Background
HTN remains a leading modifiable risk factor for cardiovascular, cerebrovascular, and chronic kidney diseases, all disproportionately affecting people with HIV (PWH). Disparities in HTN care have been described in the general population, though such data is limited in PWH. We apply the care cascade framework to HTN to evaluate the association between personal and neighborhood level social determinants of health (SDH) and HTN outcomes in a nationwide cohort of Veterans with HIV.
Methods
We queried the Veterans Health Administration (VHA) databases to identify PWH who received care across any VHA facility nationwide during calendar year (CY) 2023. HTN care cascade was defined as: diagnosis – HTN ICD-10 codes associated outpatient encounters; treatment – active prescription of ≥1 antihypertensive drugs; HTN monitoring at least 2 recorded blood pressure (BP) readings at least 90 days apart; control – last BP recording less 140/90 in CY 23. Patient zip codes were used to derive the area deprivation index (ADI) and rurality. Summary statistics are used describe the groups and comparisons were tested using Chi-square statistic and Kruskal-Wallis.
Results
Of the 33,569 PWH in care, 42% had a HTN diagnosis in CY 23. HTN diagnosis was more common in birth sex males than females (38% vs. 42%, p=0.0002), Blacks compared with Whites (48% vs. 38%, p<0.0001), and those living in more deprived compared to better resourced neighborhoods (median ADI national rank 57 vs. 52, p<0.0001). Of those with a diagnosis of HTN, 87% of PWH in care were on treatment in CY23, birth sex males more likely to be treatment than females (87% vs. 81%, p=0.0001) and those on treatment being older than those not receiving treatment (65 v 63 p = 0.0001). Of the patients with a diagnosis, 54% were monitored, without significant differences across groups. Of those who were monitored, 64% were controlled, with Blacks having the lowest proportion of control at 58%, Whites highest at 67% (p=0.0086).
Conclusions
HTN is common among PWH and associated with male sex, Black race, and lower resourced neighborhoods. While most PWH who have a diagnosis of HTN are receiving treatment, monitoring, and control steps in the HTN care cascade need strengthening. Differences along SDH groups appear to mostly disappear after the diagnosis step, except for Black race.
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