Prevalence of hypertension and cardiovascular risk factors in HIV-1 infected patients on anti-retroviral therapy
Background: With increased use of HAART in HIV-infected individuals there is concern that anti-retrovirals may be associated with hypertension, a known cardiovascular risk factor. This association could be related to duration of therapy, or the metabolic complications associated with HAART or finally to certain specific anti-retrovirals. Objective: To determine the period prevalence of hypertension in HAART experienced patients and compare this to the period prevalence of HAART naive patients and to determine the cardiovascular risk factors of these patients attending the Kenyatta National Hospital. Design: A cross-sectional comparison study. Setting: Kenyatta National Hospital, a tertiary health care facility. Subjects: Consenting HIV- infected adults who where anti-retroviral naive or had been on anti-retrovirals for two years or more. Outcome measures: Prevalence of hypertension; associated cardiovascular risk factors-age, gender, body mass index, dyslipidemia defined as presence of any of the following lipid abnormalities: raised total or LDL- cholesterol, low HDL cholesterol, or raised triglycerides; and dysglycemia defined as presence of any of the following: impaired fasting glucose or diabetes mellitus. Results: Between July and November 2008, 3528 patients were screened, 1305 met the case definitions, 63% of whom were females .Of these 620 patients were recruited into anti-retroviral experienced group and 615 patients were recruited into the anti-retroviral naive group. Majority of the patients (95.6%) were on a non-nucleoside reverse transcriptase. At a median of 2.4 years the prevalence of hypertension was 12.9% ( 95% CI 5.1-20.9) in the HAART experienced patients and 14.3 %( 95%CI 5.9-22.1) in the HAART naive group (p=0.507). Dyslipidemia was the most common cardiovascular risk factor in 71.3% of the hypertensive patient on HAART. There was no statistical difference in the prevalence of dyslipidemia in HAART naive patients (p~0.299). Among the HAART experienced patients dysglycemia was noted in 35% of patients and 27.3% of HAART naive patients (p=0.23). Conclusion: At a median of 2.4 years on HAART there was no increased prevalence of hypertension compared to HAART naive patients. Dyslipidemia and dysglycemia are important cardiovascular risk factors in hypertensive HIV populations, especially in patients on HAART. Therefore there is need to actively screen this hypertensive population for both of these risk factors.