Table 2.
Summary of results for published human studies of novel mechanisms for hypertension in HIV-infected adults
| Study | Results | Novel mechanism supported |
|---|---|---|
| Thiebaut 2005 (Antivir Ther) |
Factors associated with new onset hypertension included: male sex, higher BMI, older age, higher BP at baseline and clinical lipodystrophy | Lipodystrophy |
| Crane 2006 (AIDS) |
Lopinavir/ritonavir was significantly associated with an increased incidence of new-onset hypertension (OR=2.5, p=0.03) | Antiretroviral therapy (protease inhibitors) |
| Palacios 2006 (HIV Med) |
Higher SBP at follow-up was significantly associated with: older age, higher baseline SBP, high total cholesterol, and lower baseline CD4 T-cell count | Dyslipidemia, immune suppression/reconstitution |
| Baekken 2008 (Nephrol Dial) |
Microalbuminuria was more common in HIV-infected adults (compared to HIV-negative adults) and was associated with higher blood pressure | Renal disease (microalbuminuria) |
| Baekken 2008 (J Hypertens) |
Statistically significant predictors of new-onset hypertension: older age, higher BMI, higher total cholesterol, longer duration of ART, and microalbuminuria | Dyslipidemia, antiretroviral therapy, renal disease |
| Crane 2009 (HIV Med) |
Lipohypertrophy (OR 4.3, p=0.006) and lipoatrophy (OR=5.5, p=0.01) were both associated with hypertension | Lipodystrophy |
| Freitas 2012 (J Clin Hypertens) |
Compared to normotensive HIV-infected adults, HIV-infected adults with hypertension had higher total fat, central, and central/peripheral fat mass ratios | Lipodystrophy |
| Glyn 2013 (J Hum Hypertens) |
Low eGFR was associated with higher blood pressure and higher L-arginine levels in HIV-infected African men but not uninfected men | Renal disease (L-arginine) |
| Hadigan 2013 (Am J Nephrol) |
Microalbuminuria was associated with new-onset hypertension, low CD4 T-cell counts (< 200 cells/μl) and ritonavir use | Renal disease, immune suppression, ART |
| Manner 2013 (HIV Med) |
LPS and sCD14, both markers of microbial translocation, independently predicted new-onset hypertension in ART-naïve, HIV-infected adults | Microbial translocation, chronic inflammation |
| Manner 2013 (J Clin Hypertens) |
Nadir CD4 cell count < 50 cells/μl (aOR 2.48; 95% CI 1.27-4.83) and ART duration (aOR 1.13; 95% CI 1.03-1.24) independently predicted new-onset hypertension | Immune suppression, antiretroviral therapy |
| Morimoto 2014 (Nutrition) |
HIV-infected adults with metabolic syndrome had higher SBP and DBP measurements and lower plasma adiponectin levels than those without | Dyslipidemia, adipokines |
| Peck 2014 (BMC Medicine) |
Age, alcohol use, BMI, microalbuminuria, low eGFR and higher current CD4 T-cell count were independently associated with hypertension. | Renal disease, immune reconstitution, ART |
| Tenorio 2014 (J Infect Dis) |
Among HIV-infected adults on ART, elevated IL-6 were strongly associated with hypertension at baseline (OR 1.6, p <0.001) and at one year (OR 1.8, p <0.001) | Chronic inflammation |
| Rokx 2015 (AIDS Res Hum) |
Switching from a nevirapine to a rilpivirine-based regimen led to a 6 mm Hg reduction in SBP at 24 and 48 weeks (95% CI −1.7 to −10.3, p=0.007) | Antiretroviral therapy (NNRTI) |
| Wensink 2015 (PLoS One) |
In HIV-infected adults on ART, albuminuria was significantly associated with hypertension, diminished eGFR, and increased HIV viral load | Renal disease (microalbuminuria) |
| Castley 2016 (PLoS One) |
CXCL10, sCD163 and sCD14 remained elevated despite ART use and were associated with total cholesterol and LDL-c levels, but not hypertension | Chronic inflammation, dyslipidemia |
| Maffongelli 2016 (AIDS) |
X4-tropic HIV (but not R5-tropic virus) independently predicted new-onset hypertension (HR 2.29, 95% CI 1.39-3.76, p=0.001) | HIV tropism |
| Nduka 2016 (Int J Cardiol) |
A propensity score matching model estimated the average treatment effect of ART on SBP and DBP to be 7.85 mm Hg and 7.45 mm Hg, respectively (p <0.001) | Antiretroviral therapy |
| Pirro 2016 (Sci Rep) |
Endothelial dysfunction was independently associated with hypertension, HIV RNA levels, and microalbuminuria in HIV-infected adults | Renal disease, chronic vascular inflammation |
| van Zoest 2016 (Clin Infect Dis) |
Prior stavudine use independently predicted new-onset hypertension among HIV-infected adults. The effect was attenuated after adjustment for abdominal obesity | Antiretroviral therapy (NRTI), lipodystrophy |
| Ascher 2017 (Hypertension) |
Higher urine albumin-to-creatinine levels and lower eGFR independently predicted new-onset hypertension in HIV-infected, but not HIV-uninfected, women | Renal disease (microalbuminuria) |
| Ding 2017 (AIDS Res Hum) |
Lower nadir CD4 T-cell count (< 50 cells/μl) was independently associated with hypertension, but only in HIV-infected adults who were underweight or obese | Immune suppression/reconstitution |
| Rodriguez-Arboli 2017 (PLoS One) |
Age, BMI, and eGFR, but not ART exposure or CD4 count, were found to be independent predictors of new-onset hypertension among HIV-infected adults | Renal disease |
Abbreviations: ART, antiretroviral therapy; BMI, body mass index; BP, blood pressure; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; LDL-c, low density lipoprotein cholesterol; LPS, lipopolysaccharide; sCD14, soluble CD14; SBP, systolic blood pressure