title: Ambulatory blood pressure profiles in a subset of HIV-positive patients pre and post antiretroviral therapy.
abstract: OBJECTIVE
  Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) are associated with renal disease and increased cardiovascular risk. The relationship between HIV and ambulatory blood pressure (ABP) non-dipping status, a risk factor for cardiovascular events and target-organ damage, has never been assessed in South Africa. Study objectives were to establish the prevalence of chronic kidney disease, and assess the ABP profile in asymptomatic HIV-positive clinic out-patients.
  
  
  METHODS
  This was a prospective cohort study. Office blood pressure (BP), urinary microalbumin-creatinine ratio, urine dipsticks, serum creatinine and estimated glomerular filtration rate (eGFR) were measured at baseline and six months after ART initiation. A subset of HIV-positive subjects and an HIV-negative control group underwent 24-hour ABP monitoring.
  
  
  RESULTS
  No patient had an eGFR < 60 ml/min, three patients (4.7%) had microalbuminuria and one had macroalbuminuria. Mean office systolic BP was 111 ± 14 mmHg at baseline and increased by 5 mmHg to 116 ± 14 mmHg (p = 0.05) at six months. This increase was not confirmed by ABP monitoring. In the HIV-positive and -negative patients, the prevalences of non-dipping were 80 and 52.9%, respectively (p = 0.05, odds ratio = 3.56, 95% CI: 0.96-13.13). No relationship between dipping status and ART usage was found.
  
  
  CONCLUSIONS
  The prevalence of chronic kidney disease (CKD) was lower than anticipated. HIV infection was associated with an ambulatory non-dipping status, which suggests an underlying dysregulation of the cardiovascular system. In the short term, ART does not seem to improve loss of circadian rhythm.
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa. mborkum@gmail.com.
authors.forename: Megan
authors.initials: M
authors.lastname: Borkum
authors.affiliation: Department of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
authors.forename: Nicola
authors.initials: N
authors.lastname: Wearne
authors.affiliation: Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Athlet
authors.initials: A
authors.lastname: Alfred
authors.affiliation: Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Dave
authors.affiliation: Division of Diabetic Medicine and Endocrinology, University of Cape Town, Cape Town, South Africa.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Levitt
authors.affiliation: Department of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
authors.forename: Brian
authors.initials: B
authors.lastname: Rayner
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology