Background: Previous studies have documented that hypertension in HIV-positive (HIV+) individuals is associated with traditional risk factors such as older age, male gender, diabetes, dyslipidemia and high body mass index (BMI). However, controversy remains as to whether the exposure to antiretroviral therapy (ART) poses additional risk. We investigated this issue in the D:A:D Study.
Methods: The incidence of hypertension (systolic blood pressure (BP) >140 and/or diastolic BP >90 mmHg and/or initiation of antihypertensive treatment) in patients with normal BP at baseline was determined overall and in various strata defined by demographic, metabolic- and HIV-related factors, including cumulative exposure (/year) to each ART drug. Predictors of hypertension were identified using uni- and multivariable Poisson regression models, adjusted for potential confounders. Follow-up was from 1/2/99 until the earliest of confirmed hypertension, 6 months after last visit or 1/2/2013.
Results: Of 33,278 included persons, 7636 (22.9%) developed hypertension over 223,149 person years (PYRS) (rate ratio (RR): 3.42 [95% CI 3.35-3.50]/100 PYRS). The demographic and HIV-related factors independently associated with a significantly increased rate of hypertension in multivariable models were male gender (RR 1.39 [1.30-1.48]), older age (vs. <30 years): 30-39 years (1.58 [1.37-1.82]); 40-49 years (2.60 [2.27-2.99]); 50-59 years (4.15 [3.60-4.78]); >60 years (6.09 [5.24-7.08]), black African origin (1.39 [1.25-1.54]), mode of HIV acquisition via injection drug use (1.09 [1.01-1.18]) and previous AIDS diagnosis (1.15 [1.09-1.20]). In univariate analyses, there were significant associations between cumulative exposure to almost all ART drugs and risk of hypertension. However, after adjustment for demographic, HIV-related factors and smoking, only abacavir, nevirapine, ritonavir and indinavir continued to be significantly associated with an increased risk of hypertension, although effects were small (Table). The estimates were similar when additionally adjusting for metabolic factors potentially on the causal pathway (Table).
Conclusions: We did not find evidence for any strong independent association between exposure to any of the ART drugs and the risk of hypertension. Established risk factors for hypertension in the general population were confirmed in this population of HIV+ persons, providing reassurance that screening policies for hypertension in HIV+ persons should follow algorithms used for the general population.