Association between HIV infection and hypertension: a global systematic review and meta-analysis of cross-sectional studies

BMC Medicine

Edward Gregg¹  Keri N. Althoff²  Peter Reiss³  Annika Hoyer⁴  Ralph Brinks⁵  Mikaela Smit⁶  Katherine Davis⁶  Pablo Perez-Guzman⁶  Simon Gregson⁷  Amy C. Justice⁸ 

[1] Department of Epidemiology and Biostatistics, Imperial College London, London, UK;Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA;Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands;HIV Monitoring Foundation, Amsterdam, Netherlands;Department of Statistics, Ludwig-Maximilians-University Munich, Munich, Germany;Hiller Research Unit of Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany;MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, W2 1PG, London, UK;MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, St Mary’s Campus, Imperial College London, W2 1PG, London, UK;Biomedical Research and Training Institute, Harare, Zimbabwe;Schools of Medicine and Public Health, Yale University, New Haven, CT, USA;

关键词: HIV;    Hypertension;    Blood pressure;    Systematic review;    Meta-analysis;   

DOI  :  10.1186/s12916-021-01978-7

来源: Springer

【 摘 要 】

BackgroundImproved access to effective antiretroviral therapy has meant that people living with HIV (PLHIV) are surviving to older ages. However, PLHIV may be ageing differently to HIV-negative individuals, with dissimilar burdens of non-communicable diseases, such as hypertension. While some observational studies have reported a higher risk of prevalent hypertension among PLHIV compared to HIV-negative individuals, others have found a reduced burden. To clarify the relationship between HIV and hypertension, we identified observational studies and pooled their results to assess whether there is a difference in hypertension risk by HIV status.MethodsWe performed a global systematic review and meta-analysis of published cross-sectional studies that examined hypertension risk by HIV status among adults aged > 15 (PROSPERO: CRD42019151359). We searched MEDLINE, EMBASE, Global Health and Cochrane CENTRAL to August 23, 2020, and checked reference lists of included articles. Our main outcome was the risk ratio for prevalent hypertension in PLHIV compared to HIV-negative individuals. Summary estimates were pooled with a random effects model and meta-regression explored whether any difference was associated with study-level factors.ResultsOf 21,527 identified studies, 59 were eligible (11,101,581 participants). Crude global hypertension risk was lower among PLHIV than HIV-negative individuals (risk ratio 0.90, 95% CI 0.85–0.96), although heterogeneity between studies was high (I2 = 97%, p < 0.0001). The relationship varied by continent, with risk higher among PLHIV in North America (1.12, 1.02–1.23) and lower among PLHIV in Africa (0.75, 0.68–0.83) and Asia (0.77, 0.63–0.95). Meta-regression revealed strong evidence of a difference in risk ratios when comparing North American and European studies to African ones (North America 1.45, 1.21–1.74; Europe 1.20, 1.03–1.40).ConclusionsOur findings suggest that the relationship between HIV status and prevalent hypertension differs by region. The results highlight the need to tailor hypertension prevention and care to local contexts and underscore the importance of rapidly optimising integration of services for HIV and hypertension in the worst affected regions. The role of different risk factors for hypertension in driving context-specific trends remains unclear, so development of further cohorts of PLHIV and HIV-negative controls focused on this would also be valuable.

【 授权许可】

CC BY