The preverance hypertension among HIV infected women of reproductive age in HIV care atfour health facilities in Kampala and Wakiso districts, in Uganda

Abstract

ABSTRACT Introduction: Non-Communicable Diseases including hypertension are increasingly becoming common among HIV-infected patients in chronic care. HIV-infected women who also become pregnant are at increased risk of hypertensive disorders of pregnancy, resulting in suboptimal maternal and fetal outcomes. However, there is paucity of data on the prevalence of hypertension and associated factors among HIV infected women of reproductive age. Method: Data were obtained from four urban facilities in Kampala and Wakiso districts, which provide HIV-care and treatment to HIV-infected persons. Patient data of HIV+ women aged 15-49 years and active in HIV care from October 1st to December 31st, was abstracted from the clinical records. It included variables on age, marital status, gravidity, BMI, HAART regimen, duration on HAART and use of antihypertensives drugs. For non-pregnant women, blood pressure was determined as a mean of the two BP readings taken between October and December 2014, categorized as normal (BP<140/90) or hypertensive (BP> 140/90mmHg). Hypertensive disorders of pregnancy were determined from a review of 2014 antenatal records for a series of 3 BP recordings, taken in early, mid and late pregnancy and categorized as Normal, chronic hypertension (recorded before 20 weeks gestation) or gestational hypertension (recorded after 20 weeks gestation). The primary outcome was being hypertensive, and key independent variables were age, BMI, parity, HAART regimen and duration on HAART. Data were analyzed using STATA. Prevalence was expressed as percentage and prevalence rate ratios at 95% confidence level were used as the measure of association between the independent and outcome variables Results: A total of 523 non-pregnant and 236 pregnant women in HIV-care were randomly selected for this study from a total of 8,998 women available in Oct-Dec 2014HIV care database. The overall prevalence of hypertension was 11% (82/759), similar between non-pregnant 11% (58/523) and pregnant women 10% (24/236) (p=0.705). Of the 24 women with hypertension in pregnancy, 33% (8/24) were chronic and 67% (16/24) were gestational hypertension. Twenty nine percent (29%) of hypertensive women were on antihypertensives. Commonly used drugs were Calcium channel blockers (75%), followed by diuretics (50%), beta blockers (33%) and Angiotensin converting enzyme inhibitors (2%). Being 35 years and older was associated with a higher risk of hypertension among pregnant women, PRR= 6.0(2.5-15).Other factors including marital status, HAART status, BMI, and prime-parity were not significantly associated with hypertension. Conclusion: There is a significant burden of hypertension among women living with HIV, yet only 29% of hypertensive HIV infected women in care were receiving antihypertensive therapy. HIV care systems should be strengthened to broaden their focus from only the infectious complications of HIV to incorporate management of NCD.