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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

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slide1

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

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
slide5

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
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)
ad