Hypertension in HIV-1-infected patients and its impact on renal and cardiovascular integrity.
BACKGROUND
With increasing life spans of HIV-infected individuals under highly active antiretroviral therapy, long-term consequences of the chronic infection and antiretroviral treatment are becoming more prevalent. Data on prevalence and consequences of hypertension are limited, but recent studies suggest that HIV-infected individuals are at a higher risk of developing hypertension.


METHODS
In this prospective study, HIV-1-infected patients from the Frankfurt AIDS Cohort Study (FACS) were followed for 1 year to determine the frequency of systemic hypertension and to assess the associated clinical and demographic factors.


RESULTS
A total 214 HIV-1-infected patients, predominantly Caucasian males, participated in the study. Prevalence of systemic hypertension was 29%. The groups of hypertensive and normotensive individuals were comparable in terms of ethnic background and duration of infection. As in the general population, hypertensive subjects were older (49.1+/-11.1 vs 39.0+/-8.1 years; P<0.0001) and waist-to-hip ratio was higher than in normotensive individuals (0.99+/-0.07 vs 0.93+/-0.08; P<0.0001). Hypertension was associated with a much higher frequency of persistent proteinuria (41.1% vs 2.8%; P<0.001), coronary heart disease (16.1% vs 1.3%; P<0.0001) and myocardial infarction (8.1% vs 0.7%; P<0.005), whereas most cardiovascular risk factors were similar in both groups.


CONCLUSIONS
Our data do not demonstrate any association between the presence of hypertension and antiretroviral therapy or immune status. However, hypertension seems to have a high impact on the existing risk for premature cardiovascular disease. Furthermore, overt proteinuria is frequent in HIV-1 infection with hypertension and might be due to hypertensive nephrosclerosis as well as yet undefined renal disease in these patients.
Jung
Oliver
O
Klinikum der Johann Wolfgang Goethe-Universität, Medizinische Klinik IV, Funktionsbereich Nephrologie, D-60590 Frankfurt/Main, Germany. jung@zphys1.uni-frankfurt.de
Bickel
Markus
M
Ditting
Tilmann
T
Rickerts
Volker
V
Welk
Thomas
T
Helm
Eilke B
EB
Staszewski
Schlomo
S
Geiger
Helmut
H
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D044966:Anti-Retroviral Agents