Hypertension risk in virally suppressed people with HIV similar to general population in Scandinavian study

In Denmark, hypertension incidence in well-treated people living with HIV (PLWH) is similar to that in the general population—and is associated with traditional risk factors, but not HIV-related aspects, a recently published study found.

About This Study

“Incidence of hypertension in people with HIV infection: a longitudinal observational study” was published online on May 25, 2023, in AIDS. The lead author is Marco Gelpi, M.D., Ph.D., of the Viro-immunology Research Unit in the Department of Infectious Diseases at Rigshospitalet of the University of Copenhagen, Denmark. Study support was provided by two pharmaceutical companies, Novo Nordisk Foundation and Gilead.

Key Research Findings

In this longitudinal, observational trial, researchers assessed hypertension among 532 virally suppressed participants in the Copenhagen Co-morbidity in HIV Infection Study who were followed for a median of 2.3 years. The goal of the study was to explore both lifestyle and HIV-specific factors associated with hypertension. Participants were mostly white men (83% of participants were male, 73% of Scandinavian origin) with a median age of 48 years at baseline.

During the study period, 20% of participants developed hypertension, for a rate of 8.5 cases/100 person-years of follow-up. This is similar to the rate in the general Danish population of a similar socioeconomic background. The risk of hypertension was associated with increasing age, waist-to-hip ratio, and central obesity, but not with HIV-related factors.

At the study’s end, the mean difference between participants with and without hypertension was 5 mmHg for both systolic and diastolic blood pressure. Among the 105 participants who developed hypertension, 12% were prescribed antihypertensive drugs.

Discussion Highlights and Implications for Practice

Study limitations included the demographic characteristics and geographic setting of participants, the lack of antiretroviral treatment (ART)-naïve participants, and a lack of data on street drug use or cardiovascular events, both of which are known to affect hypertension risk.

Previous studies on this topic had shown heterogeneous results, likely due to differences in demographic characteristics, ART exposure, and geographical setting. The lack of association with HIV-related factors, which differs from other studies, may be related to the fact that HIV in this cohort was well treated.

The observed association between hypertension and adipose tissue is important in light of the weight gain experienced by many PLWH taking integrase strand transfer inhibitors. To manage the risk of hypertension, health care providers should focus on lifestyle changes and weight loss in their virally-suppressed patients.

By Barbara Jungwirth