title: Evidence of increased blood pressure and hypertension risk among people living with HIV on antiretroviral therapy: a systematic review with meta-analysis.
abstract: Owing to antiretroviral drug-induced endothelial dysfunction, HIV-infected patients on antiretroviral therapy (ART) may have elevated blood pressure. We conducted a systematic review and meta-analysis to estimate the effects of ART on blood pressure levels and hypertension risk among HIV-infected populations worldwide. We sought articles that compared the mean blood pressure measurements and hypertension prevalence between HIV-infected adults naive and exposed to ART. Thirty-nine studies comprising 44 903 participants met the inclusion criteria. Overall, systolic (mean difference (MD) 4.52 mm Hg, 95% confidence interval (CI) 2.65-6.39, I(2)=68.1%, 19 studies) and diastolic blood pressure levels (MD 3.17 mm Hg, 95% CI 1.71-4.64, I(2)=72.5%, 16 studies) were significantly higher among ART-exposed patients compared with treatment-naive patients. Similarly, the risk of hypertension was significantly higher among ART-exposed patients, such that among 28 908 ART-exposed patients, 4195 (14.5%) had hypertension compared with 950 of 9086 (10.5%) in those who were treatment-naive (odds ratio 1.68, 95% CI 1.35-2.10, I(2)=81.5%, 32 studies). In summary, exposure to ART is significantly associated with increased systolic and diastolic blood pressure levels, and increased risk of hypertension, regardless of study-level sociodemographic differences. This meta-analysis supports the need for population-based strategies to reduce the risk of high blood pressure among people living with HIV on ART.
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick Medical School, Coventry, UK.
authors.forename: C U
authors.initials: CU
authors.lastname: Nduka
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick Medical School, Coventry, UK.|Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
authors.forename: S
authors.initials: S
authors.lastname: Stranges
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick Medical School, Coventry, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Sarki
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick Medical School, Coventry, UK.
authors.forename: P K
authors.initials: PK
authors.lastname: Kimani
authors.affiliation: Division of Health Sciences, Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick Medical School, Coventry, UK.|Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK.
authors.forename: O A
authors.initials: OA
authors.lastname: Uthman
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D020276:HIV Long-Term Survivors; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents