title: Incidence and predictors of hypertension in adults with HIV-initiating antiretroviral therapy in south-western Uganda.
abstract: OBJECTIVE
  The successful scale-up of antiretroviral therapy (ART) in sub-Saharan Africa has led to increasing life expectancy, and thus increased risk of hypertension. We aimed to describe the incidence and predictors of hypertension in HIV patients receiving ART at a publicly funded clinic in rural Uganda.
  
  
  METHODS
  We abstracted data from medical records of adult patients who initiated ART at an HIV clinic in south-western Uganda during 2010-2012. We defined hypertension as at least two consecutive clinical visits, with a SBP at least 140 mmHg and/or SBP of at least 90 mmHg, or prescription for an antihypertensive medication. We calculated the incidence of hypertension and fit multivariable Cox proportional-hazards models to identify predictors of hypertension.
  
  
  RESULTS
  A total of 3389 patients initiated ART without a prior diagnosis of hypertension during the observation period. Over 3990 person-years of follow-up, 445 patients developed hypertension, for a crude incidence of 111.5/1000 (95% confidence interval 101.9-121.7) person-years. Rates were highest among men aged at least 40 years (158.8 per/1000 person-years) and lowest in women aged 30-39 years (80/1000 person-years). Lower CD4 cell count at ART initiation, as well as traditional risk factors including male sex, increasing age, and obesity, were independently associated with hypertension.
  
  
  CONCLUSIONS
  We observed a high incidence of hypertension in HIV-infected persons on ART in rural Uganda, and increased risk with lower nadir CD4 cell counts. Our findings call for increased attention to screening of and treatment for hypertension, along with continued prioritization of early ART initiation.
authors.affiliation: aDepartment of Internal Medicine bImmune Suppression Syndrome Clinic, Mbarara Regional Referral Hospital, Mbarara, Uganda cThe Robert M. Berne Cardiovascular Research Center & Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia dDivision of HIV/AIDS, Department of Medicine, University of California, San Francisco, California eDepartment of Epidemiology fDepartment of Biostatistics, Harvard T.H Chan School of Public Health gDepartment of Medicine and Center for Global Health, Massachusetts General Hospital hHarvard Medical School, Boston, Massachusetts, USA.
authors.forename: Samson
authors.initials: S
authors.lastname: Okello
authors.forename: Michael
authors.initials: M
authors.lastname: Kanyesigye
authors.forename: Winnie R
authors.initials: WR
authors.lastname: Muyindike
authors.forename: Brian Herb
authors.initials: BH
authors.lastname: Annex
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.forename: Sebastien
authors.initials: S
authors.lastname: Haneuse
authors.forename: Mark Jacob
authors.initials: MJ
authors.lastname: Siedner
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D008297:Male; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents