title: D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda.
abstract: OBJECTIVE
  We sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda.
  
  
  METHODS
  We used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension.
  
  
  RESULTS
  In the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count <100 cells (AOR 3.08, 95% CI: 1.07 to 8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI: 0.37 to 0.99). Although not significant, similar associations were seen with sCD14 and kynurenine/tryptophan ratio.
  
  
  CONCLUSIONS
  BP increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation, were associated with incident hypertension in this population.
authors.affiliation: *Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; †Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA; ‡Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; §Epicentre Mbarara Research Centre, Mbarara, Uganda; ‖Center for Global Health, Massachusetts General Hospital, Boston, MA; ¶Harvard Medical School, Massachusetts General Hospital, Boston, MA; #Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA; **Department of Biology, Boston College, Chestnut Hill, MA; ††Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT; ‡‡Department of Global Health and Populations, Harvard T.H Chan School of Public Health, Boston, MA; and §§Department of Medicine, University of California, San Francisco, CA.
authors.forename: Samson
authors.initials: S
authors.lastname: Okello
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Asiimwe
authors.forename: Michael
authors.initials: M
authors.lastname: Kanyesigye
authors.forename: Winnie R
authors.initials: WR
authors.lastname: Muyindike
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.forename: Bosco B
authors.initials: BB
authors.lastname: Mwebesa
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.forename: Yong
authors.initials: Y
authors.lastname: Huang
authors.forename: Kenneth
authors.initials: K
authors.lastname: Williams
authors.forename: Tricia H
authors.initials: TH
authors.lastname: Burdo
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: A Rain
authors.initials: AR
authors.lastname: Mocello
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents; D000959:Antihypertensive Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D