Prehypertension, hypertension, and the risk of acute myocardial infarction in HIV-infected and -uninfected veterans.
BACKGROUND
Compared to uninfected people, human immunodeficiency virus (HIV)-infected individuals may have an increased risk of acute myocardial infarction (AMI). Currently, HIV-infected people are treated to the same blood pressure (BP) goals (<140/90 or <130/80 mm Hg) as their uninfected counterparts. Whether HIV-infected people with elevated BP have excess AMI risk compared to uninfected people is not known. This study examines whether the association between elevated BP and AMI risk differs by HIV status.


METHODS
The Veterans Aging Cohort Study Virtual Cohort (VACS VC) consists of HIV-infected and -uninfected veterans matched 1:2 on age, sex, race/ethnicity, and clinical site. For this analysis, we analyzed 81 026 people with available BP data from VACS VC, who were free of cardiovascular disease at baseline. BP was the average of the 3 routine outpatient clinical measurements performed closest to baseline (first clinical visit after April 2003). BP categories used in the analyses were based on criteria of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Analyses were performed using Cox proportional hazards regression.


RESULTS
Over 5.9 years (median), 860 incident AMIs occurred. Low/high prehypertensive and untreated/treated hypertensive HIV-infected individuals had increased AMI risk compared to uninfected, untreated normotensive individuals (hazard ratio [HR], 1.60 [95% confidence interval {CI}, 1.07-2.39]; HR, 1.81 [95% CI, 1.22-2.68]; HR, 2.57 [95% CI, 1.76-3.76]; and HR, 2.76 [95% CI, 1.90-4.02], respectively).


CONCLUSIONS
HIV, prehypertensive BP, and hypertensive BP were associated with an increased risk of AMI in a cohort of HIV-infected and -uninfected veterans. Future studies should prospectively investigate whether HIV interacts with BP to further increase AMI risk.
Department of Epidemiology, Graduate School of Public Health.
Kaku A
KA
Armah
Chung-Chou H
CC
Chang
Jason V
JV
Baker
Vasan S
VS
Ramachandran
Matthew J
MJ
Budoff
Heidi M
HM
Crane
Cynthia L
CL
Gibert
Matthew B
MB
Goetz
David A
DA
Leaf
Kathleen A
KA
McGinnis
Krisann K
KK
Oursler
David
D
Rimland
Maria C
MC
Rodriguez-Barradas
Jason J
JJ
Sico
Alberta L
AL
Warner
Priscilla Y
PY
Hsue
Lewis H
LH
Kuller
Amy C
AC
Justice
Matthew S
MS
Freiberg
D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D058246:Prehypertension / Q000150:complications / Q000453:epidemiology*; D011446:Prospective Studies; D018570:Risk Assessment; D014728:Veterans
HIV; blood pressure; myocardial infarction; prehypertension