Study Shows Impact of Updated Guidelines on Rate of Hypertension in People with HIV

An estimated 1.1 million Americans live with HIV, and hypertension is a major risk factor for cardiovascular disease (CVD), as well as av common comorbidity, in this population. About 15% of deaths in the HIV population are caused by CVD.

The American College of Cardiology (ACC) and the American Heart Association (AHA) Task Force (ACC/AHA) updated the clinical practice guidelines for hypertension in 2017. Under these guidelines, the diagnostic criteria for stage 1 hypertension are a systolic pressure of 130 mmHg or higher, or a diastolic pressure 80 mmHg or higher.

In a new study published in the American Journal of Hypertension, a team of researchers from Texas examined the increase in prevalence of hypertension in the HIV population subsequent to the updated ACC/AHA guidelines.

The researchers used the Medical Monitoring Project survey to identify 957 HIV positive participants from 2013 to 2014. They identified hypertensive patients by charted diagnosis, antihypertensive medication use, blood pressure readings ≥140/90 (JNC7 guidelines) and ≥130/80 mm Hg (ACC/AHA guidelines). The prevalence of hypertension in HIV population increased from 47.6% to 68.7%, using the updated ACC/AHA guidelines.

The researchers attributed a combination of conventional CVD risk factors coupled with high rates of cigarette smoking and obesity and HIV- or antiretroviral therapy (ART) mediated effects for the high prevalence rates of hypertension in this population. About 33% of participants were current smokers, 21.6% were former smokers, and 63.9% were obese. This study also demonstrated a significant increase in hypertension with increased duration of ART.

Effective treatment with ART has increased the life span of people living with HIV, but they remain at risk for chronic diseases.

Pharmacists can routinely address the risk factors, including hypertension, in this population by taking blood pressures or asking patients to take their own when they pick up prescriptions. The updated guidelines assist in earlier identification and treatment of hypertension before cardiovascular damage develops.

Reference

Hyde JR, Sears SC, Buendia JR, Odem SL, Vaaler ML, Mgbere OO. HIV comorbidities: pay attention to hypertension amid changing guidelines — An analysis of Texas Medical Monitoring Project Data. Am J Hypertens. 2019 May 9. pii: hpz078. doi: 10.1093/ajh/hpz078. [Epub ahead of print]