The successful scale-up of antiretroviral therapy (ART) in
sub-Saharan Africa has led to increasing life expectancy, and thus increased
risk of hypertension. We aimed to describe the incidence and predictors of
hypertension in HIV patients receiving ART at a publicly funded clinic in rural
Uganda.
We abstracted data from medical records of adult patients
who initiated ART at an HIV clinic in south-western Uganda during 2010-2012. We
defined hypertension as at least two consecutive clinical visits, with a SBP at
least 140 mmHg and/or SBP of at least 90 mmHg, or prescription for an
antihypertensive medication. We calculated the incidence of hypertension and
fit multivariable Cox proportional-hazards models to identify predictors of
hypertension.
A total of 3389 patients initiated ART without a prior
diagnosis of hypertension during the observation period. Over 3990 person-years
of follow-up, 445 patients developed hypertension, for a crude incidence of
111.5/1000 (95% confidence interval 101.9-121.7) person-years. Rates were
highest among men aged at least 40 years (158.8 per/1000 person-years) and
lowest in women aged 30-39 years (80/1000 person-years). Lower CD4 cell count
at ART initiation, as well as traditional risk factors including male sex,
increasing age, and obesity, were independently associated with hypertension.
We observed a high incidence of hypertension in HIV-infected
persons on ART in rural Uganda, and increased risk with lower nadir CD4 cell
counts. Our findings call for increased attention to screening of and treatment
for hypertension, along with continued prioritization of early ART initiation.
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By:
- 1aDepartment of Internal Medicine bImmune Suppression Syndrome Clinic, Mbarara Regional Referral Hospital, Mbarara, Uganda cThe Robert M. Berne Cardiovascular Research Center & Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia dDivision of HIV/AIDS, Department of Medicine, University of California, San Francisco, California eDepartment of Epidemiology fDepartment of Biostatistics, Harvard T.H Chan School of Public Health gDepartment of Medicine and Center for Global Health, Massachusetts General Hospital hHarvard Medical School, Boston, Massachusetts, USA.
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