US: Hypertension prevalence, control in women differs by race/ethnicity, HIV status

Among women with and without HIV infection in the Southern United States, the prevalence of hypertension is highest among non-Hispanic Black women. Although hypertension prevalence is similar between women with vs without infection, receipt of antihypertensive agents is more common among those infected with HIV. These study results were published in Open Forum Infectious Diseases.

Researchers aimed to analyze cross-sectional associations between race/ethnicity and awareness, prevalence, treatment, and control of hypertension in women with and without HIV infection. Data were captured between 2013 and 2015 from women residing in the US South. Eligible women in the HIV-positive group had documentation of reactive HIV serology and either a prescription for highly active antiretroviral therapy (ART) or nonhighly active ART during pregnancy. Eligible women in the HIV-negative group had at least 1 high-risk exposure within the past 5 years, including sexually transmitted infection, injection drug use, sex with an HIV-infected man, or sex with multiple male partners. Poisson regression models with robust variance estimators were used to determine prevalence ratios for each hypertension outcome, with adjustment for sociodemographic, behavioral, and clinical risk factors.

A total of 712 women were included in the final analysis, of whom 493 were positive and 219 were negative for HIV infection. Stratified by race/ethnicity, 84% of the total population were non-Hispanic Black, 70% were non-Hispanic White, and 6% were Hispanic. Obesity and diabetes were most common among Black women.

In women with HIV infection, approximately 75% were virologically suppressed, 62% were receiving non-integrase strand transfer inhibitor-based ART, and 40% were insured by Medicaid.

There were 401 (56%) patients with hypertension in the total population, of whom 83% were aware of their hypertension diagnosis. Of patients aware of their diagnosis, 83% were receiving antihypertensive agents, 63% of whom reported their hypertension was well controlled.

The highest prevalence of hypertension was observed among Black women (60%), followed by White women (43%) and Hispanic women (25%). The percentage of patients who were aware of their hypertension diagnosis was higher for Black women (84%) compared with both White (73%) and Hispanic Women (70%). However, control of hypertension was more commonly reported among Hispanic women than in Black women.

Further analysis showed that hypertension prevalence was significantly lower in both White women (prevalence ratio [PR], 0.69; 95% CI, 0.54-0.90) and Hispanic women (PR, 0.52; 95% CI, 0.32-0.85) when compared with Black women. Similar findings were observed when the analysis was restricted to patients without HIV infection.

In both unadjusted and adjusted analyses, women with vs without HIV infection more commonly reported receipt of antihypertensive agents (88% vs 71%; PR, 1.19; 95% CI, 1.01-1.40; P =.0353). Women with HIV infection also reported higher rates of hypertension control, but the different was not significant (65% vs 58%, respectively).

Limitations of this study include the use of self-reported data, the inability to assess the effect of lifestyle interventions due to the cross-sectional design, the reliance on blood pressure measurements collected at a single study visit, and the lack of data on adherence to antihypertensive agents.

According to the researchers, “The high prevalence of hypertension and substantial proportion of individuals whose hypertension was not controlled, particularly among Black women, indicates a need for continuing efforts to diagnose and effectively treat hypertension in this population.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Janelle Barowski, MSN RN

References:

Blair J, Kempf M-C, Dionne JA, et al. Disparities in hypertension prevalence, awareness, treatment, and control among women living with and without HIV in the US south. Open Forum Infect Dis. Published online December 18, 2023. doi:10.1093/ofid/ofad642