Background:  Lipoatrophy and Lipohypertrophy are associated with metabolic abnormalities, but little is known about their effect on hypertension. The few prior studies had conflicting findings and did not examine lipoatrophy and lipohypertrophy separately. We sought to determine the association between body morphology abnormalities and hypertension by examining the independent effects of lipoatrophy and lipohypertrophy.

Methods:  Cross-sectional study of 347 patients in the University of Washington HIV Cohort who completed a self-report body morphology (FRAM) assessment at a routine clinic visit. We defined hypertension as a clinical diagnosis of hypertension, or a mean systolic blood pressure >140 or diastolic blood pressure >90 mmHg in the prior 6 months. We scored FRAM using 2 categorizations (none, any lipoatrophy, any lipohypertrophy; or none, mild lipoatrophy, mild lipohypertrophy, moderate lipoatrophy, moderate lipohypertrophy). We used logistic regression to examine the association between hypertension and lipoatrophy and lipohypertrophy controlling for covariates.

Results:  Among 347 patients, there were 2278 blood pressure readings in 6 months: 123 were classified as having hypertension due to a clinical diagnosis (n = 105), a mean systolic blood pressure >140 (n = 36), or a mean diastolic blood pressure >90 mmHg (n = 27). In analyses adjusted for age, race, sex, and CD4⁺ nadir, patients with any lipoatrophy (OR 2.2; p = 0.04) or lipohypertrophy (OR 2.7; p = 0.005) were more than twice as likely to have hypertension than patients with no lipoatrophy or lipohypertrophy. Patients with moderate lipoatrophy had 3 times the adjusted odds of having hypertension (OR 3.29; p = 0.04), those with moderate lipohypertrophy had 5 times the adjusted odds (OR 5.0; p = 0.002), and patients with mild lipohypertrophy had over twice the adjusted odds of having hypertension (OR 2.4; 95%CI 1.2 to 5.0, p = 0.02) compared with patients with no abnormalities. No significant difference was seen for mild lipoatrophy. We hypothesized that the effect of lipohypertrophy on hypertension was mediated, in part, through body mass index. When body mass index was included in the analysis, increased body mass index was significantly associated with hypertension (OR = 1.1; p <0.001/kg/m²), and the association between and lipohypertrophy hypertension was no longer present. However, the association between moderate lipoatrophy and hypertension was strengthened (OR = 5.1; p = 0.02).

Conclusions:  Lipoatrophy and lipohypertrophy are both independently associated with hypertension. There is a dose-response effect with more severe lipoatrophy and lipohypertrophy associated with greater risk of hypertension. The association between lipohypertrophy (but not lipoatrophy) and hypertension appears to be mediated by increased body mass index. Self-reported lipoatrophy and lipohypertrophy are related to hypertension with potential long-term cardiovascular implications.