Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa
One of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low- and middle-income cou...
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| Veröffentlicht in: | PloS one 2018-10, Vol.13 (10), p.e0204020 |
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| creator | Brennan, Alana T Jamieson, Lise Crowther, Nigel J Fox, Matthew P George, Jaya A Berry, Kaitlyn M Stokes, Andrew Maskew, Mhairi Sanne, Ian Long, Lawrence Cassim, Naseem Rosen, Sydney |
| description | One of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low- and middle-income countries, with the biggest increase in sub-Saharan Africa and South Africa at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive patients on ART in a large South African observational cohort.
We conducted a prospective study of ART naïve adults initiating ART at a public sector HIV clinic in South Africa between April 2004-2017. Patients with diagnosed hypertension at ART initiation were excluded from the incidence analysis. Log-binomial regression was used to estimate predictors of hypertension at ART initiation, while competing risks regression was used to evaluate the relationship between predictors of incident hypertension, accounting for death as a competing risk.
Among 77,696 eligible patients, 22.0% had prevalent hypertension at ART initiation. Of the remaining patients with no hypertension at ART initiation, 8,125 incident hypertension cases were diagnosed over the period of follow-up, corresponding to an incident rate of 5.4 per 100 person-years (95% confidence interval (CI): 5.3-5.6). We found patients ≥40 years of age and patients with a body mass index (BMI) ≥25kg/m2 were at increased risk of both prevalent and incident hypertension. Male patients and those with pre-hypertension at ART initiation had increased hazards of hypertension over the period of follow-up. When assessing the choice of antiretroviral drug in first-line ART, patients initiated on nevirapine were at 27% increased risk of developing hypertension compared to those initiated on efavirenz, while patients who initiated on either zidovudine or stavudine had a 40% increased risk of developing hypertension compared to patients initiated on tenofovir. Patientswith poorer health status at ART initiation (i.e. WHO III/IV stage, low CD4 count, low hemoglobin levels and low BMI) had a decrease risk of prevalent hypertension. We found an inverse relationship in patients with a CD4 count |
| doi_str_mv | 10.1371/journal.pone.0204020 |
| format | Article |
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We conducted a prospective study of ART naïve adults initiating ART at a public sector HIV clinic in South Africa between April 2004-2017. Patients with diagnosed hypertension at ART initiation were excluded from the incidence analysis. Log-binomial regression was used to estimate predictors of hypertension at ART initiation, while competing risks regression was used to evaluate the relationship between predictors of incident hypertension, accounting for death as a competing risk.
Among 77,696 eligible patients, 22.0% had prevalent hypertension at ART initiation. Of the remaining patients with no hypertension at ART initiation, 8,125 incident hypertension cases were diagnosed over the period of follow-up, corresponding to an incident rate of 5.4 per 100 person-years (95% confidence interval (CI): 5.3-5.6). We found patients ≥40 years of age and patients with a body mass index (BMI) ≥25kg/m2 were at increased risk of both prevalent and incident hypertension. Male patients and those with pre-hypertension at ART initiation had increased hazards of hypertension over the period of follow-up. When assessing the choice of antiretroviral drug in first-line ART, patients initiated on nevirapine were at 27% increased risk of developing hypertension compared to those initiated on efavirenz, while patients who initiated on either zidovudine or stavudine had a 40% increased risk of developing hypertension compared to patients initiated on tenofovir. Patientswith poorer health status at ART initiation (i.e. WHO III/IV stage, low CD4 count, low hemoglobin levels and low BMI) had a decrease risk of prevalent hypertension. We found an inverse relationship in patients with a CD4 count <50 cells/mm3 at ART initiation who had a 25% increased risk of incident hypertension compared to those with a CD4 count ≥350 cells/mm3.
Over 20% of patients in our cohort had hypertension at ART initiation, and 13% of those with normal blood pressure at ART initiation developed hypertension while on ART. Older patients, males, those on nevirapine, zidovudine or stavudine, and those who are overweight/obese should be targeted for frequent blood pressure monitoring and the identification of other cardiovascular risk factors to encourage lifestyle modifications. Additionally, these groups should be offered pharmaceutical therapy to help prevent myocardial infarction, heart failure, stroke, and kidney disease. Further research is needed to determine the level of access and adherence to pharmaceutical treatment for hypertension in this population. Additionally, an HIV-negative comparison population is needed to assess the association of the HIV virus itself with hypertension.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0204020</identifier><identifier>PMID: 30281618</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adults ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; Blood ; Blood pressure ; Body mass ; Body mass index ; Body size ; Body weight ; Cardiovascular disease ; Cardiovascular diseases ; CD4 antigen ; Cerebral infarction ; Clinical medicine ; Confidence intervals ; Control ; Dosage and administration ; Drug therapy ; Efavirenz ; Epidemics ; Epidemiology ; Global health ; Hazard assessment ; Health aspects ; Health economics ; Health risk assessment ; Health risks ; Health sciences ; Heart diseases ; Hemoglobin ; HIV ; HIV patients ; Human immunodeficiency virus ; Hypertension ; Incidence ; Internal medicine ; Kidney diseases ; Kidneys ; Laboratories ; Males ; Medicine ; Medicine and Health Sciences ; Mortality ; Myocardial infarction ; Nevirapine ; Overweight ; Patients ; Pharmaceuticals ; Population ; Public health ; Public sector ; Regression analysis ; Renal failure ; Risk analysis ; Risk factors ; Statistical analysis ; Stavudine ; Stroke ; Tenofovir ; Viruses ; Womens health ; Zidovudine</subject><ispartof>PloS one, 2018-10, Vol.13 (10), p.e0204020</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Brennan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Brennan et al 2018 Brennan et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c622t-d8783da9acb85fe1ed9f97dbf7ffbe727d6175857a7e6898c44125fcdb8af0753</citedby><cites>FETCH-LOGICAL-c622t-d8783da9acb85fe1ed9f97dbf7ffbe727d6175857a7e6898c44125fcdb8af0753</cites><orcidid>0000-0002-7746-0668 ; 0000-0003-4238-0200 ; 0000-0002-5766-1745</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169897/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169897/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23865,27923,27924,53790,53792,79371,79372</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30281618$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Graham, Susan Marie</contributor><creatorcontrib>Brennan, Alana T</creatorcontrib><creatorcontrib>Jamieson, Lise</creatorcontrib><creatorcontrib>Crowther, Nigel J</creatorcontrib><creatorcontrib>Fox, Matthew P</creatorcontrib><creatorcontrib>George, Jaya A</creatorcontrib><creatorcontrib>Berry, Kaitlyn M</creatorcontrib><creatorcontrib>Stokes, Andrew</creatorcontrib><creatorcontrib>Maskew, Mhairi</creatorcontrib><creatorcontrib>Sanne, Ian</creatorcontrib><creatorcontrib>Long, Lawrence</creatorcontrib><creatorcontrib>Cassim, Naseem</creatorcontrib><creatorcontrib>Rosen, Sydney</creatorcontrib><title>Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>One of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low- and middle-income countries, with the biggest increase in sub-Saharan Africa and South Africa at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive patients on ART in a large South African observational cohort.
We conducted a prospective study of ART naïve adults initiating ART at a public sector HIV clinic in South Africa between April 2004-2017. Patients with diagnosed hypertension at ART initiation were excluded from the incidence analysis. Log-binomial regression was used to estimate predictors of hypertension at ART initiation, while competing risks regression was used to evaluate the relationship between predictors of incident hypertension, accounting for death as a competing risk.
Among 77,696 eligible patients, 22.0% had prevalent hypertension at ART initiation. Of the remaining patients with no hypertension at ART initiation, 8,125 incident hypertension cases were diagnosed over the period of follow-up, corresponding to an incident rate of 5.4 per 100 person-years (95% confidence interval (CI): 5.3-5.6). We found patients ≥40 years of age and patients with a body mass index (BMI) ≥25kg/m2 were at increased risk of both prevalent and incident hypertension. Male patients and those with pre-hypertension at ART initiation had increased hazards of hypertension over the period of follow-up. When assessing the choice of antiretroviral drug in first-line ART, patients initiated on nevirapine were at 27% increased risk of developing hypertension compared to those initiated on efavirenz, while patients who initiated on either zidovudine or stavudine had a 40% increased risk of developing hypertension compared to patients initiated on tenofovir. Patientswith poorer health status at ART initiation (i.e. WHO III/IV stage, low CD4 count, low hemoglobin levels and low BMI) had a decrease risk of prevalent hypertension. We found an inverse relationship in patients with a CD4 count <50 cells/mm3 at ART initiation who had a 25% increased risk of incident hypertension compared to those with a CD4 count ≥350 cells/mm3.
Over 20% of patients in our cohort had hypertension at ART initiation, and 13% of those with normal blood pressure at ART initiation developed hypertension while on ART. Older patients, males, those on nevirapine, zidovudine or stavudine, and those who are overweight/obese should be targeted for frequent blood pressure monitoring and the identification of other cardiovascular risk factors to encourage lifestyle modifications. Additionally, these groups should be offered pharmaceutical therapy to help prevent myocardial infarction, heart failure, stroke, and kidney disease. Further research is needed to determine the level of access and adherence to pharmaceutical treatment for hypertension in this population. Additionally, an HIV-negative comparison population is needed to assess the association of the HIV virus itself with hypertension.</description><subject>Adults</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Blood</subject><subject>Blood pressure</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Body weight</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>CD4 antigen</subject><subject>Cerebral infarction</subject><subject>Clinical medicine</subject><subject>Confidence intervals</subject><subject>Control</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Efavirenz</subject><subject>Epidemics</subject><subject>Epidemiology</subject><subject>Global health</subject><subject>Hazard assessment</subject><subject>Health aspects</subject><subject>Health economics</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Health sciences</subject><subject>Heart diseases</subject><subject>Hemoglobin</subject><subject>HIV</subject><subject>HIV patients</subject><subject>Human immunodeficiency virus</subject><subject>Hypertension</subject><subject>Incidence</subject><subject>Internal medicine</subject><subject>Kidney diseases</subject><subject>Kidneys</subject><subject>Laboratories</subject><subject>Males</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Nevirapine</subject><subject>Overweight</subject><subject>Patients</subject><subject>Pharmaceuticals</subject><subject>Population</subject><subject>Public health</subject><subject>Public sector</subject><subject>Regression analysis</subject><subject>Renal failure</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Statistical analysis</subject><subject>Stavudine</subject><subject>Stroke</subject><subject>Tenofovir</subject><subject>Viruses</subject><subject>Womens 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incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa</title><author>Brennan, Alana T ; Jamieson, Lise ; Crowther, Nigel J ; Fox, Matthew P ; George, Jaya A ; Berry, Kaitlyn M ; Stokes, Andrew ; Maskew, Mhairi ; Sanne, Ian ; Long, Lawrence ; Cassim, Naseem ; Rosen, Sydney</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c622t-d8783da9acb85fe1ed9f97dbf7ffbe727d6175857a7e6898c44125fcdb8af0753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adults</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral therapy</topic><topic>Biology and Life Sciences</topic><topic>Blood</topic><topic>Blood pressure</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Body 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Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brennan, Alana T</au><au>Jamieson, Lise</au><au>Crowther, Nigel J</au><au>Fox, Matthew P</au><au>George, Jaya A</au><au>Berry, Kaitlyn M</au><au>Stokes, Andrew</au><au>Maskew, Mhairi</au><au>Sanne, Ian</au><au>Long, Lawrence</au><au>Cassim, Naseem</au><au>Rosen, Sydney</au><au>Graham, Susan Marie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-10-03</date><risdate>2018</risdate><volume>13</volume><issue>10</issue><spage>e0204020</spage><pages>e0204020-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>One of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low- and middle-income countries, with the biggest increase in sub-Saharan Africa and South Africa at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive patients on ART in a large South African observational cohort.
