title: Time trend in hypertension prevalence, awareness, treatment, and control in a contemporary cohort of HIV-infected patients: the HIV and Hypertension Study.
abstract: Hypertension control is often inadequate in HIV patients. In a contemporary, nationwide cohort of Italian HIV-infected adults, we assessed time trends in hypertension prevalence, awareness, treatment, and control. We also evaluated predictors of cardiovascular events and of new-onset hypertension.
  
  
  
  Multicenter prospective cohort study, sampling 961 consecutive HIV patients (71% men, mean age 46 ± 9 years, 30% hypertensive) examined in 2010-2014 and after a median follow-up of 3.4 years.
  
  
  
  Among hypertensive patients, hypertension awareness (63% at baseline and 92% at follow-up), treatment (54 vs. 79%), and control (35 vs. 59%) all improved during follow-up. The incidence of new-onset hypertension was 50.1/1000 person-years (95% confidence interval, 41.2-60.3). Multivariable-adjusted predictors of hypertension were age, BMI, estimated cardiovascular risk, blood pressure, and advanced HIV clinical stage.In total, 35 new cardiovascular events were reported during follow-up (11.1/1000 person-years). In a multivariate model, baseline cardiovascular risk and hypertensive status predicted incident cardiovascular events, whereas a higher CD4 cell count had a protective role. In treated hypertensive patients, the use of integrase strand transfer inhibitors at follow-up was associated with a lower SBP (average yearly change, -3.8 ± 1.6 vs. -0.9 ± 0.5 mmHg in integrase strand transfer inhibitor users vs. nonusers, respectively, P = 0.02).
  
  
  
  Hypertension awareness, treatment, and control rates all improved in adult Italian HIV patients over the last few years, although hypertension remains highly prevalent (41%) in middle-aged HIV patients, and significantly impacts cardiovascular morbidity. Traditional risk factors and advanced HIV disease predict new-onset hypertension, whereas CD4 cell count favorably affects future cardiovascular events.
authors.affiliation: aUnit of Infectious Diseases, Department of Medicine, Azienda Ospedaliero-Universitaria di Perugia, Santa Maria Hospital, PerugiabDepartment of Infectious Diseases, Luigi Sacco Hospital, MilancUnit of Infectious Diseases, University of Bari, BaridDepartment of Infectious Diseases, Pescara Hospital, PescaraeUnit of Infectious Diseases, Garibaldi Hospital, University of Catania, CataniafDepartment of Infectious Diseases, Amedeo di Savoia Hospital, TuringDepartment of Clinical and Experimental Medicine, University of Sassari, SassarihDepartment of Infectious Diseases, Careggi Hospital, FlorenceiUnit of Infectious Diseases, Busto Arsizio Hospital, Busto ArsiziojInfectious Diseases, San Marino University Hospital, GenoakUnit of Infectious Diseases, Manzoni Hospital, LeccolDepartment of Medicine, University of Perugia and Unit of Internal Medicine, 'Santa Maria' Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Giuseppe Vittorio
authors.initials: GV
authors.lastname: De Socio
authors.forename: Elena
authors.initials: E
authors.lastname: Ricci
authors.forename: Paolo
authors.initials: P
authors.lastname: Maggi
authors.forename: Giustino
authors.initials: G
authors.lastname: Parruti
authors.forename: Benedetto Maurizio
authors.initials: BM
authors.lastname: Celesia
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Orofino
authors.forename: Giordano
authors.initials: G
authors.lastname: Madeddu
authors.forename: Canio
authors.initials: C
authors.lastname: Martinelli
authors.forename: Barbara
authors.initials: B
authors.lastname: Menzaghi
authors.forename: Lucia
authors.initials: L
authors.lastname: Taramasso
authors.forename: Paolo
authors.initials: P
authors.lastname: Bonfanti
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
mesh_terms: D000328:Adult; D000367:Age Factors; D001794:Blood Pressure; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D019429:Integrase Inhibitors / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D019429:Integrase Inhibitors