24-h-Ambulatory Blood Pressure Monitoring in Sub-Saharan Africa: Hypertension Phenotypes and Dipping Patterns in Malawian HIV+ Patients on Antiretroviral Therapy
| Autor: | Thom Chaweza, Jane Chiwoko, Andrew de Forest, Sam Phiri, Hans-Michael Steffen, Adam M. Mula, Philipp Kasper, Florian Neuhann, Angellina Nhlema, Beatrice Matanje Mwagomba, Hannock Tweya |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Ambulatory blood pressure Epidemiology Renal function White coat hypertension Blood Pressure HIV Infections hiv Disease Specialists in hypertension cardiologists epidemiologists specialists in HIV care gastroenterologists specialists in infectious diseases Internal medicine Medicine Humans 24-hour ambulatory blood pressure monitoring Diseases of the circulatory (Cardiovascular) system Medical history Prospective Studies masked hypertension Original Research Community and Home Care sub-Saharan Africa HIV abnormal blood pressure dipping white-coat hypertension business.industry Blood Pressure Monitoring Ambulatory medicine.disease Clinical trial Masked Hypertension Blood pressure Phenotype sub-saharan africa RC666-701 Hypertension Public aspects of medicine RA1-1270 Cardiology and Cardiovascular Medicine business |
| Zdroj: | Global Heart, Vol 16, Iss 1 (2021) Global Heart Global Heart; Vol 16, No 1 (2021); 67 |
| ISSN: | 2211-8179 2211-8160 |
| Popis: | Background: Cardiovascular disease and especially hypertension are a growing problem among people living with HIV (PLHIV) on antiretroviral therapy (ART) in sub-Saharan Africa. Objectives: As robust data on hypertension phenotypes associated with distinct cardiovascular risks among PLHIV are limited, we aimed to assess the frequency of white-coat (WCH), masked (MH) hypertension, and blood pressure dipping-patterns in a group of Malawian PLHIV. Methods: As part of the prospective Lighthouse-Tenofovir-Cohort-Study, we analyzed clinical, laboratory and 24-h-ambulatory blood pressure monitoring (ABPM) data of PLHIV from urban Lilongwe with treated or untreated hypertension or raised office blood pressure (OBP) during routine study-visits. Results: 118 PLHIV were included and data of 117 participants could be analyzed. Twenty–four-hour ABPM normotension was found in a total of 73 PLHIV including 14/37 on antihypertensive treatment (37.8%). Using strict definitions, i.e. normal OBP plus normal mean BP for all periods of ABPM, controlled hypertension was found in only 4/37 (10.8%) PLHIV on antihypertensive treatment while true normotension was observed in 10/24 untreated patients (41.7%) with previously diagnosed hypertension and 22/56 patients (39.3%) without a medical history of hypertension. WCH with normal BP during all periods of 24-h-ABPM was identified in 12/64 OBP-hypertensive PLHIV (18.8%), primarily in patients with grade 1 hypertension (11/41 patients; 26.8%). MH was found in 17/53 PLHIV with OBP-normotension (32.1%), predominantly in patients with high normal BP (11/20 patients; 55%). The estimated glomerular filtration rate tended to be lower in MH compared to strictly defined normotensive PLHIV (92.0±20.4 vs. 104.8±15.7 ml/min/m²). 64.1 percent of PLHIV (59.5% with 24-h hypertension and 66.7% with 24-h normotension) had abnormal systolic dipping. Conclusion: The high prevalence of WCH and MH with signs of early renal end-organ damage and an abnormal dipping in approximately 2/3 of PLHIV warrants further investigation as these factors may contribute to the increased cardiovascular risk in PLHIV in resource-limited settings like Malawi. Clinical Trial Registration: https://clinicaltrials.gov (NCT02381275), registered March 6th, 2015. |
| Databáze: | OpenAIRE |
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