Incident hypertension in a cohort of HIV-infected individuals at Ndola teaching hospital
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BACKGOUND: Available data on the association between antiretroviral therapy (ART) and hypertension is inconclusive and mainly from studies carried out in the developed countries. This study aimed to determine the incidence and factors associated with hypertension in HIV-infected individuals at a teaching hospital in an urban setting in Zambia. METHODS: We conducted a retrospective analysis for a cohort of patients who initiated ART at Ndola Teaching Hospital ART clinic between 1st January 2008 and 31st December 2008. Patients had to be normotensive and with no history of using anti-hypertensive medication at baseline to be included in the study. Patients contributed person-time to the study until they were either censored on 31st December 2018, developed hypertension, transferred-out to another health facility, died, or became lost to follow up. We examined the associations between the dependent variable and the independent variables using the Cox proportional hazards (Cox PH) model and survival analysis with log-rank tests for comparison of time-to-hypertension between categories of age group, gender, ART regimen, baseline CD4 count, and BMI. We reported the unadjusted and adjusted hazard ratio and the corresponding 95% confidence intervals and p-value. RESULTS: We identified 821 individuals that started taking ART in 2008. We excluded 125 patients from the study, of whom 7.2% (n=59) had hypertension at baseline. The 696 normotensive patients included in the final analysis contributed 4260.3 person-years of observation and 129 (18.5%) patients developed hypertension, giving a crude incidence rate of 30.3 per 1000 person-years (95% CI: 25.5-36.0). In the multivariable Cox PH model, age ≥45 years at recruitment (HR=2.76; 95% CI: 1.12-6.80) and estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 (HR=3.00; 95% CI: 1.35-6.66) were independently associated with incident hypertension. CONCLUSION: The incidence of hypertension after ART initiation was 30.3 per 1000 person-years. Age 45 years or older and baseline estimated glomerular filtration rate less than 60 ml/min/1.73m2 were major risk factors for the development of hypertension in our cohort of HIV-positive patients. Recommendation: There is need for integration of the management of hypertension into the routine HIV care for patients with both HIV and hypertension in the ART clinic. Patients aged 45 years or older with eGFR less than 60 ml/min/1.73m2 coupled advanced HIV disease and CD4 counts less than 200 cells/µL at baseline require close monitoring of the blood pressure as they are at a higher risk for development of hypertension.