Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy
Cardiovascular disease is now a leading cause of mortality in people with HIV (PWH). High blood pressure is the major driver of cardiovascular disease. Despite this, little is known about blood pressure in PWH during the early years of antiretroviral therapy (ART). In this prospective cohort study i...
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| Veröffentlicht in: | The journal of clinical hypertension (Greenwich, Conn.) Conn.), 2020-09, Vol.22 (9), p.1554-1562 |
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| container_title | The journal of clinical hypertension (Greenwich, Conn.) |
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| creator | Reis, Karl G. Desderius, Bernard Kingery, Justin Kirabo, Annet Makubi, Abel Myalla, Christina Lee, Myung Hee Kapiga, Saidi Peck, Robert N. |
| description | Cardiovascular disease is now a leading cause of mortality in people with HIV (PWH). High blood pressure is the major driver of cardiovascular disease. Despite this, little is known about blood pressure in PWH during the early years of antiretroviral therapy (ART). In this prospective cohort study in Tanzania, the authors conducted unobserved blood pressure measurements at enrollment, 3, 6, 12, 18, and 24 months in 500 PWH initiating ART and 504 HIV‐uninfected adults. The authors excluded measurements taken on antihypertensive medications. Although PWH had a significantly lower blood pressure before ART initiation, they had a significantly greater increase in blood pressure during the first 2 years of ART compared to HIV‐uninfected controls. Blood pressure correlates in PWH differed from HIV‐uninfected controls. In PWH, lower baseline CD4+ T‐cell counts were associated with lower blood pressure, and greater increases in CD4+ T‐cell counts on ART were associated with greater increases in blood pressure, both on average and within individuals. In addition, PWH with a systolic blood pressure (SBP) |
| doi_str_mv | 10.1111/jch.13975 |
| format | Article |
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High blood pressure is the major driver of cardiovascular disease. Despite this, little is known about blood pressure in PWH during the early years of antiretroviral therapy (ART). In this prospective cohort study in Tanzania, the authors conducted unobserved blood pressure measurements at enrollment, 3, 6, 12, 18, and 24 months in 500 PWH initiating ART and 504 HIV‐uninfected adults. The authors excluded measurements taken on antihypertensive medications. Although PWH had a significantly lower blood pressure before ART initiation, they had a significantly greater increase in blood pressure during the first 2 years of ART compared to HIV‐uninfected controls. Blood pressure correlates in PWH differed from HIV‐uninfected controls. In PWH, lower baseline CD4+ T‐cell counts were associated with lower blood pressure, and greater increases in CD4+ T‐cell counts on ART were associated with greater increases in blood pressure, both on average and within individuals. In addition, PWH with a systolic blood pressure (SBP) <90 mm Hg at the time of ART initiation had ~30% mortality in the following 3 months due to occult infections. These patients require careful investigation for occult infections, and those with tuberculosis may benefit from corticosteroids.</description><identifier>ISSN: 1524-6175</identifier><identifier>EISSN: 1751-7176</identifier><identifier>DOI: 10.1111/jch.13975</identifier><identifier>PMID: 32815636</identifier><language>eng</language><publisher>United States: John Wiley and Sons Inc</publisher><subject>Adult ; Blood Pressure ; CD4 Lymphocyte Count ; CD4+ T cell ; Female ; global health ; HIV ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; Humans ; Hypertension ; Male ; Original Paper ; Prospective Studies ; T-Lymphocytes ; Tanzania - epidemiology</subject><ispartof>The journal of clinical hypertension (Greenwich, Conn.), 2020-09, Vol.22 (9), p.1554-1562</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4155-495a0a731b7a133e5ff85ed3e8a644a51de26dc9aa5427396d436c6a534e9ac03</citedby><cites>FETCH-LOGICAL-c4155-495a0a731b7a133e5ff85ed3e8a644a51de26dc9aa5427396d436c6a534e9ac03</cites><orcidid>0000-0002-9509-4526</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/PMC7722134/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722134/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,1417,1433,27924,27925,45574,45575,46409,46833,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32815636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reis, Karl G.</creatorcontrib><creatorcontrib>Desderius, Bernard</creatorcontrib><creatorcontrib>Kingery, Justin</creatorcontrib><creatorcontrib>Kirabo, Annet</creatorcontrib><creatorcontrib>Makubi, Abel</creatorcontrib><creatorcontrib>Myalla, Christina</creatorcontrib><creatorcontrib>Lee, Myung Hee</creatorcontrib><creatorcontrib>Kapiga, Saidi</creatorcontrib><creatorcontrib>Peck, Robert N.</creatorcontrib><title>Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy</title><title>The journal of clinical hypertension (Greenwich, Conn.)