HIV-infected patients are undertreated for hypertension and at higher risk for cardiovascular complications than age-matched controls.
The longevity of HIV-infected patients has increased significantly since the advent of highly active antiretroviral therapy (HAART).1 As this group of patients lives longer, the risk of developing hypertension and other cardiovascular conditions increases more than is expected in older HIV-negative individuals.2 Despite the well-established importance of the treatment of hypertension in HIV-infected patients in preventing cardiovascular morbidity and mortality, little was previously known about the extent of blood pressure control in HIV-infected patients in the community.
A study recently published in the Journal of Acquired Immune Deficiency Syndromes sheds more light on this issue. In this study the investigators examined changes in blood pressure over time and monitored the risk of cardiovascular events in hypertensive HIV-infected patients.3 The study population was enrolled through the Swiss HIV Cohort study database, a multicenter, prospective cohort study that includes more than 15,000 HIV-infected individuals in Switzerland. The study included patients with confirmed hypertension (defined as systolic or diastolic blood pressure above 139 or 89 mm Hg respectively on 2 consecutive visits and at least one additional cardiovascular risk factor). Patients with previous cardiovascular events or those who were already on antihypertensive drugs, and pregnant women were excluded. The researchers confirmed the diagnosis of hypertension in 2595 of 10,361 eligible patients.
One of the study’s most important findings was to show that hypertension was untreated in the majority of HIV-infected patients; in fact antihypertensive treatment was initiated in only 869 patients (corresponding to a rate of 79 patients per 1000 patient-years). Among those patients treated, the mean decrease of systolic blood pressure per year in patients was low (-2.5 mm Hg) over a median observation period of 3.7 years. In hypertensive patients, 118 experienced cardiovascular events: 54 acute myocardial infarctions, 18 coronary angioplasties, 4 coronary bypass surgeries, 32 strokes, and 10 sudden cardiac deaths. It was interesting to note that the development of cardiovascular events, diabetes, or chronic kidney disease was independently associated with increased likelihood of initiating antihypertensive treatment.
This study highlights the fact that many HIV-infected patients remain untreated or undertreated for hypertension despite being at a higher risk of cardiovascular complications than non-HIV infected patients. There is a lot of room for improvement in recognizing hypertension in HIV-infected patients and in initiating early antihypertensive treatment to reduce cardiovascular morbidity and mortality.
1. Collaboration ATC. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372:293–299.
2. Onen NF, Overton ET, Seyfried W, et al. Aging and HIV infection: a comparison between older HIV-infected persons and the general population. HIV Clin Trials. 2010;11:100–109.
3. Nesch R, Wang Q, Elzi L, et al. Risk of cardiovascular events and blood pressure control in hypertenseive HIV-infected patients: Swiss HIV Cohort Study (SHCS). J Acquir Immune Defic Syndr. 2013;62:396-404.