title: Ecological Study of HIV Infection and Hypertension in Sub-Saharan Africa: Is There a Double Burden of Disease?
abstract: METHODS
  Data on prevalence of hypertension were derived from a systematic search of literature published between 1975 and 2014 with corresponding national estimates on HIV prevalence and antiretroviral therapy (ART) coverage from the Demographic and Health Surveys and the joint United Nations Programme on HIV/AIDS databases. National estimates on gross national income (GNI) and under-five mortality were obtained from the World Bank database. Linear regression analyses using robust standard errors (allowing for clustering at country level) were carried out for associations of age-standardised hypertension prevalence ratios (standardized to rural Uganda's hypertension prevalence data) with HIV prevalence, adjusted for national indicators, year of study and sex of the study population.
  
  
  RESULTS
  In total, 140 estimates of prevalence of hypertension representing 25 nations were sex-and area-matched with corresponding HIV prevalence. A two-fold increase in HIV prevalence was associated with a 9.29% increase in age, sex and study year-adjusted prevalence ratio for hypertension (95% CI 2.0 to 16.5, p = 0.01), which increased to 16.3% (95% CI 9.3 to 21.1) after adjusting for under-five mortality, GNI per capita and ART coverage.
  
  
  CONCLUSIONS
  Countries with a pronounced burden of HIV may also have an increased burden of non-communicable diseases such as hypertension with potential economic and health systems implications.
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: C
authors.initials: C
authors.lastname: Angkurawaranon
authors.affiliation: Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Nitsch
authors.affiliation: Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Larke
authors.affiliation: Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: A M
authors.initials: AM
authors.lastname: Rehman
authors.affiliation: Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Addo
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000367:Age Factors; D001794:Blood Pressure; D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D013599:Systole