</title><addtitle>J Clin Hypertens (Greenwich)</addtitle><description>Cardiovascular disease is now a leading cause of mortality in people with HIV (PWH). High blood pressure is the major driver of cardiovascular disease. Despite this, little is known about blood pressure in PWH during the early years of antiretroviral therapy (ART). In this prospective cohort study in Tanzania, the authors conducted unobserved blood pressure measurements at enrollment, 3, 6, 12, 18, and 24 months in 500 PWH initiating ART and 504 HIV‐uninfected adults. The authors excluded measurements taken on antihypertensive medications. Although PWH had a significantly lower blood pressure before ART initiation, they had a significantly greater increase in blood pressure during the first 2 years of ART compared to HIV‐uninfected controls. Blood pressure correlates in PWH differed from HIV‐uninfected controls. In PWH, lower baseline CD4+ T‐cell counts were associated with lower blood pressure, and greater increases in CD4+ T‐cell counts on ART were associated with greater increases in blood pressure, both on average and within individuals. In addition, PWH with a systolic blood pressure (SBP) <90 mm Hg at the time of ART initiation had ~30% mortality in the following 3 months due to occult infections. These patients require careful investigation for occult infections, and those with tuberculosis may benefit from corticosteroids.</description><subject>Adult</subject><subject>Blood Pressure</subject><subject>CD4 Lymphocyte Count</subject><subject>CD4+ T cell</subject><subject>Female</subject><subject>global health</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Male</subject><subject>Original Paper</subject><subject>Prospective Studies</subject><subject>T-Lymphocytes</subject><subject>Tanzania - epidemiology</subject><issn>1524-6175</issn><issn>1751-7176</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1O3DAQx60KVD7aQ18A-UglssTx1-ZSia5oF4TUy7ZXa0gmrFE2Tm0HlD5Nn4Unw8suCA74Ymv8029G8yfkC8snLJ3T22o5YbzU8gPZZ1qyTDOtdtJbFiJTqbJHDkK4zXPJeZl_JHu8mDKpuNon4_fWuZr2HkMYPJ7QBa2wbcMJha6mK-cjtDaO1Ha0R9e3SO9tXNL5xZ91aQHdP-gs0HrwtruhcYm0sT5EWjz8HxF8oK5Jpmg9Ru_urId2DXnox09kt4E24OftfUh-_zhfzObZ1a-fF7Ozq6wSTMpMlBJy0Jxda2Cco2yaqcSa4xSUECBZjYWqqxJAikLzUtWCq0qB5AJLqHJ-SL5tvP1wvcK6wi6mKUzv7Qr8aBxY8_ans0tz4-6M1kXBuEiC463Au78DhmhWNqyXBB26IZhCcKmlEmqa0K8btPIuBI_NSxuWm3VUJkVlnqJK7NHruV7I52wScLoB7m2L4_smczmbb5SPdUSgTg</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Reis, Karl G.</creator><creator>Desderius, Bernard</creator><creator>Kingery, Justin</creator><creator>Kirabo, Annet</creator><creator>Makubi, Abel</creator><creator>Myalla, Christina</creator><creator>Lee, Myung Hee</creator><creator>Kapiga, Saidi</creator><creator>Peck, Robert N.</creator><general>John Wiley and Sons Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9509-4526</orcidid></search><sort><creationdate>202009</creationdate><title>Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy</title><author>Reis, Karl G. ; Desderius, Bernard ; Kingery, Justin ; Kirabo, Annet ; Makubi, Abel ; Myalla, Christina ; Lee, Myung Hee ; Kapiga, Saidi ; Peck, Robert N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4155-495a0a731b7a133e5ff85ed3e8a644a51de26dc9aa5427396d436c6a534e9ac03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Blood Pressure</topic><topic>CD4 Lymphocyte Count</topic><topic>CD4+ T cell</topic><topic>Female</topic><topic>global health</topic><topic>HIV</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Male</topic><topic>Original Paper</topic><topic>Prospective Studies</topic><topic>T-Lymphocytes</topic><topic>Tanzania - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reis, Karl G.</creatorcontrib><creatorcontrib>Desderius, Bernard</creatorcontrib><creatorcontrib>Kingery, Justin</creatorcontrib><creatorcontrib>Kirabo, Annet</creatorcontrib><creatorcontrib>Makubi, Abel</creatorcontrib><creatorcontrib>Myalla, Christina</creatorcontrib><creatorcontrib>Lee, Myung Hee</creatorcontrib><creatorcontrib>Kapiga, Saidi</creatorcontrib><creatorcontrib>Peck, Robert N.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The journal of clinical hypertension (Greenwich, Conn.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reis, Karl G.</au><au>Desderius, Bernard</au><au>Kingery, Justin</au><au>Kirabo, Annet</au><au>Makubi, Abel</au><au>Myalla, Christina</au><au>Lee, Myung Hee</au><au>Kapiga, Saidi</au><au>Peck, Robert N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy</atitle><jtitle>The journal of clinical hypertension (Greenwich, Conn.)</jtitle><addtitle>J Clin Hypertens (Greenwich)</addtitle><date>2020-09</date><risdate>2020</risdate><volume>22</volume><issue>9</issue><spage>1554</spage><epage>1562</epage><pages>1554-1562</pages><issn>1524-6175</issn><eissn>1751-7176</eissn><abstract>Cardiovascular disease is now a leading cause of mortality in people with HIV (PWH). High blood pressure is the major driver of cardiovascular disease. Despite this, little is known about blood pressure in PWH during the early years of antiretroviral therapy (ART). In this prospective cohort study in Tanzania, the authors conducted unobserved blood pressure measurements at enrollment, 3, 6, 12, 18, and 24 months in 500 PWH initiating ART and 504 HIV‐uninfected adults. The authors excluded measurements taken on antihypertensive medications. Although PWH had a significantly lower blood pressure before ART initiation, they had a significantly greater increase in blood pressure during the first 2 years of ART compared to HIV‐uninfected controls. Blood pressure correlates in PWH differed from HIV‐uninfected controls. In PWH, lower baseline CD4+ T‐cell counts were associated with lower blood pressure, and greater increases in CD4+ T‐cell counts on ART were associated with greater increases in blood pressure, both on average and within individuals. 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| subjects | Adult Blood Pressure CD4 Lymphocyte Count CD4+ T cell Female global health HIV HIV Infections - drug therapy HIV Infections - epidemiology Humans Hypertension Male Original Paper Prospective Studies T-Lymphocytes Tanzania - epidemiology |
| title | Blood pressure, T cells, and mortality in people with HIV in Tanzania during the first 2 years of antiretroviral therapy |
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