Prevalence, factors associated and clinical response to uncontrolled hypertension among HIV hypertensive patients at the Infectious Diseases Institute, Mulago

Abstract

Introduction: Uncontrolled hypertension (HTN) is the leading modifiable cause of cardiovascular diseases (CVD). According to the Global Burden of Disease Study, CVDs were the leading cause of death globally with more than 15 million deaths (that is 1 in 4 deaths) and the fourth leading cause in Africa. HIV-infected adults are at increased risk of developing hypertension due to a number of factors like the ongoing inflammation and hypercoagulability state and a higher prevalence of traditional risk factors like smoking, alcohol and substance use. HIV-infected hypertensive adults are more at risk of having uncontrolled hypertension due to the stress of multiple comorbidities, drug-drug interactions, putting more emphasis on HIV treatment compared to hypertension and poor adherence due to the high pill burden. Presently the burden and patient-related factors associated with uncontrolled hypertension among HIV-infected adults on antiretroviral therapy (ART) in Uganda are not well documented. Objective: To determine the prevalence, risk factors associated with and clinician response to uncontrolled hypertension among HIV-infected hypertensive patients attending the Infectious Diseases Institute. Methods: Between April –July 2018 we performed a cross-sectional study among HIV infected hypertensive patients in care at the Infectious Diseases Institute. We used routinely collected data in the electronic patient database as well as data obtained from patient interviews using a structured questionnaire. Descriptive analysis was used to document the prevalence and clinician response to uncontrolled hypertension while poison regression with robust standard errors were used to assess factors associated with uncontrolled hypertension. xv Results: In a population of mostly females (54.7%) with median age (52.4; SD 9.1), we found a prevalence of uncontrolled hypertension of 47.5% (95% confidence interval (CI): (41.9 47.9%). The factors that were associated with uncontrolled hypertension were being of male sex with an adjusted prevalence ratio (aPR) of 1.44 (1.16-1.78). The use of herbs was also associated with having uncontrolled hypertension with an aPR of 1.54 (1.15-2.06). Being adherent to antihypertensive was protective against having uncontrolled hypertension with an aPR of 0.66 (0.54-0.82). We were also able to establish that being on Efavirenz-based antiretroviral therapy was significantly associated with having uncontrolled hypertension (aPR 1.36; CI: 1.10-1.67). The clinicians did not routinely inform patients with uncontrolled hypertension at the visit that they had uncontrolled hypertension (only 67.6% were informed) and even fewer had a lifestyle recommendation (23.7%) or medical intervention (33.5%).

Conclusion: We found a high prevalence of uncontrolled hypertension in this population of HIV-infected adults on ART. In this population poor adherence and use of herbs should be targeted through patient education to achieve better hypertension control. More studies should be carried out to understand why being and use of Efavirenz were associated with uncontrolled hypertension might be useful in developing interventions to enhance hypertension control. Hypertension management protocols need to be reinforced so that clinicians seeing HIV patients can improve their management of uncontrolled hypertension.