Autor/a:
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Rodríguez Arbolí, Eduardo; Mwamelo, Kim; Kalinjuma, Aneth Vedastus; Furrer, Hansjakob; Hatz, Christoph; Tanner, Marcel; Battegay, Manuel; Letang, Emilio; KIULARCO Study Group
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Abstract:
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INTRODUCTION: Scarce data are available on the epidemiology of
hypertension among HIV patients in rural sub-Saharan Africa. We
explored the prevalence, incidence and risk factors for incident
hypertension among patients who were enrolled in a rural HIV
cohort in Tanzania. METHODS: Prospective longitudinal study
including HIV patients enrolled in the Kilombero and Ulanga
Antiretroviral Cohort between 2013 and 2015. Non-ART naive
subjects at baseline and pregnant women during follow-up were
excluded from the analysis. Incident hypertension was defined as
systolic blood pressure >/= 140 mmHg and/or diastolic blood
pressure >/= 90 mmHg on two consecutive visits. Cox
proportional hazards models were used to assess the association
of baseline characteristics and incident hypertension. RESULTS:
Among 955 ART-naive, eligible subjects, 111 (11.6%) were
hypertensive at recruitment. Ten women were excluded due to
pregnancy. The remaining 834 individuals contributed 7967
person-months to follow-up (median 231 days, IQR 119-421) and 80
(9.6%) of them developed hypertension during a median follow-up
of 144 days from time of enrolment into the cohort [incidence
rate 120.0 cases/1000 person-years, 95% confidence interval (CI)
97.2-150.0]. ART was started in 630 (75.5%) patients, with a
median follow-up on ART of 7 months (IQR 4-14). Cox regression
models identified age [adjusted hazard ratio (aHR) 1.34 per 10
years increase, 95% CI 1.07-1.68, p = 0.010], body mass index
(aHR per 5 kg/m2 1.45, 95% CI 1.07-1.99, p = 0.018) and
estimated glomerular filtration rate (aHR < 60 versus >/=
60 ml/min/1.73 m2 3.79, 95% CI 1.60-8.99, p = 0.003) as
independent risk factors for hypertension development.
CONCLUSIONS: The prevalence and incidence of hypertension were
high in our cohort. Traditional cardiovascular risk factors
predicted incident hypertension, but no association was observed
with immunological or ART status. These data support the
implementation of routine hypertension screening and integrated
management into HIV programmes in rural sub-Saharan Africa. |