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:
CreatorsEmailORCIDORCID Put Code
Kasper, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nhlema, AngellinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
De Forest, AndrewUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tweya, HannockUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chaweza, ThomUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mwagomba, Beatrice MatanjeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mula, Adam M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chiwoko, JaneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neuhann, FlorianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Phiri, SamUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Steffen, Hans-MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:
KeywordsLanguage
WHITE-COAT HYPERTENSION; MASKED HYPERTENSION; GENERAL-POPULATION; CARDIOVASCULAR-DISEASE; ISOLATED OFFICE; RISK; PREVALENCE; ASSOCIATION; BURDEN; DETERMINANTSMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/59846

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