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High Blood Pressure Increases Mortality Among HIV Seropositive Individuals Without AIDS in Western Kenya. Gerald S. Bloomfield 1 , Joseph W. Hogan 2 , Alfred Keter 3 , Thomas L. Holland 1 , James Osanya 3 , Edwin Sang 3 , Sylvester Kimaiyo 3 , Eric J. Velazquez 1

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  1. High Blood Pressure Increases Mortality Among HIV Seropositive Individuals Without AIDS in Western Kenya Gerald S. Bloomfield1, Joseph W. Hogan2, Alfred Keter3, Thomas L. Holland1, James Osanya3, Edwin Sang3, Sylvester Kimaiyo3, Eric J. Velazquez1 1Duke University, Durham, NC, USA; 2Brown University, Providence, RI, USA; 3Moi University School of Medicine, Eldoret, Kenya AHA Scientific Sessions 2012 Abstract # 10909

  2. Financial Disclosures • None

  3. Background • HIV is associated with cardiovascular (CV) disease • Most (>60%) HIV+ patients reside in Africa but CV risk in this population is not well-studied • Call for integration of communicable / non-communicable disease care in low- and middle-income countries -United Nations High Level Meeting 2011

  4. Rationale • Despite importance of CV disease globally and large HIV burden in Africa, no studies examining CV disease and mortality in HIV in the region

  5. Hypotheses • Among Kenyan HIV+ patients without AIDS: • High blood pressure is associated with higher risk of death • The blood pressure-mortality relationship varies with World Health Organization HIV clinical stage

  6. Methodology • Retrospective analysis of clinically-obtained patient medical records • Large HIV treatment program in Kenya • Academic Model Providing Access to Healthcare (AMPATH) • >115,000 adults enrolled from >20 clinics • Blood pressure from electronic medical record

  7. Study Site

  8. Methodology • Included data for 2005-10, ≥16 years old • Excluded those with AIDS, missing blood pressure,CD4 count or pregnant • Categorized age, CD4, and blood pressure • Systolic BP: <100, 100-119, 120-139, ≥140 • Calculated: • Unadjusted mortality incidence rate • Risk of death with proportional hazards regression models

  9. Results • 30,231 patients • Median age 33.5 years (28-41), 75% female, CD4 396 (287-556), 60% on HIV therapy • Incidence rate (IR) of death higher if SBP ≥140

  10. Proportional Hazard of Death Other covariates: age, diastolic BP, creatinine, body mass index, hemoglobin, anti-retroviral therapy, residence, marital status, sex in combined analysis

  11. Mortality Rate Stratified by SBP & WHO Stage Mortality SBP, Stage 1 SBP, Stage 2 SBP, Stage 3 0.24 0.18 0.12 0.10 0.08 0.04 0.0 0 4 8 Time in Years Systolic BP --- <100 --- 100-119 --- 120-139 --- ≥140

  12. Conclusions • High blood pressure is associated with high death rate in HIV+ Kenyans without AIDS • The effect of high blood pressure on mortality is comparable to that of HIV immune status • Greater effect of SBP on mortality with worse clinical stage of HIV • Limitations: Observational study, clinically-obtained data

  13. Implications • Blood pressure control is a missed opportunity to modify health in HIV+ • There is need for expansion of HIV programs to address CV diseases (IOM report 2010)

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