Blood pressure trajectories and the mediated effects of body mass index and HIV‐related inflammation in a mixed cohort of people with and without HIV in rural Uganda
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
The Journal of Clinical Hypertension
Abstract
We sought to describe changes in blood pressure and estimate the effect of HIV
on blood pressure (BP) over 4 years of observation in a cohort of 155 HIV‐infected
adults (≥40 years) on antiretroviral therapy (ART) and 154 sex‐ and age‐quartilematched,
population‐based, HIV‐uninfected controls for four years in rural Uganda,
we compared changes in blood pressure (BP) by HIV serostatus and tested whether
body mass index and inflammation (high‐sensitivity C‐reactive protein and interleukin‐
6) and immune activation (sCD14 and sCD163) mediated the effects of HIV on BP
using hierarchical multivariate and two‐stage parametric regression models. Overall
HIV‐uninfected participants had higher mean BP than HIV‐infected counterparts
(differences in trend P < 0.0001 for diastolic BP and P = 0.164 for systolic BP). After
initial declines in BP in both groups between years 1 and 2, BP moderately increased
in both groups through year 4, with greater change over time observed in the HIVuninfected
group. Body mass index mediated 72% (95%CI 57, 97) of the association
between HIV and systolic BP. We found a minimal mediating effect of sCD14 on the
relationship between HIV and SBP (9%, 95% CI 5%, 21%), but found no association
between other HIV‐related biomarkers. Over four years of observation, HIV‐infected
people in rural Uganda have lower BP than HIV‐uninfected counterparts despite having
higher levels of inflammation. BMI, rather than measures of HIV‐associated inflammation,
explained a majority of the difference in BP observed.
Description
Keywords
Blood pressure trajectories, Body mass index, HIV, Rural Uganda
Citation
Okello, S., Kim, J. H., Sentongo, R. N., Tracy, R., Tsai, A. C., Kakuhikire, B., & Siedner, M. J. (2019). Blood pressure trajectories and the mediated effects of body mass index and HIV‐related inflammation in a mixed cohort of people with and without HIV in rural Uganda. The Journal of Clinical Hypertension, 21(8), 1230-1241. DOI: 10.1111/jch.13621