMI among HIV+ than HIV– Veterans. This was true even at pre-hypertensive levels.