Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa.
Prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive adults on antiretroviral treatment in public sector treatment programs in South Africa.
复制标题
DOI：
10.1371/journal.pone.0204020
复制
发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Rosen S
中科院分区：
文献类型：
--
作者：
Brennan AT;Jamieson L;Crowther NJ;Fox MP;George JA;Berry KM;Stokes A;Maskew M;Sanne I;Long L;Cassim N;Rosen S
心血管疾病的关键危险因素之一是高血压。导致心脏病发作和中风的高血压已经影响到全球10亿人，使其成为一个全球公共卫生问题。这种疾病在低收入和中等收入国家的发病率和流行率正在上升，其中撒哈拉以南非洲和南非的增幅最大。我们在南非的一个大型观察队列中调查了接受抗逆转录病毒治疗的HIV阳性患者中高血压的患病率、发病率、预测因素、治疗和控制情况。我们对2004年4月至2017年4月在南非一家公共部门艾滋病毒诊所发起抗逆转录病毒治疗的天真成年人进行了一项前瞻性研究。在ART开始时诊断为高血压的患者被排除在发病率分析之外。对数二项回归用于评估ART开始时高血压的预测因素，而竞争风险回归用于评估高血压事件预测因素之间的关系，将死亡视为竞争风险。在77,696名符合条件的患者中，22.0%的患者在ART开始时有普遍的高血压。在开始抗逆转录病毒治疗时没有高血压的其余患者中，在随访期内诊断出8,125例高血压事件，相当于每100人年发生5.4例(95%可信区间：5.3-5.6)。我们发现，40岁的患者和体重指数(BMI)为25 kg/m2的患者患高血压的风险增加。≥≥为25 kg/m2。男性患者和那些在ART开始时有高血压前期的患者在随访期内高血压风险增加。在评估抗逆转录病毒药物在一线抗逆转录病毒治疗中的选择时，服用奈韦拉平的患者患高血压的风险比服用efavirenz的患者高27%，而服用齐多夫定或司他夫定的患者患高血压的风险比服用替诺福韦的患者高40%。开始抗逆转录病毒治疗时健康状况较差的患者(即WHO III/IV期、低CD4计数、低血红蛋白水平和低BMI)患流行高血压的风险降低。我们发现，在开始抗逆转录病毒治疗时CD_4细胞数为50个/毫米~3的患者中，与CD_4细胞计数≥为350个/毫米~3的患者相比，他们发生高血压的风险增加了25%。在我们的队列中，超过20%的患者在接受抗逆转录病毒治疗时患有高血压，而在接受抗逆转录病毒治疗时血压正常的患者中，有13%的患者在接受抗逆转录病毒治疗时发生高血压。老年患者、男性、服用奈韦拉平、齐多夫定或司他夫定的患者，以及超重/肥胖的患者应该经常进行血压监测，并识别其他心血管危险因素，以鼓励改变生活方式。此外，应该为这些群体提供药物治疗，以帮助预防心肌梗死、心力衰竭、中风和肾脏疾病。需要进一步的研究来确定该人群中高血压药物治疗的可获得性和依从性水平。此外，需要一个艾滋病毒阴性对照人群来评估艾滋病毒本身与高血压的关联。
One of the key risk factors for cardiovascular disease is hypertension. Hypertension, which leads to heart attacks and strokes, already affects one billion people worldwide, making it a global public health issue. Incidence and prevalence of the condition is on the rise in low- and middle-income countries, with the biggest increase in sub-Saharan Africa and South Africa at the forefront. We examined the prevalence, incidence, predictors, treatment, and control of hypertension among HIV-positive patients on ART in a large South African observational cohort. We conducted a prospective study of ART naïve adults initiating ART at a public sector HIV clinic in South Africa between April 2004–2017. Patients with diagnosed hypertension at ART initiation were excluded from the incidence analysis. Log-binomial regression was used to estimate predictors of hypertension at ART initiation, while competing risks regression was used to evaluate the relationship between predictors of incident hypertension, accounting for death as a competing risk. Among 77,696 eligible patients, 22.0% had prevalent hypertension at ART initiation. Of the remaining patients with no hypertension at ART initiation, 8,125 incident hypertension cases were diagnosed over the period of follow-up, corresponding to an incident rate of 5.4 per 100 person-years (95% confidence interval (CI): 5.3–5.6). We found patients ≥40 years of age and patients with a body mass index (BMI) ≥25kg/m2 were at increased risk of both prevalent and incident hypertension. Male patients and those with pre-hypertension at ART initiation had increased hazards of hypertension over the period of follow-up. When assessing the choice of antiretroviral drug in first-line ART, patients initiated on nevirapine were at 27% increased risk of developing hypertension compared to those initiated on efavirenz, while patients who initiated on either zidovudine or stavudine had a 40% increased risk of developing hypertension compared to patients initiated on tenofovir. Patientswith poorer health status at ART initiation (i.e. WHO III/IV stage, low CD4 count, low hemoglobin levels and low BMI) had a decrease risk of prevalent hypertension. We found an inverse relationship in patients with a CD4 count <50 cells/mm3 at ART initiation who had a 25% increased risk of incident hypertension compared to those with a CD4 count ≥350 cells/mm3. Over 20% of patients in our cohort had hypertension at ART initiation, and 13% of those with normal blood pressure at ART initiation developed hypertension while on ART. Older patients, males, those on nevirapine, zidovudine or stavudine, and those who are overweight/obese should be targeted for frequent blood pressure monitoring and the identification of other cardiovascular risk factors to encourage lifestyle modifications. Additionally, these groups should be offered pharmaceutical therapy to help prevent myocardial infarction, heart failure, stroke, and kidney disease. Further research is needed to determine the level of access and adherence to pharmaceutical treatment for hypertension in this population. Additionally, an HIV-negative comparison population is needed to assess the association of the HIV virus itself with hypertension.
登录
查看更多内容
DOI：
10.1086/597476
发表时间：
2009-04-15
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Jiang W;Lederman MM;Hunt P;Sieg SF;Haley K;Rodriguez B;Landay A;Martin J;Sinclair E;Asher AI;Deeks SG;Douek DC;Brenchley JM
通讯作者：
Brenchley JM
影响因子：
5.2
作者：
Calza, L;Manfredi, R;Chiodo, F
通讯作者：
Chiodo, F
影响因子：
7.7
作者：
Dillon DG;Gurdasani D;Riha J;Ekoru K;Asiki G;Mayanja BN;Levitt NS;Crowther NJ;Nyirenda M;Njelekela M;Ramaiya K;Nyan O;Adewole OO;Anastos K;Azzoni L;Boom WH;Compostella C;Dave JA;Dawood H;Erikstrup C;Fourie CM;Friis H;Kruger A;Idoko JA;Longenecker CT;Mbondi S;Mukaya JE;Mutimura E;Ndhlovu CE;Praygod G;Pefura Yone EW;Pujades-Rodriguez M;Range N;Sani MU;Schutte AE;Sliwa K;Tien PC;Vorster EH;Walsh C;Zinyama R;Mashili F;Sobngwi E;Adebamowo C;Kamali A;Seeley J;Young EH;Smeeth L;Motala AA;Kaleebu P;Sandhu MS;African Partnership for Chronic Disease Research (APCDR)
通讯作者：
African Partnership for Chronic Disease Research (APCDR)
影响因子：
8.6
作者：
Fernandez, Sonia;Price, Patricia;French, Martyn A.
通讯作者：
French, Martyn A.
DOI：
10.1097/qai.0b013e318186519c
发表时间：
2008-09-01
影响因子：
3.6
作者：
Kotler, Donald P.
通讯作者：
Kotler, Donald P.