High Blood Pressure Increases
This presentation is the property of its rightful owner.
Sponsored Links
1 / 13

Financial Disclosures PowerPoint PPT Presentation


  • 65 Views
  • Uploaded on
  • Presentation posted in: General

High Blood Pressure Increases Mortality Among HIV Seropositive Individuals Without AIDS in Western Kenya. Gerald S. Bloomfield 1 , Joseph W. Hogan 2 , Alfred Keter 3 , Thomas L. Holland 1 , James Osanya 3 , Edwin Sang 3 , Sylvester Kimaiyo 3 , Eric J. Velazquez 1

Download Presentation

Financial Disclosures

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Financial disclosures

High Blood Pressure Increases Mortality Among HIV Seropositive Individuals Without AIDS in Western Kenya

Gerald S. Bloomfield1, Joseph W. Hogan2, Alfred Keter3, Thomas L. Holland1, James Osanya3, Edwin Sang3, Sylvester Kimaiyo3, Eric J. Velazquez1

1Duke University, Durham, NC, USA; 2Brown University, Providence, RI, USA; 3Moi University School of Medicine, Eldoret, Kenya

AHA Scientific Sessions 2012

Abstract # 10909


Financial disclosures

Financial Disclosures

  • None


Background

Background

  • HIV is associated with cardiovascular (CV) disease

  • Most (>60%) HIV+ patients reside in Africa but CV risk in this population is not well-studied

  • Call for integration of communicable / non-communicable disease care in low- and middle-income countries

    -United Nations High Level Meeting 2011


Rationale

Rationale

  • Despite importance of CV disease globally and large HIV burden in Africa, no studies examining CV disease and mortality in HIV in the region


Financial disclosures

Hypotheses

  • Among Kenyan HIV+ patients without AIDS:

    • High blood pressure is associated with higher risk of death

    • The blood pressure-mortality relationship varies with World Health Organization HIV clinical stage


Methodology

Methodology

  • Retrospective analysis of clinically-obtained patient medical records

  • Large HIV treatment program in Kenya

    • Academic Model Providing Access to Healthcare (AMPATH)

    • >115,000 adults enrolled from >20 clinics

    • Blood pressure from electronic medical record


Study site

Study Site


Methodology1

Methodology

  • Included data for 2005-10, ≥16 years old

  • Excluded those with AIDS, missing blood pressure,CD4 count or pregnant

  • Categorized age, CD4, and blood pressure

    • Systolic BP: <100, 100-119, 120-139, ≥140

  • Calculated:

    • Unadjusted mortality incidence rate

    • Risk of death with proportional hazards regression models


  • Results

    Results

    • 30,231 patients

    • Median age 33.5 years (28-41), 75% female, CD4 396 (287-556), 60% on HIV therapy

    • Incidence rate (IR) of death higher if SBP ≥140


    Proportional hazard of death

    Proportional Hazard of Death

    Other covariates: age, diastolic BP, creatinine, body mass index, hemoglobin,

    anti-retroviral therapy, residence, marital status, sex in combined analysis


    Mortality rate stratified by sbp who stage

    Mortality Rate Stratified by SBP & WHO Stage

    Mortality

    SBP, Stage 1

    SBP, Stage 2

    SBP, Stage 3

    0.24

    0.18

    0.12

    0.10

    0.08

    0.04

    0.0

    0

    4

    8

    Time in Years

    Systolic BP --- <100 --- 100-119 --- 120-139 --- ≥140


    Conclusions

    Conclusions

    • High blood pressure is associated with high death rate in HIV+ Kenyans without AIDS

    • The effect of high blood pressure on mortality is comparable to that of HIV immune status

    • Greater effect of SBP on mortality with worse clinical stage of HIV

    • Limitations: Observational study, clinically-obtained data


    Implications

    Implications

    • Blood pressure control is a missed opportunity to modify health in HIV+

    • There is need for expansion of HIV programs to address CV diseases (IOM report 2010)


  • Login