Abstract 10909: High Blood Pressure Increases Risk of Death Among Human Immunodeficiency Virus Seropositive Individuals in Kenya

Abstract

Introduction High blood pressure (BP) is common in sub-Saharan Africa. The region is home to the majority of human immunodeficiency virus seropositive (HIV+) people globally. The impact of BP on mortality among HIV+ adults in sub-Saharan Africa is unknown.

Hypothesis We assessed the hypothesis that higher BP increases the risk of death among HIV+ adults without Acquired Immune Deficiency Syndrome (AIDS).

Methods We conducted a retrospective analysis of 92,586 adult (16-80 years) patients of an HIV treatment program in western Kenya between 2005 and 2010. We excluded patients with AIDS or who were missing relevant data. Hypertension was classified according to international standards. Main outcome measures were incidence rate of death and mortality risk using Cox proportional hazards models adjusted for potential confounders and stratified by sex.

Results There were 30,231 (75.4% female) patients that met inclusion criteria with a median age of 33.5 years (IQR: 27.5-41.4). Median CD4 count was 396 (IQR: 287-556). Hypertension was found in 7.4% of patients. The incidence rate of death was higher among those with systolic BP ≥140 mmHg (2.2/100 person years, 95% CI 1.7-2.8) than those in the 120-139 (1.4/100 person years, 95% CI 1.3-1.6) or <120 mmHg ranges (2.0/100 person years, 95% CI 1.9-2.1). The hazard of death was highest comparing worse HIV stage to better. (Figure) Having a systolic BP ≥140 mmHg was associated with a 54% increase in risk of death compared to lower BP. The mortality risk associated with systolic BP ≥140 mmHg was second only to that of worse HIV clinical stage in adjusted analyses including age, CD4 count and relevant variables.

Conclusion In conclusion, in HIV+ patients without AIDS in Kenya, high BP is associated with high mortality and is second only to HIV stage in its contribution to mortality risk. Blood pressure is an important determinant of death in sub-Saharan African patients with HIV and deserves attention within HIV treatment programs in the region.