title: Predictors of hypertension and changes of blood pressure in HIV-infected patients.
abstract: OBJECTIVE
  We assessed predictors of changes in systolic (SBP) and diastolic (DBP) blood pressure during follow-up and of the development of hypertension in HIV-infected individuals.
  
  
  METHODS
  International cohort collaborative study (D:A:D) of established prospective cohorts of HIV-1-infected patients. Longitudinal analysis of changes in blood pressure (BP) was performed using mixed effects models in 17170 patients. Predictors of development of hypertension during follow-up (systolic BP > or =140 and/or diastolic BP > or =90 mmHg or initiation of antihypertensive treatment) were assessed using Cox models in 8 984 patients with a normal BP level at baseline.
  
  
  RESULTS
  73548 BP measurements with a median of 4 per patient (interquartile range [IQR]: 2-6) were recorded over a median follow-up of 2.3 years (IQR: 1.5-2.6). Risk factors significantly associated with a development of higher systolic BP and diastolic BP (differences > or =5 mmHg and P-values <0.001) during follow-up were: older age, male sex, higher body mass index (BMI) and use of BP-lowering drugs. In patients with normal BP at baseline, 1186 developed hypertension for an incidence of 72.1 per 1000 person-years (95% confidence interval: 68.2-76.0). Factors associated with development of hypertension were: male sex, higher BMI, older age, higher BP at baseline, high total cholesterol and clinical lipodystrophy. Cumulative duration of exposure to nucleoside reverse transcriptase inhibitors (P=0.75), protease inhibitors (P=0.92) as well as type of antiretroviral treatment at baseline (P=0.18) were not associated with a higher risk of hypertension. Cumulative duration of exposure to non-nucleoside reverse transcriptase inhibitors (NNRTIs) was significantly associated with lower risk of hypertension (hazard ratio=0.78 and 0.67 for those treated < or =10 months and >10 months compared with no exposure; P=0.005).
  
  
  CONCLUSIONS
  Increased blood pressure in HIV-infected individuals is associated with established risk factors for hypertension. There was no evidence for an independent deleterious effect of any class of antiretroviral drugs on BP, although the use of NNRTIs was associated with a lower risk of development of hypertension.
authors.affiliation: INSERM E0338 epsilont U593, ISPED, Université Victor Segalen Bordeaux 2, Bordeaux, France. rodolphe.thiebaut@isped.u-bordeaux2.fr
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thiébaut
authors.forename: Wafaa M
authors.initials: WM
authors.lastname: El-Sadr
authors.forename: Nina
authors.initials: N
authors.lastname: Friis-Møller
authors.forename: Martin
authors.initials: M
authors.lastname: Rickenbach
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Antonella D'Arminio
authors.initials: AD
authors.lastname: Monforte
authors.forename: Linda
authors.initials: L
authors.lastname: Morfeldt
authors.forename: Eric
authors.initials: E
authors.lastname: Fontas
authors.forename: Ole
authors.initials: O
authors.lastname: Kirk
authors.forename: Stephane
authors.initials: S
authors.lastname: De Wit
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Calvo
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Law
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012727:Sex Characteristics; D013997:Time Factors
chemical_list: D044966:Anti-Retroviral Agents