HomeHealthMedicineIncident hypertension, cumulative viral load possibly linked in people with HIV

Incident hypertension, cumulative viral load possibly linked in people with HIV

01 October 2022

2 minutes reading

disclosures:
The authors report no relevant financial disclosures.


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Cumulative viral load may be associated with occasional hypertension in people with HIV, despite cardiovascular disease risk factors may differ between health care systems, researchers found.

Adovich S. Riveradoctor, doctorate, postdoctoral researcher at Kaiser Permanente Southern California, who was a PhD student at Northwestern University Feinberg School of Medicine at the time of the study, and colleagues analyzed 7,628 people with HIV without diabetes at baseline and 7,450 people with HIV without hypertension at baseline.

checking the blood pressure of male patient
Source: Adobe Stock

The data was collected from two Chicago health systems: Northwestern Medicine, a major academic system serving the Chicago area, and Howard Brown Health, a federally qualified center with a focus on LGBTQ+, low-income, and uninsured populations.

Of the cohort, 71% were male, 47% were non-Hispanic white, and the mean age at first viral load measurement was 36 years. In the diabetes cohort, 3% had hypertension at baseline, while in the hypertension cohort, 7% had diabetes at baseline.

The Howard Brown Health cohort had lower unadjusted incidence rates than the Northwestern cohort for hypertension (2.6% vs. 16.9%) and diabetes (1.4% vs. 6.8%). At follow-up, in the baseline cohort without diabetes, 230 people developed diabetes (3%) and in the cohort without hypertension at baseline, 496 people developed hypertension (6.7%). The median time to event of the overall cohort was 3.1 years for hypertension and 3.2 years for diabetes, with a longer time to event for those at Northwestern compared to those at Howard Brown Health (diabetes, 5.4 years vs. 2.7 years; hypertension, 5.3 years vs. 2.7 years).

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In a pooled analysis, viraemia copy year was associated with incident hypertension (HR = 1.2; 95% CI, 1.14-1.26), but not with incident diabetes (HR = 1.03; 95% CI, 0, 96-1.1).

In addition, viraemia copy year was associated with incident hypertension in the Northwestern cohort (HR = 1.29; 95% CI 1.08-1.32) but not in the Howard Brown Health cohort (HR = 0.98; 95% CI 0.86-1.02).

“Given previous observational and mechanistic data, we expected that a higher viremia copy year (poor viral suppression over time) would be associated with a higher risk of diabetes and hypertension. However, we only observed this higher risk of hypertension with a higher viremia copy year in people with HIV seen in an academic tertiary care setting, but not a community care setting, Rivera and colleagues wrote.

Male gender, older age, black race, Hispanic ethnicity, being in the Northwestern subgroup, and higher baseline BMI were associated with significantly higher risks for both hypertension and diabetes. Having a higher baseline CD4 count was associated with higher risks for hypertension, but not for diabetes. Private or uninsured/other insurance was associated with lower rates of hypertension and diabetes compared to public insurance.

Higher social deprivation index at both sites and diagnosis of mental disorder at the Howard Brown Health site were associated with occasional hypertension and diabetes, according to the researchers.

“Racial discrimination and having a mental disorder can be sources of daily stress. In addition, having a mental health disorder has been linked to social isolation and an increased occurrence of traditional risk factors, both of which can increase the risk of hypertension. However, the combined outcome of different mechanisms is difficult to predict. We expected LGBTQ+ to be at higher risk due to minority stress and structural marginalizations. However, LGB individuals had a significantly lower risk of diabetes compared to heterosexual people with HIV,” Rivera and colleagues wrote.

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