High prevalence of "non-dipping" blood pressure and vascular stiffness in HIV-infected South Africans on antiretrovirals

M S Borkum; J M Heckmann; K Manning; J A Dave; N S Levitt; B L Rayner; N Wearne

doi:10.1371/journal.pone.0185003

High prevalence of "non-dipping" blood pressure and vascular stiffness in HIV-infected South Africans on antiretrovirals

PLoS One. 2017 Sep 20;12(9):e0185003. doi: 10.1371/journal.pone.0185003. eCollection 2017.

Authors

M S Borkum¹, J M Heckmann², K Manning³, J A Dave⁴, N S Levitt⁴, B L Rayner¹, N Wearne¹

Affiliations

¹ Department of Nephrology and Hypertension, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa.
² Division of Neurology, Department of Medicine, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa.
³ Department of Medicine, University of Cape Town, Cape Town, South Africa.
⁴ Department of Endocrinology and Metabolism, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa.

Abstract

Background: HIV-infected individuals are at increased risk of tissue inflammation and accelerated vascular aging ('inflamm-aging'). Abnormal diurnal blood pressure (BP) rhythms such as non-dipping may contribute to an increased risk of cardiovascular and cerebrovascular events in HIV infected individuals. However, little data exists on ambulatory blood pressure (ABP) and measures of vascular stiffness in the black African HIV infected population.

Methods: This is a cross-sectional analysis of otherwise well, HIV infected outpatients on ART for >5 years. Study assessments included: 24hr ABP monitoring, pulse wave velocity (PWV) and central aortic systolic pressure (CASP) using a AtCor Medical Sphygmocor device, fasting lipogram, oral glucose tolerance test, high-sensitivity C-reactive protein (hsCRP) and anthropometric data. Patients completed a questionnaire of autonomic symptoms. CD4+ counts and viral loads were obtained from the National Laboratory results system.

Results: Sixty seven black participants were included in the analysis of whom 91% (n = 61) were female with a mean age of 42.2 ± 8.6 years. The median duration on ART was 7.5 years (IQR = 6-10), 84% were virally supressed and the median CD4 count was 529.5cells/mm3 (IQR = 372.0-686.5). The majority (67%) were classified as overweight and 76% had an increased waist circumference, yet only 88% of participants were normotensive. A hsCRP level in the high cardiovascular risk category was found in 68% of participants. The prevalence of non-dipping BP was 65%. Interestingly, there was no association on multivariable analysis between dipping status and traditional risk factors for non-dipping BP, such as: obesity, autonomic dysfunction and older age.

Conclusion: This relatively young cross-sectional sample of predominantly normotensive, but overweight black women on effective ART >5 years showed: a high prevalence of non-dipping BP, inflammation and vascular stiffness. Causality cannot be inferred but cardiovascular risk reduction should be emphasized in these patients.

MeSH terms

Adult
Aging / drug effects*
Anti-Retroviral Agents / adverse effects*
Blood Pressure / drug effects*
Cardiovascular Diseases / chemically induced*
Cardiovascular Diseases / epidemiology
Cross-Sectional Studies
Female
HIV Infections / complications*
HIV Infections / drug therapy
HIV Infections / virology
HIV-1 / drug effects*
Humans
Male
Prevalence
Pulse Wave Analysis
Risk Factors
South Africa / epidemiology
Vascular Stiffness / drug effects*

Substances

Anti-Retroviral Agents

Grants and funding

This study was supported by Medical Research Council of South Africa (NW, JH), Astra Zeneca (MB). Some research funding awarded from a commercial source: Astra Zeneca. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.