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Hypertension in HIV
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Reported by Jules Levin
8th Intl Congress on Drug Therapy in HIV, Glasgow, Nov 12-16, 2006
"HOMA-Index [insulin resistance, diabetes] is significantly associated with hypertension 10 years after PI-ART start"
G Bratt, s Lifeqvist*, c Ek, T Nystrom*, and A Sjoholm*
Venhalsan, Dept of Infectious Disease, University of Karolinska, university Hospital and *Dept of Internal Medicine, Sodersjukhuset, Stockholm, Sweden
".....Of the evaluable patients 36/148 (24%) have been diagnosed with hypertension.... In uni- and multivariate analysis, only HOMA-index [insulin resistance/diabetes] above 3 emerged as a significant factor of influence..... Hypertension in ART treated patients seems to be linked to well known risk factors like BMI, increased W/H ratio and decreased insulin sensitivity...... Increased visceral fat and multifactorial influence on insulin sensitivity are underlying mechanisms to be considered..."
This study looked at a patient cohort of 202 patients, who started PI-ART before Jan 1997. There were 148 evaluable patients in the 2006 analysis. The purpose of this analysis as stated by the authors was "to study the importance of demographic, baseline immunological parameters and metabolic parameters 10 years after PI-based ART was started".
MATERIALS & METHODS. Patients with and without hypertension, defined as repeated blood pressure >130/85 mmHg or antihypertensive treatment, were compared. The influence of several factors on hypertension was evaluated. For 1996 the independent factors were: age, baseline and nadir CD4 count, baseline HIV-RNA, AIDS, months with known HIV-infection, BMI and NRTI-based ART experience vs naïve state when starting PI-ART.
In 2006, BMI, the waist/hip (W/H) ratio and fasting values of troglycerides (TG), total cholesterol, LDL, and HDL-cholesterol, hsCRP, insulin, glucose, HOMA-index and type of ART were compared.
HOMA = insulin resistance index measured as Homeostatis Model assessment
HOMA = insulin (pmol / 6.945 x glucose (mmol) /22.5
HOMA > 3 is a marker for insulin resistance
The non-parametric MW U and Fisher's exact tests were used.
Uni- and multivariate analysis were performed with hypertension as the dependent factor.
Table II. Comparison between patients with and without hypertension in 2006. P-values were not significant, no statistical signifucance except for HOMA-index (p=0.025), BMI 1996 (p=0.007), and waist/hip ratio (p=0.023). Close to significance are triglycerides p=0.053), insulin (p=0.065), BMI 2006 (p=0.094), and waist (p=0.055).
(10 yrs after start of PI-ART); median values. MW U-test or Fisher's exact test for comparison.
RESULTS
34 patients (17%) have died and 20 were lost to followup. Of the evaluable patients 36/148 (24%) have been diagnosed with hypertension.
BMI in 1996 and HOMA-index, W/H ratio in 2006 were higher among patients with hypertension (p<0.05). There was a trend for higher TG, insulin, waist-circumference and BMI in 2006 among the patients with hypertension (p<0.1, Table II.
In uni- and multivariate analysis, only HOMA >3 was significantly correlated to hypertension, Table III.
AUTHOR CONCLUSIONS
We found a high prevalence of hypertension in this group of patients 10 years after PI-ART start.
Patients with hypertension had higher BMI when starting PI-ART in 1996 and higher HOMA-index and W/H ratio in 2006.
In uni- and multivariate analysis, only HOMA-index above 3 emerged as a significant factor of influence".
AUTHOR DISCUSSION
Hypertension in ART treated patients seems to be linked to well known risk factors like BMI, increased W/H ratio and decreased insulin sensitivity. No correlations to history of severe immune deficiency, AIDS, nadir CD4 count, HIV-RNA at PI-ART start, actual lipid levels or hsCRP were found. However, the treatment time with various ART drugs cannot be ruled out as an underlying factor of importance. Increased visceral fat and multifactorial influence on insulin sensitivity are underlying mechanisms to be considered.
With the aim to understand and best prevent the development of hypertension in patients on long-term anti-HIV treatment, we plan to study the importance of treatment time for individual drugs.
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