We conducted a prospective study of ART naïve adults initiating ART at a public sector HIV clinic in South Africa between April 2004-2017. Patients with diagnosed hypertension at ART initiation were excluded from the incidence analysis. Log-binomial regression was used to estimate predictors of hypertension at ART initiation, while competing risks regression was used to evaluate the relationship between predictors of incident hypertension, accounting for death as a competing risk.
Among 77,696 eligible patients, 22.0% had prevalent hypertension at ART initiation. Of the remaining patients with no hypertension at ART initiation, 8,125 incident hypertension cases were diagnosed over the period of follow-up, corresponding to an incident rate of 5.4 per 100 person-years (95% confidence interval (CI): 5.3-5.6). We found patients ≥40 years of age and patients with a body mass index (BMI) ≥25kg/m2 were at increased risk of both prevalent and incident hypertension. Male patients and those with pre-hypertension at ART initiation had increased hazards of hypertension over the period of follow-up. When assessing the choice of antiretroviral drug in first-line ART, patients initiated on nevirapine were at 27% increased risk of developing hypertension compared to those initiated on efavirenz, while patients who initiated on either zidovudine or stavudine had a 40% increased risk of developing hypertension compared to patients initiated on tenofovir. Patientswith poorer health status at ART initiation (i.e. WHO III/IV stage, low CD4 count, low hemoglobin levels and low BMI) had a decrease risk of prevalent hypertension. We found an inverse relationship in patients with a CD4 count <50 cells/mm3 at ART initiation who had a 25% increased risk of incident hypertension compared to those with a CD4 count ≥350 cells/mm3.
Over 20% of patients in our cohort had hypertension at ART initiation, and 13% of those with normal blood pressure at ART initiation developed hypertension while on ART. Older patients, males, those on nevirapine, zidovudine or stavudine, and those who are overweight/obese should be targeted for frequent blood pressure monitoring and the identification of other cardiovascular risk factors to encourage lifestyle modifications. Additionally, these groups should be offered pharmaceutical therapy to help prevent myocardial infarction, heart failure, stroke, and kidney disease. Further research is needed to determine the level of access and adherence to pharmaceutical treatment for hypertension in this population. Additionally, an HIV-negative comparison population is needed to assess the association of the HIV virus itself with hypertension.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30281618</pmid><doi>10.1371/journal.pone.0204020</doi><tpages>e0204020</tpages><orcidid>https://orcid.org/0000-0002-7746-0668</orcidid><orcidid>https://orcid.org/0000-0003-4238-0200</orcidid><orcidid>https://orcid.org/0000-0002-5766-1745</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2018-10, Vol.13 (10), p.e0204020 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2117857462 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adults Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Blood Blood pressure Body mass Body mass index Body size Body weight Cardiovascular disease Cardiovascular diseases CD4 antigen Cerebral infarction Clinical medicine Confidence intervals Control Dosage and administration Drug therapy Efavirenz Epidemics Epidemiology Global health Hazard assessment Health aspects Health economics Health risk assessment Health risks Health sciences Heart diseases Hemoglobin HIV HIV patients Human immunodeficiency virus Hypertension Incidence Internal medicine Kidney diseases Kidneys Laboratories Males Medicine Medicine and Health Sciences Mortality Myocardial infarction Nevirapine Overweight Patients Pharmaceuticals Population Public health Public sector Regression analysis Renal failure Risk analysis Risk factors Statistical analysis Stavudine Stroke Tenofovir Viruses Womens health Zidovudine |
| title | Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa |
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