Universität zu Köln

Kasper, Philipp, Nhlema, Angellina, De Forest, Andrew, Tweya, Hannock, Chaweza, Thom, Mwagomba, Beatrice Matanje, Mula, Adam M., Chiwoko, Jane, Neuhann, Florian, Phiri, Sam and Steffen, Hans-Michael (2021). 24-h-Ambulatory Blood Pressure Monitoring in Sub-Saharan Africa: Hypertension Phenotypes and Dipping Patterns in Malawian HIV+ Patients on Antiretroviral Therapy. Glob. Heart, 16 (1). LONDON: UBIQUITY PRESS LTD. ISSN 2211-8179

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Abstract

Background: Cardiovascular disease and especially hypertension are a growing problem among people living with HIV (PLHIV) on antiretroviral therapy (ART) in sub-Saharan Africa. Objectives: As robust data on hypertension phenotypes associated with distinct cardiovascular risks among PLHIV are limited, we aimed to assess the frequency of white-coat (WCH), masked (MH) hypertension, and blood pressure dipping-patterns in a group of Malawian PLHIV. Methods: As part of the prospective Lighthouse-Tenofovir-Cohort-Study, we analyzed clinical, laboratory and 24-h-ambulatory blood pressure monitoring (ABPM) data of PLHIV from urban Lilongwe with treated or untreated hypertension or raised office blood pressure (OBP) during routine study-visits. Results: 118 PLHIV were included and data of 117 participants could be analyzed. Twenty-four-hour ABPM normotension was found in a total of 73 PLHIV including 14/37 on antihypertensive treatment (37.8%). Using strict definitions, i.e. normal OBP plus normal mean BP for all periods of ABPM, controlled hypertension was found in only 4/37 (10.8%) PLHIV on antihypertensive treatment while true normotension was observed in 10/24 untreated patients (41.7%) with previously diagnosed hypertension and 22/56 patients (39.3%) without a medical history of hypertension. WCH with normal BP during all periods of 24-h-ABPM was identified in 12/64 OBP-hypertensive PLHIV (18.8%), primarily in patients with grade 1 hypertension (11/41 patients; 26.8%). MH was found in 17/53 PLHIV with OBP-normotension (32.1%), predominantly in patients with high normal BP (11/20 patients; 55%). The estimated glomerular filtration rate tended to be lower in MH compared to strictly defined normotensive PLHIV (92.0 +/- 20.4 vs. 104.8 +/- 15.7 ml/min/m(2)). 64.1 percent of PLHIV (59.5% with 24-h hypertension and 66.7% with 24-h normotension) had abnormal systolic dipping. Conclusion: The high prevalence of WCH and MH with signs of early renal end-organ damage and an abnormal dipping in approximately 2/3 of PLHIV warrants further investigation as these factors may contribute to the increased cardiovascular risk in PLHIV in resource-limited settings like Malawi.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kasper, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Nhlema, Angellina UNSPECIFIED UNSPECIFIED UNSPECIFIED De Forest, Andrew UNSPECIFIED UNSPECIFIED UNSPECIFIED Tweya, Hannock UNSPECIFIED UNSPECIFIED UNSPECIFIED Chaweza, Thom UNSPECIFIED UNSPECIFIED UNSPECIFIED Mwagomba, Beatrice Matanje UNSPECIFIED UNSPECIFIED UNSPECIFIED Mula, Adam M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Chiwoko, Jane UNSPECIFIED UNSPECIFIED UNSPECIFIED Neuhann, Florian UNSPECIFIED UNSPECIFIED UNSPECIFIED Phiri, Sam UNSPECIFIED UNSPECIFIED UNSPECIFIED Steffen, Hans-Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-598466
DOI:	10.5334/gh.945
Journal or Publication Title:	Glob. Heart
Volume:	16
Number:	1
Date:	2021
Publisher:	UBIQUITY PRESS LTD
Place of Publication:	LONDON
ISSN:	2211-8179
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language WHITE-COAT HYPERTENSION; MASKED HYPERTENSION; GENERAL-POPULATION; CARDIOVASCULAR-DISEASE; ISOLATED OFFICE; RISK; PREVALENCE; ASSOCIATION; BURDEN; DETERMINANTS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59846